Table 1.

The scenario of Mrs. M

Sub-scenario: prevention

Female M aged 84 years, presented to the Emergency Department with dyspnoea, cough and fever for 3 days. Concomitant diseases: Hypertension, COPD and hypercholesterolemia. Home treatment: on amlodipine, ipratropium bromide and simvastatin. In the emergency room she was given intravenous diuretics, steroids, antibiotics and oxygen, and a bladder catheter was placed for fluid monitoring. Prior to admission she lived with her husband, was autonomous in instrumental and basic activities of daily living, drove a car and played cards. After 2 h in the emergency room, she was transferred to the medical unit with the diagnosis of pneumonia. At the nurse’s assessment in the medical unit the following data were noted: TC 38.8 °C, regular HR 70 bpm, BP 140/68 mm Hg, RR 24 beats/min, SpO2 92% with venturi mask FIO2 28%; shallow breathing, presence of productive cough with dense, yellow sputum; no skin turgor; PAINAD 5/10; wearing glasses and hearing aid. On admission, in the morning shift, Mrs. M is unable to answer questions appropriately, shows difficulty in maintaining attention and disorganised thinking, seems to talk to herself and it’s difficult to understand what she says. In addition, she does not know why she is in hospital and thinks it is 1990. Her daughter is worried because she has noticed that her mother is very confused. The following are prescribed: blood cultures, sputum cultures, oxygen therapy with venturi mask FIO2 28%; antibiotic intravenous therapy every 6 h, painkiller, antihypertensive, statins, steroids and diuretics

Sub-scenario: management

At 3 a.m., Mrs M’s daughter called the night nurse because she had psychomotor agitation, had removed her PVC and was trying to get out of bed. Her daughter reported that her mother had been evacuating for the previous 3 days and had refused food and drink for the last 2 days

BP blood pressure, COPD chronic obstructive pulmonary disease, FIO₂ inhaled fraction of oxygen, HR heart rate, RR respiratory rate, SpO₂ oxygen saturation, PAINAD Pain Assessment IN Advanced (1–3, mild pain; 4–6, moderate pain; 7–10, severe pain), PVC peripheral venous catheter, TC body temperature