Here are two examples:
A nurse enters an exam room. Looking at the person sitting on the exam table she sees someone with dirty matted hair, bright orange top mis buttoned closed and lime green pants, clothes are wrinkled but clean. On their feet are flip-flops. Upon getting closer to the person, there is the odor of stale beer.....the nurse assumes the person is an alcohlic and does a brief mental status exam thinking they have alcoholic problems..........
When in actuality the person is an adult non-insulin diabetic whos family of 6 has had a GI virus the past week. They have been up at night for past 4 days cleaning up vomitus, preparing light meals , popsicles so they haven't eaten themselves properly. Laundry was only for sheets and clean towels and kids clothes, didn't bother with their own clothes. Their blood sugar is 1,020 so acteone breath is what the RN smells, not beer and flip-flops worn cause child puked in their sneakers, not wearing heels to ER.
Arriving for a home SN visit to admit a patient for homecare due to Uncontrolled Hypertension. the RN sees an clean, well kept home and sees the patient is eating a grilled cheese sandwich.
The elderly women is able to answer most questions about health, can say she takes lasix and norvasc for BP, bladder pills for leakage (she's taken these for the past four years) and that granddaughter fills her pill container weekly. She is sweet and smiling so RN assumes patient is oriented times three, not forgetful from conversation, RN copies emergency contact phone numbers from referral intake sheet .....
In actuality, patient is alert to name and place only. Only eating grilled cheese every day because its the one thing she can remeber to cook easily, forgets how to use a can-opener. If the RN checked the pill container would have found that it was completely full----granddaughter left note on table that it was filled on Sunday, when patient got home from hospital; Patient admitted Tuesday afternoon. Freezer is filled with meat items/TV prepared dinners. Refrigerator milk is spoiled cause hidden in the back behind orange juice container. Patient is unable to make telephone calls to get help anymore because can't understnd that a new area code has been added and she now needs to dial 10 numbers.
This patient was my grandmother in real life.
The admitting RN got an earful when I check on grandmom on Friday and found no prepared meals eaten and all pills still in container--(Told my Dad she just started new container), RN had visited early in day and told me BP still up but everything was ok, Grandmom eaten as dishes being placed in sink on arrival.
Hope this helps!!