Alzheimer’s Delirium and Dementia Q 56
82-year-old Mr. Robeson together with his daughter arrived at the medical-surgical unit for diagnostic confirmation and management of probable delirium. Which statement by the client’s daughter best supports the diagnosis?
A. "Maybe it's just caused by aging. This usually happens by age 82."
B. "The changes in his behavior came on so quickly! I wasn't sure what was happening."
C. "Dad just didn't seem to know what he was doing. He would forget what he had for breakfast."
D. "Dad has always been so independent. He's lived alone for years since mom died."
Correct Answer: B. “The changes in his behavior came on so quickly! I wasn’t sure what was happening.”
Delirium is an acute process characterized by abrupt, spontaneous cognitive dysfunction. Delirium, also known as the acute confusional state, is a clinical syndrome that usually develops in the elderly. It is characterized by an alteration of consciousness and cognition with reduced ability to focus, sustain, or shift attention. It develops over a short period and fluctuates during the day.
Option A: Cognitive impairment disorders (dementia or delirium) are not normal consequences of aging. There are two groups of risk factors related to delirium: predisposing and precipitant factors. The most common predisposing factors are older age (older than 70 years), dementia (often not recognized clinically), functional disabilities, male gender, poor vision and hearing, and mild cognitive impairment. Alcohol use disorder and laboratory abnormalities have been associated with an increased risk.
Option C: Option C would be characteristic of someone with dementia. The clinical presentation of delirium can vary, but usually, it flourishes with psychomotor behavioral disturbances such as hyperactivity or hypoactivity with increased sympathetic activity and impairment in sleep duration and architecture. It is caused by a medical condition, substance intoxication, or withdrawal in addition to the medication side effects, as well as; it is no better explained by another preexisting, involving, or established neurocognitive disorder.
Option D: Although Option D provides background data about the client, it is unrelated to the current problem of delirium. Only 12% to 35% of delirium cases are recognized. The first thing one has to do is determine the patient’s baseline mental status and the acuity of the symptom presentation, delirium presents over hours to days. This step requires a knowledgeable informant to obtain the history. Although, it is necessary for the diagnosis to know if the disturbance in mental status started alone or with other symptoms as dyspnea or dysuria or with medication changes.