View Patient Profiles

Graham, Mary

MRN: 243032

Room: 156

DOB: 8/15/1946

Age: 79

Gender: Female

Allergies: PCN (hives)

Admit Notes

Clinical Notes

Vitals

Labs, Cultures, Imaging

Clinical Calculators

MAR

Current Orders

Home Med List

Med Reconciliation

Discharge Planning

Setting	Adult Psychiatric Unit
Scenario	You are rounding as part of the psychiatry care team.
Admission note taken on 10/19/25
CC	extreme agitation and lethargy
HPI	MG was transferred to this hospital from Pleasant Nursing Home following a 3-day history of alternating periods of extreme agitation and lethargy. She has resided in the nursing home for the past 7 months after an increase in paranoid delusions over several months. Just prior to nursing home admission, she threatened to kill her son with a knife because she thought be was an intruder. She was also increasingly agitated in the early evening hours and would wander the house at night. It was becoming increasingly difficult for her husband to care for her and her children were also concerned for his safety. She remains able to feed herself; no incontinence; bathing and grooming with prompts.
PMH	Hypertension x 20 years Hyperlipidemia x 17 years Type 2 Diabetes Mellitus x 14 years Dementia, Alzheimer's type x 6 years (with delusions x 1 year) Cataract removal, right eye 3 years ago
Social History	Tobacco: 1 ppd x 20 years; none for last 20 years ETOH: none for past 6 years; previously 1 glass of wine a day x 15 years Illicit Drugs - none Caffeine: 1 cup coffee in the morning Education: through 10th grade Occupation: secretary x 8 years; homemaker since age 26 Status: married x 59 years, husband is alive at age 82 w/ arthritis Children: 2 sons age 53 and 49; 1 daughter age 47 Physical Activity: Ambulation per nursing home protocol Diet: Following ADA diet since nursing home admission 7 months ago	Family History	Father: deceased; myocardial infarction age 69 Mother: deceased; pneumonia age 73 Sister 1: age 82; alive, arthritis Sister 2: age 70; alive, type 2 diabetes mellitus Sister 3: deceased; CVA age 84
Vaccine History	None on file	Surgical History	None on file
Physical Exam	Gen: overweight white female appearing to be stated age, agitated HEENT: PERRLA, EOMI, R & L fundus exam without retinopathy, mucus membranes dry, no oral lesions, dentition intact; no sores noted Skin: dry skin, no rashes Neck: No JVD appreciated, no carotid bruits, no thyromegaly Heart: tachycardia, no S3, S4 no murmur Lungs: clear to auscultation and percussion Abdomen: bowel sounds nonnal, non-tender, non-distended GU: uncooperative; deferred Extremities: warm to the touch, pedal and brachial pulses present bilaterally Neuro: Cranial nerves II - XII intact MSE: initially agitated, volume elevated, moderately resistive to physical exam; periods of interspersed lethargy and briefly non-responsive; paranoid delusions (feels her food is being poisoned); A & O to person only; can name 1/3 objects on immediate recal, 0/3 on delayed recall. Would not cooperate w/ MMSE.

Clinical Laboratory Report

Test Name	10/19/25	03/23/25	Range
Sodium (Na⁺)	144	137	136-145 mEq/L
Potassium (K⁺)	4.0	3.8	3.5-5 mEq/L
Chloride (Cl^-)	98	98	98-106 mEq/L
Bicarbonate (HCO₃^-)	24	23	23-28 mEq/L
Urea nitrogen (BUN)	20	15	8-20 mg/dL
Creatinine	1.6	1.4	0.5-1.3 mg/dL
Glucose	115	100	70-115 mg/dL
Hemoglobin A1c	6.8	6.5	5.3-7.5 %
Calcium,Total	8.6	8.3	8.6-10.2 mg/dL
Phosphate	4.1	4.2	3-4.5 mg/dL
Magnesium	2.0	2.1	1.6-2.6 mEq/L
Protein, total	7.9	7.7	5.5-9 g/dL
Albumin	3.5	3.5	3.5-5.5 g/dL
Aminotransferase,aspartate (AST)	16	20	10-40 units/L
Aminotransferase,alanine (ALT)	25	26	10-40 units/L
Lactic dehydrogenase (LDH)	90	92	80-225 units/L
Alkaline phosphatase	56	54	30-120 units/L
Bilirubin, Total	0.7	0.8	0.3-1 mg/dL
Leukocytes (WBC)	8.6	7.5	4.5-11 x10³/mcL
Red blood cells (RBC), Female	5.0	5.1	4.3-5.7 x10⁸/mcL
Hemoglobin, Female	13.1	13.3	12-16 g/dL
Hematocrit, Female	37	37.5	37-47 %
Mean corpuscular hemoglobin (MCH)	27.6	28	27-33 picogram
Mean corpuscular volume (MCV)	81.9	81	76-100 mcm³
Platelets	175	170	150-450 x10³/mcL
International normalized ratio (INR)	1.1	1.0	0.8-1.2
Prothrombin time (PT)	10.1	9.7	9.5-11.3 sec
Partial thromboplastin time,activated (aPTT)	28.6	27	25-35 sec

