Question

Your goal is to generate a diagnosis. Explain why you have chosen the diagnoses (what about the vignette makes you think this is the explanation?). What would you do to confirm the diagnosis? Can you suggest initial treatment? This can usually be done in a single page

A 71-year-old man was brought to the emergency department by his family because of 2 days of progressive confusion. He had no medical history. His family reported that he might be a little forgetful and he took a wrong turn and got lost while driving home from a dentist’s appointment 1 week after he had a tooth extraction. He took no routine medications, although the dentist had prescribed Oxycontin for pain.

Vital signs were remarkable for a temperature of 38.1C (100.5F). The general physical examination showed mild suprapubic tenderness. There was no periodontal abscess. Neurologic exam was notable for disorientation, confusion, and visual hallucinations. MMSE was attempted but he could not complete it. A urinalysis was positive for nitrites and numerous white blood cells, and the patient was hospitalized for urinary tract infection and delirium. The evening of admission, he became agitated and tried to leave the hospital, saying that the nurses were holding him hostage. He was restrained and given a dose of IM haloperidol after which he fell asleep. The next morning when his family arrived they found him in restraints and barely arousable.

Answer 1

• DIAGNOSIS- DELIRIUM
• Here the client is an elderly man with 71 years old. His tooth extraction was done 1 week before, Also, he had mild suprapubic tenderness and urinalysis was positive for nitrites and numerous white blood cells which revealed urinary tract infection. So this sudden illness is the reason for Delirium. He was not feeling ill but was more confused and agitated after hospital admission which is remarkably seen in delirium.
• Delirium can be confirmed by the Mental Status Examination by assessing mental state, confusion, perception, and memory.
• Initial treatment of delirium include treating the underlying cause. So, treat urinary tract infection first and move on to the management of delirium.