Please reply to the following discussion with one or more references. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
Responses must consist of at least 350 words (not including the greeting and the references), do NOT repeat the same thing your classmate is saying, try to add something of value like a resource, educational information to give to patients, possible bad outcomes associated with the medicines discussed in the case, try to include a sample case you’ve seen at work and discuss how you feel about how that case was handled. Try to use supportive information such as current Tx guidelines, current research related to the treatment, and anything that will enhance learning in the online classroom.
References must come from peer-reviewed/professional sources (No WebMD/Mayo Clinic or Wikipedia please!).
One of the earliest symptoms of dementia (ICD-10 code F03. 90) is delirium (ICD-10 code F05), which could be the primary warning that an individual is getting sick. Cases of both dementia and acute delirium in the elderly are presented. Especially when it comes to alleged dementia as well as severe delirium, the healthcare practitioner’s focus will be on determining the highly likely diagnosis (Lai et al., 2021). In accordance with the case study’s findings, a number of factors, including substance withdrawal, stress, inflammation, and direct intoxication may all have a role in the development of acute delirium. If an individual is going through detox from addiction, their neurotransmitter system will go through a time of disruption inside the excitatory and inhibitory pathways.
Anticholinergic medications, dopaminergic drugs, and electrolyte imbalances are some more examples of conditions that can affect neurotransmitter production or release. It might affect the process in a roundabout way. These include, but are not limited to, hypercalcemia, hypoxia, hypoglycemia, and ischemia. All of those are obviously only a small sample of the many examples of inequality. Furthermore, cytokines are a group of molecules that are produced as a result of inflammation (Tieges et al., 2020). As a result, these cytokines commonly interfere with the proper action of neurotransmitters. Comparatively, the stress response is linked to the secretion of neurotoxic glucocorticoids as well as noradrenaline. The information covered so far suggests that while attempting to diagnose acute delirium, it is important to take into account any coexisting clinical disorders. In particular, renal failure or injury; cerebrovascular illness; insomnia; malignancy; heart arrhythmias; seizures; delirium from medicines; and pulmonary pathology are all conditions that can cause hypovolemia.
Additional Testing to Be Considered
Particularly for elderly individuals, there are a variety of options available when treating acute delirium plus dementia situations addressed by healthcare professionals. According to Mattison (2020), depending on the circumstances, it is necessary to first explain how to diagnose delirium signs by analyzing the patient’s medical history and doing a comprehensive physical examination. We can then proceed to determine what caused the delirium after that is complete. Supplemental diagnostic tests may be required to determine the highly likely origin of the medical issue. Particular tests that could be performed on the patient include electrolyte levels, complete blood count, creatine, C-reactive protein, liver function tests, thyroid-stimulating hormone, calcium, kidney tests, blood glucose levels, and urinalysis. The potential of acute delirium can be ruled out by performing the aforementioned medical tests and diagnostics. Additional diagnostic techniques, including a computer tomography scan of the head, an electroencephalogram, and a chest x-ray, may be performed in conjunction with testing cerebrospinal fluid. Acute delirium can be caused by a number of medical issues, including but not limited to electrolyte imbalances, seizures, cardiac irregularities, renal failure, respiratory disorders, and strokes. Thus, further evaluations might be useful in excluding them.
Whereas doctors are expected to treat a wide variety of illnesses, it is ultimately the patient’s obligation to shape the course of treatment. However, there are a variety of considerations that go into deciding how to manage medical disorders. According to Pavone et al. (2018), any and all treatment decisions made for the patient in the pilot case will be consistent with the most recent etiology for the patient and any adjustments to that etiology. Antibiotics may be utilized to cure infections, replacement treatment could reverse hypovolemic shock, anticonvulsant drugs could reduce the severity of seizures, and hypoxia could be remedied, among many other things. It is also worth noting that antipsychotics are routinely used for recurrent hyperactive delirium, despite there being little evidence to back up this practice. Case study data suggest that clomethiazole is the best treatment for alcohol withdrawal. In other words, clomethiazole is usually the medication of choice for treating alcohol withdrawal symptoms.
Paradoxical reactions and oversedation are possible side effects of benzodiazepines. However, they remain an integral component of the treatment regimen for people suffering from severe psychomotor agitation, and who also require antipsychotics. Additionally, haloperidol is the antipsychotic of choice because it is supported by the largest body of evidence compared to other drugs in its class (Mulkey et al., 2019). One mg of haloperidol every 3 hours is recommended, with a maximum daily dose of 25 milligrams. Surprisingly, it is possible to treat acute delirium without the use of pharmaceuticals by providing the client with a stable and familiar environment. Encompassing the patient’s loved ones in his or her care is also recommended, as are strategies such as increasing stimulation throughout the day and decreasing it at night, encouraging the patient to get up and walk around, soothing the patient with aromatherapy and music, and enabling the client to start receiving physical contact from loved ones. The ones who make the sufferer feel the most at ease are on this list.
Lai, P. H. L., Halvorsen, C., & Matz, C. (2021). The relationship between occupation types, education, and volunteer behaviors among older Americans.
Innovation in Aging, 5(Supplement_1), 690–690.
Mattison, M. L. P. (2020). Delirium.
Annals of Internal Medicine, 173(7), ITC49–ITC64.
Mulkey, M. A., Everhart, D. E., Kim, S., Olson, D. M., & Hardin, S. R. (2019). Detecting delirium using a physiologic monitor.
Dimensions of Critical Care Nursing, 38(5), 241–247.
Pavone, K. J., Cacchione, P. Z., Polomano, R. C., Winner, L., & Compton, P. (2018). Evaluating the use of dexmedetomidine for the reduction of delirium: An integrative review.
Heart & Lung, 47(6), 591–601.
Tieges, Z., Stott, D. J., Shaw, R., Tang, E., Rutter, L.-M., Nouzova, E., Duncan, N., Clarke, C., Weir, C. J., Assi, V., Ensor, H., Barnett, J. H., Evans, J., Green, S., Hendry, K., Thomson, M., McKeever, J., Middleton, D. G., Parks, S., & Walsh, T. (2020). A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients.
PLOS ONE, 15(1), e0227471.