Identification and Management of Delirium

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see sample attached PURPOSE: Assess ability to apply course content to the clinical environment. Instructions: 1. Develop and present in writing a case study This case study can be made up or be an actual presentation of a patient seen in clinical practice. Include in your write up the patients past medical, and social history, physical exam, and pertinent diagnostics. Case Study#2: Elderly patient (age 60-75) in the acute care setting, previously healthy with waxing/waning cognitive status, and progressive decline with medical team recommendations for “temporary” tube feeding. 2. Discuss the concepts and issues of the topic using evidence from the course readings and research. 3. Apply concepts from the course content to resolve this clinical situation. Possible questions to guide the case study presentation follow. This is a suggested list and is NOT meant to be a complete list of things you might want to know or discuss. Be creative, this is to help you learn! This is the time to ask those questions. 1. Using evidence based practice, what are the goals and appropriate intervention for this situation. 2. When should I consider this intervention? What else can I do first? 3. What are the essential elements to consider when selecting intervention options for this situation? 4. What is the physiologic or psychological underpinnings for this patient? 5. How do I know the intervention is working? 6. Why have we chosen this particular intervention? 7. In which circumstances do you need to be cautious with this scenario? 8. How is an interdisciplinary team beneficial for this scenario? 9. Are there any religious or cultural issues with this treatment plan that need to be considered?

All too often, when patients present with confusion or altered mental status they are labeled as having dementia or some other form of confusion. There is no further assessment conducted to identify the source of these symptoms or to develop a treatment plan that addresses the cause(s). This leads patients to be inaccurately treated while being at risk for falls, worsening confusion and distress. This distress is experienced not only by the patient but the family who helplessly watch these events take place. In some instances these behaviors are due to delirium which goes unidentified and untreated. This case study will discuss the case of a patient who presented with signs and symptoms of delirium and the consequences that occur when it is not identified or treated.

Case Study

A 67 year old man was admitted to a long term acute care hospital (LTACH) after suffering a prolonged episode of respiratory failure due to chronic obstructive pulmonary disease (COPD). The patient has a tracheostomy, requires mechanical ventilation and is experiencing frequent and intense episodes of anxiety, agitation, combativeness, pulling at his tracheostomy tube, and attempts to get out of bed. He has mitten restraints placed on his hands in an attempt to prevent decannulation. The patient has a 97 year old mother who visits him daily and is highly concerned about his neurological condition. The patient has an as needed order for intravenous (IV) Lorazepam and IV Hydromorphone as needed for pain. Upon interview of the nursing staff, there is a great deal of fear that the patient will fall as he is impulsive. Lorazepam and Hydromorphone were given by the nursing staff in an attempt to keep the patient from getting out of bed.