Contributing to patient altered mental status

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Reference no: EM133916521

Case Scenario

Patient Baby is a 77-year-old with a past medical history of Hypertension, Diabetes Mellitus, chronic low back pain, tremors, hearing impairment, and hyperlipidemia brought to the Emergency Room 10 days ago complaining of leg weakness and numbness, facial asymmetry with slurred speech that began upon awakening on the day of admission.

MRI of the head and neck showed a subacute right Middle Cerebral Artery (MCA) infarct and patent intracranial vessels. The discharge summary states that a full stroke work-up on the neurology service was otherwise unremarkable, but she suffered a fall 2 days prior to discharge. She sustained no injuries.

Upon admission to your institution, her exam is remarkable for left arm weakness 3/5, left leg weakness 4/5, left facial droop, and dysarthria. During the interview, you notice she is drowsy and confuse on names, date, and time. She scores an 18/30 on the Mini Mental State Exam, missing several answers because she had significant difficulty focusing on your questions. Vital signs: BP 122/78, HR 84 bpm, RR 20 bpm, Temp - 36.4ºC.

Her daughter is present at the bedside and concerned about her mother, saying that on several occasions in the last few days she had not been herself and had rambling speech, appeared to be confused, and asked her the same questions repeatedly. At other times, however, she was - back to normal. The daughter also notes that in the last year her mother has had several episodes of confusion involving word-finding difficulty and slurred speech. Although the patient had been driving and completing basic chores prior to her admission.

Medications include:

· aspirin 80 mg PO daily

· simvastatin 80 mg PO qhs

· famotidine 20 mg PO daily

· propranolol 40 mg PO q12h

· glipizide 5 mg PO BID

· hydrochlorothiazide 12.5 mg PO daily

· oxycodone extended release 10 mg PO q12h

· multivitamin 1 tablet PO daily

· docusate 100 mg PO q12h

· acetaminophen/oxycodone 5/325 mg PO q4h PRN pain,

· Ambien 5 mg PO qhs PRN sleep.

Questions:

1. Using the Confusion Assessment Method (CAM), identify whether this patient has delirium. Justify your answer.

2. Identify the factors that could be contributing to this patient's altered mental status.

3. Based on the data above, what are the manifestations that patient Maria has delirium.

4. Develop Nursing care plan for patient Maria.

Reference no: EM133916521

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