Assignment: Case Study of a 72- year- old Male with Acute Delirium
Assignment Case Study of a 72- year- old Male with Acute Delirium
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.
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?
Lopes Write Policy
For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy
The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication
Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.
Important information for writing discussion questions and participation
Welcome to class
Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to
I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.
Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.
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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.
Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.
I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Hi Class,
Please read through the following information on writing a Discussion question response and participation posts.
Contact me if you have any questions.
Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- Student paper example
- Citing Sources
- The Writing Center is a great resource