USMLE Forum Archives - USMLE Step 3 - pt acting strangely
pt acting strangely
harry206 - 05-05-09 04:35
You are the current "on call physician" for your group, when you receive a call regarding one of your nursing home patients. The nurse reports that one patient has been acting strangely for the last few hours and is agitated at times. This patient is an 82-year-old female who has been in the nursing home for the last two years, and has always been very pleasant. You know her very well from your recent nursing home visit. She has a past medical history of hypertension, diabetes mellitus, osteoporosis, and Alzheimer’s dementia. Her daily medications are amlodipine, metformin, calcium - vitamin D, and donepezil. You are concerned that something is not right with the patient.
Which of the following is the most appropriate next step in the management of this patient?
harry206 - 05-05-09 04:35
You are the current "on call physician" for your group, when you receive a call regarding one of your nursing home patients. The nurse reports that one patient has been acting strangely for the last few hours and is agitated at times. This patient is an 82-year-old female who has been in the nursing home for the last two years, and has always been very pleasant. You know her very well from your recent nursing home visit. She has a past medical history of hypertension, diabetes mellitus, osteoporosis, and Alzheimer’s dementia. Her daily medications are amlodipine, metformin, calcium - vitamin D, and donepezil. You are concerned that something is not right with the patient.
Which of the following is the most appropriate next step in the management of this patient?
The correct answer and explanation will be available after you answer.
Page 1
#2
Re: pt acting strangely sarabrodke1 - 05-05-09 10:59 she might have hypoglycemia, high BP or even UTI ..needs to be treated in ER
#5
Re: pt acting strangely
harry206 - 05-06-09 03:31 ANSWER: C
EXPLANATION:
The most common factors that increase the patient’s susceptibility to delirium include advanced age and an underlying brain disorder (i.e., dementia, Parkinson’s disease, and history of prior stroke).
The factors that precipitate delirium include multiple medication use (polypharmacy), infections (i.e., urinary tract infections and pneumonia), fluid and electrolyte disturbances (dehydration, hyponatremia, or hypernatremia), malnutrition, immobility (including the use of restraints), use of bladder catheters, and a wide variety of other medical conditions.
In fact, delirium may be the only presenting complaint in an older demented patient suffering from an acute medical illness; therefore, checking this patient’s vital signs should be the first step to rule out early infections and fluid and electrolyte disturbances.
Use of psychotropic medications as a first line therapy for behavioral problems is not recommended
#17
Re: pt acting strangely babbu5508 - 09-30-10 09:25 My answer is: c.
Ask the nurse to check vital signs and pulse oximetry..the first best step in the evaluation of any patient...gives many clues..
Page 1