Chapter 59 and 60 case studies.docx - Chapter 59 and 60...

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Chapter 59 and 60 – case studies Chapter 59 Postoperative Delirium Patient Profile M.C. is a 74-year-old male who has been in the intensive care unit (ICU) for 3 days after unexpected major abdominal surgery. He is becoming increasingly confused and agitated. Before surgery, he was alert and oriented. Subjective Data States he needs to “get out of here” Angry at family members for not “taking me home” Family members are very upset about M.C.’s confusion Objective Data Blood pressure 110/70, pulse 98, respirations 20, temperature 97.3o F Oxygen saturation 97% on nasal cannula oxygen at 2L Abdominal incision healing, no redness or drainage Difficulty speaking with decreased short-term memory and recall Trying to climb out of bed Oriented to person only Discussion Questions 1. What type of cognitive impairment does M.C. likely have? He has symptoms of delirium. Delirium is a temporary but acute mental confusion that is common in the hospitalized elderly. Patient with delirium can have a variety of manifestations, ranging from hypoactivity and lethargy to hyperactivity, agitation, and hallucination. Manifestations of delirium are sometimes confused with those of dementia. A key distinction between them is that the patient who has sudden cognitive impairment disorientation, or clouded sensorium is more likely to have delirium 2. How can this diagnosis be confirmed? Diagnosis complicated because many critically ill patient cannot communicate their needs. Medical history, psychologic history, physical examination, careful
Chapter 59 and 60 – case studies attention to medication both prescription and OTC, confusion assessment method(CAM) is reliable tool for assessing delirium. Laboratory test include, complete blood count(CBC), Serum electrolytes, Blood urea nitrogen level, creatine level, drug and alcohol levels, electrocardiogram(ECG), urinarysis, liver and thyroid function tests, Oxygen saturation level, lumbar puncture, brain imaging. If the patient’s history includes head injury appropriate x-ray or scans may be ordered such as CT, MRI 3. Are there any other issues that you need to consider as possible causes for his mental state? Delirium a state of temporary but acute mental confusion, is a common, life threatening and possibly preventable syndrome in older adults. Clinically delirium is rarely caused by a single factor. It is often the result of the interaction of the patient’s underlying condition with a precipitating event. Early manifestations

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