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Acute Delirium Case
Acute Delirium Case
A. Yes
B. No
Question 4
Which of the following are likely causes for her delirium. While delirium has
numerous causes, and each of these options can potentially contribute to
delirium, pick the three most significant contributing causes in the list below.
A. Hypersomnolent delirium
B. Hypervigilant delirium
C. Mixed delirium
D. No consistent association with any type
Question 6
A. Yes
B. No
Question 7
A. Norepinephrine
B. Dopamine
C. Glutamine
D. Acetylcholine
E. Serotonin
Question 8
In this case, the attending ordered the patient be kept in a well lit
room, no overstimulation, and staff and family members to re-orient
the patient periodically. Is this a reasonably good treatment plan?
A. Yes
B. No
Question 9
Because of this one episode of delirium, how does this roughly change
her 12 month survival prognosis?
How long will it most likely take for the patient in this case to fully recover
and return to her previous cognitive baseline?
A. 4 hours
B. 4 days
C. 4 weeks
D. 4 months
E. 4 years
Answer Key
• Q1 = A and H • Q6 = A
• Q2 = A • Q7 = D
• Q3 = A • Q8 = A
• Q4 = A, C, E • Q9 = C
• Q5 = B • Q10 = C
Answers
1. The celecoxib is a poor idea to treat pain
of any kind in the elderly and especially
with CHF, since it causes fluid retention
by decreasing renal blood flow. The
hydrocodone/APAP is the proximate
cause of her delirium and certainly needs
to be removed.
Answers
2. Acetaminophen is an excellent analgesic,
especially when given routinely. There is no
reason to switch antibiotics unless the C&S
indicates the need. She has no symptoms of
uncompensated CHF.
3. An antipsychotic is indicated for the agitation and
psychotic symptoms.
Answers
4. The multifactorial scenario is the strange hospital
environment, the opioids, and the infection.
5. Hypervigilance occurs due to the sudden
removal of a CNS suppressive substance.
6. The damaged brain is more likely to fail just as a
damaged heart is more likely to fail.
Answers
7. Acetylcholine deficiency from the effect of
anticholinergics causes delirium.
8. This plan will help calm this agitated patient.
9. Delirium is a serious complication and doubles the
risk of death in the next year.
10.While it can resolve in a week, 4 weeks is not
surprising and is often seen.