Once you get sick, you loose your mind??

[gt4everpn, BSN, RN]

i had two patients, one was a women in her late 50's who had cancer of the skin, or abdomen (don't remember which one), the other was a 72 year old with pancreatic cancer that had metastisized. both women were alert and responsive and were able to communicate some things but then would go into periods of confusion, the 72 year old would start screaming when iasked she wasnt in pain, and the 50 year old would start talking about one things then drift back and forth between various unrelated topics. my question is that these women are young and are already exhibiting altered mental status, does it have anything to do with their illness or the prevalence of an illness??

[leslie :-D]

pain, se's of meds, dehydration, alt nutrition, electrolyte surplus/deficiencies, infection, can all affect mental status.

it's not necessarily the disease, but often, the complications of it.

leslie

[EmmaG, RN]

It could be from any number of sources. The disease itself (liver or brain mets, for example), medications, infection, dehydration, hypoxia, altered blood sugars (esp in the one with pancreatic involvement) or chemistries...or even mental/emotional stress or depression; this just off the top of my head. It's hard to say without additional info.

[Blee O'Myacin, BSN, RN]

i had two patients, one was a women in her late 50's who had cancer of the skin, or abdomen (don't remember which one), the other was a 72 year old with pancreatic cancer that had metastisized. both women were alert and responsive and were able to communicate some things but then would go into periods of confusion, the 72 year old would start screaming when iasked she wasnt in pain, and the 50 year old would start talking about one things then drift back and forth between various unrelated topics. my question is that these women are young and are already exhibiting altered mental status, does it have anything to do with their illness or the prevalence of an illness??

without complete information, i have a few ideas, but no real answers. i'd say metastasis to the brain would be an option, as would infection altering mental status, or pain (even if she said she didn't have any when you asked), dehydration, confusion and lack of sleep that comes from being in the hospital for more than an overnight.

transient alterations in mental status is expected when a person is that ill. i wouldn't call it "losing your mind", more of a transient delerium when it can be treated. it's a big assessment piece. pay attention when behavior is not of the norm and then look for causes. just to say that they've "lost their mind" is not critically analyzing the situation and hopefully finding something that you can reverse.

sometimes medications also produce effects that mimic altered mental status. combine ativan and ambien and you have either a sleeping patient or a patient who is wandering the halls naked talking about baking a cake... solution? stop giving the meds and the patient's mental status returns to baseline.

try looking at what the patient is or isn't doing that's different and try to backtrack. fever? low bp? decreased urinary output? increased frequency? new meds? new situation? disease progression?

not all people who have cancer "lose their minds" - not even close. having been there, done that and am now wearing the t-shirt, i can tell you that i much prefered the caregivers who took the time to figure out what was going on.

good luck with these patients.

blee

ps - check the liver and renal function. hepatic and renal encelopathy can come on quickly too.

[EmmaG, RN]

lack of sleep that comes from being in the hospital for more than an overnight.

Unfamiliar surroundings and sleep deprivation will do it; hospitals and LTCs are not conducive to sleep... heck, after no sleep last night and working all day, I'm having a bit of mental status change right now myself

[Diary/Dairy, RN]

Unfamiliar surroundings and sleep deprivation will do it; hospitals and LTCs are not conducive to sleep... heck, after no sleep last night and working all day, I'm having a bit of mental status change right now myself

I know - if you woke me up every 4 hours for VS - I can tell you I would be one cranky woman in short order - and yet we do this all the time on tele floors. Try to let them sleep - see if things get better.

All the other suggestions have been equally appropriate too.

Change in location, lack of sleep, depression, medication can all contribute to confusion.