Dementia Discussion Assignment
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? Dementia Discussion Assignment
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In patients with dementia, acute delirium often occurs as a result of disorders of metabolism, toxins, viral and bacterial infections, polypharmacy and neurological deficits (Balogun & Philbrick, 2014).This case involves an elderly patient with several underlying illnesses which can possibly trigger delirium. The most likely comorbidities to trigger delirium in this case are infections of the urinary tract and pneumonia.
The additional diagnostic tests to be ordered based on the client’s presentation include: a Complete Blood Count (CBC), Erect PA Chest X-ray, arterial blood gases, TSH panel (Thyroid Stimulating Hormone), BMP and urinalysis. An elevated count of leukocytes as revealed in the CBC would confirm the presence of an underlying infection (Morandi et al., 2017). Urinalysis would help to detect the presence or absence of a urinary tract infection. Disorders of the thyroid have also been evidenced to cause acute delirium. This explains why it would be necessary to order for a TSH panel. Dementia Discussion Assignment
With regards to options for treatment, it is essential to note that the patient is elderly thus his metabolism is significantly reduced due to a decreased liver mass. Besides, the renal function is also reduced thus can easily accumulate toxic products of metabolism. Mr. White also has COPD and hypertension which are generally managed by medications. Therefore, it would be necessary to take a non-pharmacological approach in the management of his delirium. This involves administering fluids to maintain hydration, scheduling for him a sleep pattern, observing adequate nutrition and re-orientation (Inouye, Westendorp & Saczynski, 2014). In case of an underlying bacterial infection, it would recommendable to administer abroad spectrum antibiotic such as Amoxil/clavulniic acid. Should the patient’s condition worsen or the delirium becomes persistent, medications should immediately be considered with haloperidol as the first line medication. To ensure adherence, the patent should be closely monitored.
Balogun, S. A., & Philbrick, J. T. (2014). Delirium, a symptom of UTI in the elderly: fact or fable? a systematic review. Canadian Geriatrics Journal, 17(1), 22.
Inouye, S. K., Westendorp, R. G., & Saczynski, J. S. (2014). Delirium in elderly people. The Lancet, 383(9920), 911-922.
Morandi, A., Davis, D., Bellelli, G., Arora, R. C., Caplan, G. A., Kamholz, B., … & Meagher, D. (2017). The diagnosis of delirium superimposed on dementia: an emerging challenge. Journal of the American Medical Directors Association, 18(1), 12-18. Dementia Discussion Assignment