felecia brown, BSN, RN

A patient brought by ambulance from a nursing home with Adult Failure to Thrive. Per EMS "She lost 111 lbs in 3 months". Dr. A H&P stated, "She says that food does not taste good" and "over last month has been losing weight and has had difficulty swallowing". There is a DNR on the chart and it also states no PEG. The case manager assumed that patient was nearing the end of life and was choosing not to eat rather than neglect on the part of the nursing home. The case manager was planning to speak to Dr. A regarding Hospice. Felecia sat with the patient during dinner for a while and made a connection with her. The patient voiced that she has Rheumatoid Arthritis and is physically unable to feed herself and that no one at assisted living was assisting her with her meals. Felecia fed the patient her dinner and the patient ate the entire meal and enjoyed it. The patient told Felecia that she is hungry and wants to eat. When Dr. A rounded, the case manager and discharge nurse discussed the previous evenings situation with Dr. A and plans were arranged for PT/OT evaluations and to speak with the patient and her son regarding SNF placement and then possible transition to long-term care so that the patient will have appropriate assistance with her meals and other ADL's. Without Felecia making a connection with the patient, the outcome for this patient could have been very different.