Complex Regional Pain Syndrome:This is MY life, doc!: Signs of Neglect

Signs of Neglect

As our population ages, the number of elder Americans in nursing homes and assisted living facilities continues to soar. Research indicates that one-half of women and one-third of men will eventually need nursing home or assisted living care. By the year 2020, the demand for nursing home and assisted living beds will increase by almost 250%. Nursing homes and assisted living facilities eagerly accept the financial benefits of the "graying of America." They must also accept responsibility when our loved ones do not receive the care, dignity, and respect they deserve.
Nursing home and assisted living neglect and abuse take a variety of forms. Pressure ulcers, falls, malnutrition, dehydration, and medication errors are painful, but frequent, reminders that more must be done. Fortunately, increased media scrutiny of nursing homes and assisted living facilities and their business practices has resulted in a heightened awareness of the problem. State and federal governments have also come to the aid of families by enacting laws and regulations designed to ensure that patients receive appropriate care.

Unfortunately, media attention and regulatory oversight are poor substitutes for good care. Patients and their families need to recognize the "red flags" of nursing home and assisted living neglect and abuse. If your loved one is a patient in a nursing home or assisted living facility, look carefully for any of the following signs of neglect and abuse:

wandering and elopement
Resident to Resident Assault
Pressure Ulcers
Medication Errors Malnutrition and Weight Loss
Falls
Dehydration
burns, fires, other hazard
Bedrail entrapment and asphyxiation

Malnutrition and Weight Loss

A nursing home or assisted living facility must ensure its patients receive proper nutrition and maintain proper body weight and protein levels. Unplanned weight loss, peripheral edema, cachexia, and laboratory tests indicating low serum albumin levels are signs that a patient may not be receiving proper nutrition. The amount of weight lost during one-month, three-month, and six-month intervals reveals the severity of the weight loss:

                One Month, Significant = 5%, Severe = Greater than 5%
                Three Months, Significant = 7.5%, Severe = Greater than 7.5%
                Six Months, Significant = 10%, Severe = Greater than 10%

For example, a weight loss of five percent of a patient’s body weight in one month is “significant,” but a loss of more than five percent in one month is “severe.” The percentage of weight loss is calculated using the following formula: (usual weight - actual weight)/(usual weight) x 100.

Malnutrition can be diagnosed clinically and with laboratory tests.
My H & H was positive for anemia. Hemoglobin a patient (older than 60-but in my depleted state and record low of Vitamin D/Calcitonin was a red FLAG I was headed for a malnourishment. Hemoglobin should remain between 180-300 g/dl. Hemoglobin in males should remain between 14-17 g/dl and in females should remain between 12-15 g/dl.

Hematocrit in males should remain between 41-53 and in females between 36-46.

My albumin was 2.3g/dL
My hemoglobin was 67g/dL
My hematocrit was 12g/dL.

At the hospital, multiple other electrolyte and my ABG's were fouled up BAD!!!

My total vitamin D that day was 17

Clinical signs of malnutrition include pale skin, dull eyes, swollen lips, swollen gums, swollen or dry tongue with scarlet or magenta hue, poor skin turgor, cachexia, swelling in the extremities, and muscle wasting. Laboratory tests can also detect malnutrition. For example, in a patient over 60 years of age, albumin (which reveals protein depletion) should remain between 3.4-4.8 g/dl. Plasma transferrin in a patient older than 60 years of age should remain between 180-300 g/dl. Hemoglobin in males should remain between 14-17 g/dl and in females should remain between 12-15 g/dl. Hematocrit in males should remain between 41-53 and in females between 36-46. Likewise, potassium levels should remain between 3.5-5.0 mEg/L and magnesium should remain between 1.3-2.0 mEg/L. Departures from these laboratory values may, with or without clinical symptoms, establish malnutrition.
Risk factors for malnutrition and weight loss include drug therapy that may contribute to nutritional problems (i.e. cardiac, glycosides, diuretics, anti-inflammatory drugs, overuse of antacids, overuse of laxatives, overuse of psychotropic drugs, anticonvulsants, antineoplastic drugs, phenophiazines, oral hypoglycemics), poor oral hygiene, poor eyesight, poor motor coordination, taste alterations, depression, dementia, cancer, a therapeutic or mechanically altered diet, a lack of access to culturally acceptable foods, a slow eating pace which makes food unpalatable, and poor feeding practices by staff like removing food trays before the patient has finished eating.

In order for a nursing home or assisted living facility to ensure a patient receives proper nutrition, the nursing home or assisted living facility must first assess the patient’s risk factors for becoming malnourished, plan and provide care to minimize the effects of these risk factors, and implement and document compliance with the care plan. For example, a nursing home or assisted living facility must monitor the amount of food consumed at each meal and at snack times and ensure all snacks and nutritional supplements are provided and consumed as appropriate. The amounts of all meals, snacks, and nutritional supplements, as well as any refusals by the patient to eat, should be carefully documented in the records of the nursing home or assisted living facility. Even if the patient becomes malnourished, sustains significant or severe weight loss, or does not eat, the nursing home or assisted living facility must consider changes to its plan of care (e.g. by providing the patient with alternative forms of nutrition like total parenteral nutrition (TPN), partial parenteral nutrition (PPN), or a feeding tube) to guard against worsening malnutrition.