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Delirium Diagnosis in Geriatric Patient
Case study 1
Delirium, dementia and depression are serious health complication common among geriatric population. The clinical manifestation of these healthcare complications is mainly impaired cognitive function, which makes it difficult to differentiate. This is usually a challenge because most of geriatric patients often present with multiple medical comorbidities which contribute to the affective and cognitive changes. Advanced nurse practitioners are expected to understand the key differences between these diseases as it is the first step to effective treatment (Holt, Young & Heseltine, 2013).
In this case study, the list of differential diagnosis would include dementia, depression and delirium. However, the fact that the patient is very confused, agitated, mental status fluctuates and rambles in an incoherent and disorganized manner, then, the most likely definitive diagnosis is the patient is derelict. Delirium is differentiated from the other two mental disorders by a) onset, b) Attention, c) and d) fluctuation of the symptoms.
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The onset of delirium in geriatric population occurs rapidly as compared to other two diseases where symptoms onset is mainly gradual and worsens progressively. In patients that are derelict, the patient is unable to remain focused. In early stages of dementia and depression, the patient is generally able to remain alert. In delirium patients, the signs and symptoms fluctuation is predominant throughout the day (Flaherty & Resnick, 2011).
To further confirm the diagnosis, the cognitive assessment should be done using comprehensive geriatric assessment tool. The physical exams, neurological exam, blood test and urine test should be conducted to check indicators of underlying health complications. I would not request from brain imaging test unless the aforementioned diagnostic tests fails to confirm delirium or underlying health complications (Featherstone, Hopton & Siddiqi, 2010).
The first step in treatment of the patient is to address underlying triggers. This includes terminating medication identified as underlying cause. With regard to pharmacological management of delirium, the patient should be give antipsychotics of choice, administered at lowest dosage.
Therefore, the patient should be administered Haloperidol and benzodiazepines. The healthcare provider must ensure that the patient gets an individualized care plan to treat and prevent further complications. This includes devising environmental interventions to address the disorientation and cognitive impairments (Holroyd-Leduc & Reddy, 2012).
Reference
Featherstone, I., Hopton, A., & Siddiqi, N. (2010). An intervention to reduce delirium in care homes. Nursing Older People, 22(4), 16-21. http://dx.doi.org/10.7748/nop2010.05.22.4.16.c7732
Flaherty, E., & Resnick, B. (2011). GNRS. New York, NY: American Geriatrics Society.
Holroyd-Leduc, J., & Reddy, M. (2012). Evidence-based geriatric medicine. Chichester, West Sussex, UK: Blackwell Pub.
Holt, R., Young, J., & Heseltine, D. (2013). Effectiveness of a multi-component intervention to reduce delirium incidence in elderly care wards. Age and Ageing, 42(6), 721-727. http://dx.doi.org/10.1093/ageing/aft120
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