Acute Confusion (Delirium)

Question Answered step-by-step Acute Confusion (Delirium) Sara Garnet is a 78-year-old woman who is accompanied by her daughter, Megan, to a preoperative visit for a scheduled total hip replacement. Sara had been active, playing bridge and taking daily walks, until about 6 months ago when her hip began hurting so much as to limit her activity. She states she had experienced sporadic pain for years, but the hip started “giving out” on occasion, resulting in several falls. Sara is in otherwise good health, though her daughter reports that she has noticed that Sara has been having some difficulty with her short-term memory recently. She is able to compensate for this loss by keeping an appointment calendar next to her phone and using Post-it notes to help her remember messages and daily tasks. Sara has a history of depression, which is treated with Celexa (citalopram), and hypertension, which is treated with Lopressor (metoprolol). Lily Arnse, RN, performs some presurgical cognitive screening tests, the Geriatric Depression Scale (GDS), Mini-Cog, and Trails B. Sara’s score of 1 on the GDS indicates that her depression is well managed with her current medications. She struggles with three-item recall and the Clock Draw Test, as she is able to recall only two of three items and cannot correctly position the numbers on the clock. She is almost completely unable to perform the Trails B test. 1. What is delirium? 2. How common is delirium in hospitalized, older adults? 3. Is Sara at high risk to develop postoperative delirium? What risk factors does she have? 4. How does surgery increase the risk for development of delirium? 5. Is delirium always reversible? 6. What negative sequelae can develop as a result of delirium? 7. An evidence-based guideline for recognizing, preventing, and treating delirium has been created through the Hartford Institute for Geriatric Nursing. Review this guideline, which is available at http://consultgerirn.org/topics/delirium/want_to_know_more (Tullmann, Fletcher, & Foreman 2012). How can Sara’s risk for developing delirium during this hospitalization be reduced? 8. The Confusion Assessment Method is a valid and reliable tool for assessing delirium. Go to the Hartford Institute for Geriatric Nursing website, http://consultgerirn.org/uploads/File/trythis/try_this_13.pdf (Waszynski, 2012), to view this tool. Describe how to use the confusion assessment method (CAM) to make a diagnosis of delirium. 9. What medications are known to increase the risk of development of delirium? 10.Describe the cognitive screening tests that Lily performed. You can find the (a) GDS (Greenberg, 2012) at http://consultgerirn.org/uploads/File/trythis/try_this_4.pdf, the (b) Mini-Cog (Doerflinger, 2013) at http://consultgerirn.org/uploads/File/trythis/try_this_3.pdf, and (c) a description of the Trails B can be viewed at http://alzheimers.about.com/od/testsandprocedures/a/The-Trail-Making-Test-And-Its-Use-As-A-Screening-For-Dementia.htm (Heerema, 2014). Suggested Resources American Association of Critical-Care Nurses. (2014). Delirium assessment and management. Retrieved from http://www.aacn.org/wd/practice/content/practicealerts/delirium-practice-alert.pcms?menu=practice Doerflinger, D. M. C. (2013). How to try this: The mini-cog. The Hartford Institute for Geriatric Nursing. Retrieved from http://consultgerirn.org/uploads/File/trythis/try_this_3.pdf Greenberg, S. A. (2012). The Geriatric Depression Scale (GDS). Hartford Institute for Geriatric Nursing. Retrieved from http://consultgerirn.org/uploads/File/trythis/try_this_4.pdf Heerema, E. (2014). The Trail Making Test and its use as a screening tool for dementia. About.com Alzheimer’s/Dementia. Retrieved from http://alzheimers.about.com/od/testsandprocedures/a/The-Trail-Making-Test-And-Its-Use-As-A-Screening-For-Dementia.htm Tullmann, D. F., Fletcher, K., & Foreman, M. D. (2012). Nursing standard of practice protocol: Delirium: prevention, early recognition, and treatment. Hartford Institute for Geriatric Nursing. Retrieved from http://consultgerirn.org/topics/delirium/want_to_know_more Waszynski, C. M. (2012). The Confusion Assessment Method (CAM). Hartford Institute for Geriatric Nursing. Retrieved from http://consultgerirn.org/uploads/File/trythis/try_this_13.pdf Health Science Science Nursing NUR 257 Share QuestionEmailCopy link Comments (0)