Additional Labs:

Fasting	Today	7 Months Ago
TC (mg/dL)	230	185
Trig (mg/dL)	205	150
HDL-C (mg/dL)	30	32
LDL-C (mg/dL)	159	123

Urinalysis	Today	7 Months Ago
Glucose	neg	neg
Ketones	neg	neg
Specific Gravity	1.014	1.020
Bacteria	neg	neg
WBC	neg	neg
RBC	neg	neg
Protein	2+	neg
Leuk Est	neg	neg
Nitrite	neg	neg

Mini-Mental State Exam	Score
5.5 years ago	26/30
5 years ago	25/30
4.5 years ago	25/30
4 years ago	23/30
3 years ago	22/30
2 years ago	20/30
1.5 years ago	19/30
1 year ago	17/30
10 months ago	16/30
7 months ago	15/30

Cultures:

None

Imaging Studies:

CT scan (6 years ago): mild cortical atrophy

Vital Sign	10/19/25 08:41	03/23/25 08:30
Height (cm)	160	160
Weight (kg)	64	66
Body Temperature (°C)	37	36.8
Blood Pressure (mmHg)	146 / 84	130/72
Heart Rate (bpm)	102	74
Respiratory Rate (bpm)	20	16
Oxygen Saturation (%)	99	98

Current Orders

Medication
History

Upon diagnosis of Alzheimer's, patient was started on tacrine for the first 6 months. Patient's daughter reported that she had noticed some unused medication and her mother admitted to "forgetting" some doses on occasion. Mary was switched to donepezil at that time and remained on this medication until she went into the nursing home and it was changed to rivastigmine.
Last year, Mary became increasingly suspicious of family members and agitated in early evening hours and was admitted to the nursing home 7 months ago.

Home Medication List: verified by pharmacy on admit (10/19/25)

Patient Name: Graham, Mary Date of Birth: 8/15/1946 Room#: 156	Allergies:	Immunization History:
Community Rx Info: Rx Insurance:	Social History:
Additional Notes:

DRUG STRENGTH DF	STRENGTH ROUTE FREQ	PRN?	NOTES	MED REC ACTION
Rivastigmine 1.5 mg capsule	1 PO BID	no
Vitamin E 400 IU capsule	1 PO QD	no
Metformin 750 mg tablet	1 PO BID	no
Amitriptyline 50 mg tablet	1 PO HS	no
Haloperidol 10 mg tablet	1 PO QD	no	increased from 5 mg one month ago
Benztropine 1 mg tablet	1 PO BID	no
Hydroxyzine 25 mg tablet	1 PO TID	yes, agitation	3 doses yesterday, 1 dose 2 days ago, 2 doses 3 days ago
Lisinopril 10 mg tablet	1 PO QD	no
Glyburide 5 mg tablet	1 PO QD	no
Simvastatin 5 mg tablet	1 PO QAM	no
Furosemide 20 mg tablet	1 PO QAM	no
Estrogens (conjugated) 0.625 mg tablet	1 PO QAM	no
				Action Key: C = Continue, D = Discontinue^, H = Hold^, M = Modify^* ^*must provide reason

Medication

10/19/25

Clinical Notes

Medication Discharge Orders

Hospital Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Previous Home Medications
Medication	Instructions	Comments	Continue	Modify	Discontinue	New Rx sent

Discharge Planning - Medication List and Instructions

Patient Name:
Admission Date:	Discharge Date:	Service:
Principle Diagnosis on Admission:
Secondary Diagnosis:
Allergies:

Medications ADDED this visit: (begin taking these)	Medications CHANGED this visit: (modify what you were taking)	Medications STOPPED this visit: (stop taking these)

Final Discharge Medication List
Medication/Route/Dosage/Frequency/Duration	Comments	Morning	Afternoon	Evening	Bedtime










As Needed Medications

Medication Reconciliation - Finalized Medication List

Patient Name: Graham, Mary

Date of Birth: 8/15/1946

Room: 156

Medication (name/strength)	Dose	Route	Frequency	Notes

Height	160 cm
Actual Body Weight (ABW)	64 kg
Ideal Body Weight (IBW)	52.4 kg
ABW % of IBW	122 %
Adjusted Body Weight (AjBW)	57 kg
Body Surface Area (BSA)	1.69 m²
Body Mass Index (BMI)	25 kg/m²