Patient: Martin CHEN
Weight: 110 kgs
Two sons: Jason and Kenneth and two daughters: Mandy and Chu.
All of Mr Chens children are now grown adults with children of their own. Since his wife’s death in 2005, Mr Chen has lived with his youngest daughter Chu and her husband Eric in their home in the metropolitan suburb of Blackwood in South Australia. Chu is a pharmacist and Eric is a social worker at the local hospital. Chu and Eric have two teenage children, Lily and Cherry.
Mr Chen is a 79 year old widower who emigrated to Australia from Hong Kong with his wife and four children in 1997.
Mr Chen and his family have strong Buddhist beliefs. As he doesn’t drive, he attends the Buddhist temple in Adelaide when one of his children can drive him. Mr Chen feels that the visits to the temple provide him with much needed time for meditation and relaxation. For many years, Mr Chen has contributed to the family by cooking and tending to the vegetable garden, although he prefers to eat take away meals himself.
Over the last couple of years Mr Chens health has begun to deteriorate and Chua and Eric have become more concerned about his erratic behaviours. Over the past year or so, when the family is asleep, Mr Chen often awakens and cries out. He seems fearful and confused and thinks he is back in Hong Kong.
Mr Chens ability to speak English seems to be decreasing and he sometimes struggles finding the right English words to say to express himself, although he understands what people are saying to him. When this happens, he becomes quite agitated, not wanting to partake in any activities and stays in his room for long periods.
On a few occasions Mr Chen has left the stove unattended, burning the food. Once Lilly and Cherry watched on in amusement as their grandfather carefully placed a garden fork in the back of the freezer. Mr Chen has become increasingly frustrated when he cannot remember the names of people and of common household objects. Recently Mr Chen told Chua that the neighbour was poisoning the soil in their garden and deliberately killing some of the vegetables.
Chua and Eric have been wanting to take their daughters on an overseas holiday but feel that it would be unsafe to leave Martin alone in the family home.
Mr Chen was recently admitted to hospital for a colonoscopy following a bout of PR bleeding. The colonoscopy showed that the blood was from some haemorrhoids which were banded during the procedure. Rather than being discharged after the procedure, Mr Chen was admitted for five days because his blood pressure was extremely high and his blood glucose levels (BGL) were uncontrolled requiring him to have insulin. During his hospital stay, the nurses called three code black emergencies due to Mr Chens aggressive behaviour, he became combative towards the nursing staff and was attempting to leave the ward to go home. Concerned about his behaviour during his hospital stay, Mr Chen was referred to a gerontologist for cognitive screening assessment and it was determined after a series of tests that Mr Chen had signs of early dementia.
Once Mr Chens blood pressure and BGL levels settled, he was discharged home. The nurses at the hospital also noticed a small ulcer on his L ankle which was dressed prior to discharge.
Past Medical History:
Trans ischaemic attack 2018
T2 diabetes mellitus (Last HbA1C 6 months ago= 7%)
Past family history
Father – Myocardial infarction age 52- deceased
Brother – Cerebro vascular Accident age 60- deceased
Wife dies of bowel cancer 15 years ago
Non steroidal anti inflammatory medications (NSAIDs)
Lipitor (atorvastatin) 40mg daily
Metformin 1000mg daily
Carvedilol IR 6.25mg b.d.(recently commenced while in hospital)