NSG 6999 Acute Delirium Case
NSG 6999 Acute Delirium Case
In the present case, a 72-year-old known as Mr. White presents with classic symptoms of acute delirium. However, his history reveals that in addition to the current delirium episodes, the client had a medical history of moderate dementia, hypertension and COPD. In demented patients, delirium exists because of certain several factors. The present article will thus explore the frequent cause of delirium in demented patients, additional tests, and treatment options for the patient.
Likely Causes of Delirium in Demented Patients
Delirium is a mental disorder that is characterized by acute disturbance of consciousness associated with an alteration in cognitive function and attention deficit. Studies have struggled to reveal the association between dementia and delirium; however, they confirm that both conditions can co-exist in a human being especially the elderly. Studies done previously reveal that an interrelationship exists between the two conditions but they did not reveal whether delirium is a biomarker of dementia (Fong et al., 2015). However, in demented patients, predictive models indicate that the predisposing factors for delirium include dementia or pre-existing cognitive impairment. In these situations, the precipitating factors entail medications which may result in polypharmacy, sedative-hypnotic use, and psychoactive medication use (Fong et al., 2015). The usage of medications with anticholinergic properties has been associated with delirium in older adults. In addition, patients who use more than one drug with the above property have a high likelihood of developing delirium when an adjusted correlation was examined. Therefore, in demented patients, medications become more responsible for the causation of delirium.
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Additional Tests
The presence of delirium in an erstwhile demented patient calls for a comprehensive evaluation of a patient. One of the ways that these evaluations will be done include ordering for more tests such a urinalysis. In older patients, urinary tract infections have been known as the precursors of delirium. Thus, performing a urinalysis will result in the elimination of the UTIs as the cause of the condition in the patient (Morandi et al., 2017). Moreover, serum electrolytes need to be obtained in order to eliminate electrolyte abnormalities encompassing hypocalcemia, hypernatremia, and hyponatremia. In addition, uremia can also cause delirium. As a result, a serum creatinine and blood urea analysis should be ordered by the physician.
In addition, ordering for serum drug levels is also important to confirm for the presence of medications in the system of the patient. However, this test should only be ordered if the patient is on a drug whose measurement can occur in the serum. In addition to the laboratory tests, imaging tests such as the Magnetic Resonance Imaging (MRI) and a Computerized Tomography (CT) scans (Fong et al., 2015). These two imaging tests will be used to eliminate inflammation as the cause of delirium in the patient.
Treatment Options to Consider for Mr. White
The treatment modalities for delirium in a demented patient can be multifaceted. In most cases providers will provide corticosteroids so as to managed the swelling in the patient’s brain. However, given that there is a high likelihood of the disease having been caused by a medication or medications, the appropriate intervention would be to discontinue the offending drugs (Maust et al., 2015). The removal of those drugs will allow the patient to stabilize while some of the symptoms that he demonstrated will resolve. Moreover, antibiotic and antiviral medications may also be considered in the off-chance that the patient’s condition is caused by a UTI given that he suffers from urinary incontinence.
NSG 6999 Acute Delirium Case References
Fong, T. G., Davis, D., Growdon, M. E., Albuquerque, A., & Inouye, S. K. (2015). The interface between delirium and dementia in elderly adults. The Lancet. Neurology, 14(8), 823–832. doi:10.1016/S1474-4422(15)00101-5
Maust, D. T., Kim, H. M., Seyfried, L. S., Chiang, C., Kavanagh, J., Schneider, L. S., & Kales, H. C. (2015). Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA psychiatry, 72(5), 438-445.
Morandi, A., Davis, D., Bellelli, G., Arora, R. C., Caplan, G. A., Kamholz, B., … & Meagher, D. (2017). The diagnosis of delirium superimposed on dementia: an emerging challenge. Journal of the American Medical Directors Association, 18(1), 12-18.
This week’s content discussed common psychiatric disorders in the Adult and Older Adult client. Often times a secondary diagnosis is masked due to their psychiatric disorder. Review the following case study and answer the following questions.
Mr. White is a 72-year-old man, with a history of hypertension, COPD and moderate dementia, who presents with 4 days of increased confusion, nighttime restlessness, visual hallucinations, and urinary incontinence. His physical exam is unremarkable except for tachypnea, a mildly enlarged prostate, inattentiveness, and a worsening of his MMSE score from a baseline of 18 to 12 today.
Mr. White’s presentation is most consistent with an acute delirium (acute change in cognition, perceptual derangement, waxing and waning consciousness, and inattention).
What is the most likely diagnosis to frequently cause acute delirium in patients with dementia?
What additional testing should you consider if any?
What are treatment options to consider with this patient?
