Can confusion from brain met show itself suddenly?

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i always thought brain met-related dementia was progressive. on sunday i opened a new pt with lung ca for home care. she was sleepy but with it when spoken to. on tuesday i received a call from her daughter that she was concerned about her mom, because mom was having trouble remembering when she took her prn morphine. i went over there and mom was definitely confused. i broached the subject of 23-hr caregivers, but mom wasn't having none of that. i came up with a med plan with daughter, to make it easier to keep track of when the morphine is taken.

yesterday she had chemo. daughter called me afterwards and said the onc said that mom needs 24-hr care, that the confusion was too great and a big change since last weekend. i told the daughter how to go about finding caregivers.

today (my day off) i got a call from the woman that runs the caregiver referral service. the cops wanted to talk to me. i thought, "oh ****, i missed something." turns out mom herself called the cops because she wanted her meds back. (daughter and i decided that it would be best if meds were out of mom's grasp and monitored.) mr. cop wanted my opinion and the doc's about whether or not mom is a danger to herself.

that's a 4-day time span. brain met has not yet been diagnosed, but can that cause confusion this quickly?

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up to 60% of lung ca pts, have brain mets.

yes, it can show itself that suddenly.

but she was presenting with lethargy before that, right?

likely r/t increased icp- hallmark s/s are nausea, ha, altered loc

depending on where the brain lesion is, it will manifest itself in sev'l ways.

visual

ha

n/v

loc

numbness, tingling (not to be confused with tingling in hands/feet r/t chemo)

paralysis

gait, balance

speech

seizures

ms

if can be confirmed through ct or mri, preferably mri.

there are treatments, all with poor prognosis.

she'll need atc care, tazz.

and probably, some haldol. :o

leslie

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Oh yes, I have seen the mental status change hit like a lightening bolt. Just went through it with my husband's cousin. She passed away just last week. She had colon cancer but it was the brain mets that killed her. My heart goes out to this patient and her family and to the very fine nurses that cares for her.

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I have heard of people with brain mets getting confused really quick. She will probably need 24 hour care at this point. Also, with my dad, his cancer was everywhere. They never did a scan of his brain towards the end, he was confused. The hospice people were really great and we had to take turns staying with my mom to help her care for him because we promised to keep him at home.

Leslie

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okay, thanks guys. i was afraid i'd missed something and delayed intervention.

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Specializes in ICU, ER, EP,.

well not my area of expertise, but I have some limited experience with this. I did an oncology internship for 12 weeks (wanted to be an oncology RN), then did bone marrow transplant last semester internship 12 week, and have a few admits over the years with acute LOC changes.

so based on that, I don't have you're day to day perspective, same as the family... where subtle changes may be occurring and are a bit unnoticed. I've dealt with... however and what ever has presented itself over an estimated short period of time.... LOC changes... confusion.

Lung cancer especially seems to go right to the brain, mets and cause quick changes.

So to specifically reply to your post. Brain mets occur BEFORE being diagnosed. It is diagnosed AFTER the LOC or mental changes and the docs are now scanning. Due to insurance $$, the docs do not preventively look and early seek out brain mets, but diagnose and "treat" only once the symptoms show.

Does that make sense? No patient or family would know ahead of time unless a symptom presented that told the docs to look. So you, the family... NO ONE missed anything.... chemo, low blood count, infection, change of environment... all that can cause confusion in our elderly. At this point it HAS ALREADY happened, you could have done NOTHING, not ANYTHING to PREVENT it.

It is not for you to place blame on yourself for an unfortunate, expected growth of the cancer to occur "unnoticed".... You picked it up immediately, created a change in the plan of care for safety. We second guess ourselves TOO much and expect way too much foresight with monday night 20/20 vision. don't blame yourself. Actually thought you did a great job, the cops too for following up!

Mets is a very unfortunate, expected outcome (what everyone is fighting against and hoping with NO control over!!!!!), this means you too! Love ya taz, you can't carry this load, its not yours to carry.

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thanks, zooey!

i know i can't change the met at all, what i meant was, should i have seen earlier that she needed supervision? did i miss something on sunday that, had i put something in place sooner, might have prevented the double-dosing of meds?

