Reference no: EM133619635

Brief Patient History

Mr. K is a 42-year-old Asian businessman who is visiting your city. He is transported to your facility from his hotel because of a witnessed grand mal seizure. Paramedics administered lorazepam in the field. Mr. K's wife reports by phone that he is in good health and that she is not aware that he takes any medications regularly. However, she states that he recently quit drinking alcohol because of pressure from the family. She also comments that she thinks he takes alprazolam to "calm his nerves" once in a while.

Clinical Assessment

Mr. K is admitted to the intensive care unit from the emergency department with hypertension, restlessness, mental confusion, paranoid ideations with rambling speech, and visual and auditory hallucinations. Mr. K's skin is warm and moist. Intravenous administration of thiamine, folic acid, multivitamins, and magnesium was begun in the emergency department. Physician orders were written for lorazepam every 6 hours and clonidine every 4 hours as needed for delirium-related symptoms.

Diagnostic Procedures

Mr. K's baseline vital signs are as follows: blood pressure of 190/92 mm Hg, heart rate of 130 beats/min (sinus tachycardia), respiratory rate of 26 breaths/min, and temperature of 98.8°F. Pulse oximetry O2 saturation is 90% on 4 L/min oxygen using a nasal cannula. Confusion assessment method indicates presence of acute and fluctuating change in mental status, inattention, and disorganized thinking. The Riker Sedation-Agitation Scale score is 5. Serum and urine toxicology studies are negative for ethyl alcohol, cannabis, and opioids; urine is strongly positive for benzodiazepines. The sodium level is 135 mmol/L, potassium level is 4.3 mmol/L, chloride level is 84 mmol/L, carbon dioxide level is 26 mEq/L, calcium level is 8 mg/dL, magnesium level is 2.0 mg/dL, and γ-glutamyl transpeptidase (GGT) level is 80 IU/L.

Medical Diagnosis

Delirium tremens caused by alcohol and benzodiazepine withdrawal is diagnosed.

Questions

1. What major outcomes do you expect to achieve for this patient?

2. What problems or risks must be managed to achieve these outcomes?

3. What interventions could be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?

4. What interventions could be initiated to promote optimal functioning, safety, and well-being of the patient?

5. What technology can be used to monitor this patient and prevent complications?

6. What other interprofessional team members are needed to assist with the management of this patient?

7. What possible learning needs would you anticipate for this patient?

8. What cultural and age-related factors might have a bearing on the patient's plan of care?