Comprehensive exams for Mental Health Q 178
Loretta, a newly admitted client was diagnosed with delirium and has a history of hypertension and anxiety. She had been taking digoxin, furosemide (Lasix), and diazepam (Valium) for anxiety. This client’s impairment may be related to which of the following conditions?
A. Infection
B. Metabolic acidosis
C. Drug intoxication
D. Hepatic encephalopathy
Correct Answer: C. Drug intoxication
This client was taking several medications that have a propensity for producing delirium; digoxin (a digitalis glycoside), furosemide (a thiazide diuretic), and diazepam (a benzodiazepine). Precipitating factors usually vary among the population. However, drugs are the most important factor. There are many drugs related to delirium, especially sedative-hypnotic agents and anticholinergic, but opioid analgesics (especially meperidine), nonbenzodiazepines, sedatives, hypnotics, antihistamines (especially first generation), alcohol, anticholinergics, anticonvulsants, tricyclic antidepressants, histamine H2-receptor blockers, antiparkinsonian agents, antipsychotics (especially low-potency typical antipsychotics), barbiturates, digoxin, and antibiotics have been reported as well. The risk increases as high as four and a half times if the patient consumes three or more drugs (polypharmacy), and the medication is psychoactive.
Option A: Among other precipitating factors are surgery, anesthesia, high pain levels, anemia, infections, acute illness, and acute exacerbation of chronic illness. The nature of delirium is transient, but it can persist in patients with predisposing factors. A systematic review showed that hospital delirium persisted at hospital discharge in 45% of cases, and one month later in 33% of cases.
Option B: 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 D: Sufficient supporting data don’t exist to suspect the other options as causes. Delirium is a medical condition complex to understand; a single factor can cause it; however, it is not the common course. The multifactorial model has been accepted as an interaction of a vulnerable patient with predisposing factors, exposed to noxious insults or precipitant factors.