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Specializes in ICU, ER, EP,.
thanks, zooey!

i know i can't change the met at all, what i meant was, should i have seen earlier that she needed supervision? did i miss something on sunday that, had i put something in place sooner, might have prevented the double-dosing of meds?

ahh, missed that, sorry, thought you were kicking yourself in the orifice. we need to communicate better, seem to miss each others points, sorry:trout: my bad, grab the fish and have at it;)

umn, reviewing your post, it's very difficult, not knowing your client. unfortunately with home health there are so many more unknown variables than having complete control at our "in hospital nursing".

in fairness, your post isn't clear as how the patient was double dosed , or i'm an idiot (most likely), but re-read your post, remember that i can't read your mind, you do leave a bit out at times;) and i misread you the others:uhoh3:. i don't see where a double dose occurred??

help, you're hitting wine time here and now i'm re-reading too much:lol2: worked last night in short, yep, drinking wine. love ya

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Specializes in ICU, CCU, Trauma, neuro, Geriatrics.

Tazzi, you missed nothing, onset of confusion is many times very quick. Yes I would have assumed that the pain meds had been taken too often in this case as the patient had been lucid prior and brain mets had not been diagnosed. You alerted family about this and gave a plan, you also were available for ongoing input from everyone involved.

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Specializes in ER, Occupational Health, Cardiology.

Wow, Tazz, are you getting some unusual cases! I read your post just after I was talking with an Echo Tech instructor who works part time on-call at the hospital. Last night he had a fiftyish man who was dx w/small cell lung ca last week. He was sitting with his feet elevated yesterday evening watching TV when his left foot "turned as blue as a bluberry, and it was so cold you could have chilled a 6-pack with it." Turns out he had thrown an arterial clot secondary to the lung CA. May be your pt had one go to the brain?

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Specializes in ICU, SDU, OR, RR, Ortho, Hospice RN.
up to 60% of lung ca pts, have brain mets.

yes, it can show itself that suddenly.

but she was presenting with lethargy before that, right?

likely r/t increased icp- hallmark s/s are nausea, ha, altered loc

depending on where the brain lesion is, it will manifest itself in sev'l ways.

visual

ha

n/v

loc

numbness, tingling (not to be confused with tingling in hands/feet r/t chemo)

paralysis

gait, balance

speech

seizures

ms

if can be confirmed through ct or mri, preferably mri.

there are treatments, all with poor prognosis.

she'll need atc care, tazz.

and probably, some haldol. :o

leslie

Yes I agree with my matey Leslie.

Can be very frightening to the family at these sudden and irreversible changes. :uhoh21:

Hang in their Tazzie.

Would they consider Hospice care for her??

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ahh, missed that, sorry, thought you were kicking yourself in the orifice. we need to communicate better, seem to miss each others points, sorry:trout: my bad, grab the fish and have at it;)

umn, reviewing your post, it's very difficult, not knowing your client. unfortunately with home health there are so many more unknown variables than having complete control at our "in hospital nursing".

in fairness, your post isn't clear as how the patient was double dosed , or i'm an idiot (most likely), but re-read your post, remember that i can't read your mind, you do leave a bit out at times;) and i misread you the others:uhoh3:. i don't see where a double dose occurred??

help, you're hitting wine time here and now i'm re-reading too much:lol2: worked last night in short, yep, drinking wine. love ya

*hmph* you're s'posed to be able to read my mind, what's wrong with you????? :lol2:

pt was given morphine by daughter and less than three hours later pt forgot and took another one.

wow, tazz, are you getting some unusual cases! i read your post just after i was talking with an echo tech instructor who works part time on-call at the hospital. last night he had a fiftyish man who was dx w/small cell lung ca last week. he was sitting with his feet elevated yesterday evening watching tv when his left foot "turned as blue as a bluberry, and it was so cold you could have chilled a 6-pack with it." turns out he had thrown an arterial clot secondary to the lung ca. may be your pt had one go to the brain?

pt was discharged last weekend after having clots, but mri two days earlier showed nothing in the brain. i saw her today, she seems way more alert than the other day. lots of weird family dynamics going on, this goes way deeper than i thought.

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