What was wrong with my patient??

[Dazglue]

Seriously! We were at a lost at work last night. Pt is A&O X 4. But keep asking where her baby is, she needs a pamper to change baby, and keep pointing and talking to people that's not there. She's even tried to get out of bed a couple of times even though she can't walk. However, she knows phone numbers (and remembers to press 9 to dial out), she knows her name, time, day, where she is, the floor she's on, and her room number! She knows what she's eaten, how much, and even her blood sugars and amounts of insulin. She's a young lady (in her 50's), negative for UTI and no change in her medication regimen! Someone mentioned that she's "faking" but I don't think so but if she is, she's doing an awesome job. I'm a new nurse, but even the seasoned nurses are at a lost for words!

[CoffeeRTC, BSN, RN]

How recent was the surgery? Some people really react bad to the anesthesia...did we know her kidney function?

[tiroka03, LPN]

My daughter has seizures, the ones that you might stare for a moment, usually unnoticed by me, because they are so brief. But, she tells me during the time just before it happens, and during it, see will see and hear things that she knows are not there.

[nurseprnRN, BSN, RN]

if she's a few days postop for her surgery, it's certainly prime time for the dts. i'm also all for ruling out steroids, polypharmacy (from home or otherwise), and underlying acute or chronic psych disorder. hypoxia from a dvt-> pe is possible, but less likely down my differential diagnosis list.

[lrobinson5]

Someone who has a fixed delusion can be like this. Totally alert and oriented, except for the delusion. I took care of a psych pt who had a delusion that Jesus was her boyfriend. It was so bizarre, you could talk to her about anything and it would be totally normal, until you started talking about where she lived and her family.

I work in hospice, and the first thing that popped into my mind from my background is terminal restlessness. It sounds like that is probably not it for this pt, but if she was on hospice that is what I would suspect.

So would an appropriate diagnosis for a patient that you described be dementia? (Assuming they were older).

My grandmother was recently diagnosed with dementia after we took her in for what you described EXACTLY. She had delusions a bit worse and more frequently, but she still knew the time and day etc. She also would. not. sleep.

I hope this doesn't qualify as asking for medical advice... She is under a Doctor's care, but we don't know what questions to ask.

[Dazglue, ADN, BSN, MSN, RN]

So would an appropriate diagnosis for a patient that you described be dementia? (Assuming they were older).

My grandmother was recently diagnosed with dementia after we took her in for what you described EXACTLY. She had delusions a bit worse and more frequently, but she still knew the time and day etc. She also would. not. sleep.

I hope this doesn't qualify as asking for medical advice... She is under a Doctor's care, but we don't know what questions to ask.

I'm not asking for medical advice. I know I am not a doctor and I am not trying to diagnose the patient myself, just baffled.

[2bTraumaRN2008]

I was thinking anesthesia also...

[Esme12, ASN, BSN, RN]

so would an appropriate diagnosis for a patient that you described be dementia? (assuming they were older).

my grandmother was recently diagnosed with dementia after we took her in for what you described exactly. she had delusions a bit worse and more frequently, but she still knew the time and day etc. she also would. not. sleep.

i hope this doesn't qualify as asking for medical advice... she is under a doctor's care, but we don't know what questions to ask.

there are many forms of dementia and causes......the wiki link is very informative.

there are many other medical and neurological conditions in which dementia only occurs late in the illness, or as a minor feature. for example, a proportion of patients with [color=#0645ad]parkinson's disease develop dementia, though widely varying figures are quoted for this proportion.[[color=#0645ad]citation needed] when dementia occurs in parkinson's disease, the underlying cause may be [color=#0645ad]dementia with lewy bodies or [color=#0645ad]alzheimer's disease, or both.[color=#0645ad][17] cognitive impairment also occurs in the parkinson-plus syndromes of [color=#0645ad]progressive supranuclear palsy and [color=#0645ad]corticobasal degeneration (and the same underlying pathology may cause the clinical syndromes of [color=#0645ad]frontotemporal lobar degeneration). chronic inflammatory conditions of the brain may affect cognition in the long term, including [color=#0645ad]behçet's disease, [color=#0645ad]multiple sclerosis, [color=#0645ad]sarcoidosis, [color=#0645ad]sjögren's syndrome and [color=#0645ad]systemic lupus erythematosus. although the acute [color=#0645ad]porphyrias may cause episodes of confusion and psychiatric disturbance, dementia is a rare feature of these rare diseases.[color=#0645ad][18]

aside from those mentioned above, inherited conditions which may cause dementia alongside other features include:[color=#0645ad][19]

• [color=#0645ad]alexander disease
  
• [color=#0645ad]canavan disease
  
• [color=#0645ad]cerebrotendinous xanthomatosis
  
• [color=#0645ad]drpla
  
• [color=#0645ad]fragile x-associated tremor/ataxia syndrome
  
• [color=#0645ad]glutaric aciduria type 1
  
• [color=#0645ad]krabbe's disease
  
• [color=#0645ad]maple syrup urine disease
  
• [color=#0645ad]niemann pick disease type c
  
• [color=#0645ad]kufs' disease
  
• [color=#0645ad]neuroacanthocytosis
  
• [color=#0645ad]organic acidemias
  
• [color=#0645ad]pelizaeus-merzbacher disease
  
• [color=#0645ad]urea cycle disorders
  
• [color=#0645ad]sanfilippo syndrome type b
  
• [color=#0645ad]spinocerebellar ataxia type 2
  

http://en.wikipedia.org/wiki/dementia

http://www.mayoclinic.com/health/dementia/ds01131

http://www.dementiacarecentral.com/

i hope these help:p

[Esme12, ASN, BSN, RN]

I was thinking anesthesia also...

or smal TIA/CVA

[lrobinson5]

There are many forms of dementia and causes......the wiki link is very informative.

I hope these help:p

They do very much! It is such a complicated disease... and it doesn't help that everyone expects me to know all of the different causes, as well as signs, symptoms etc.

All of this is very new to our family, so it looks like I have some reading to do!

Thanks :)

[NewLPN11]

She is not A&O x4, if she is asking for diapers for a non existant child.

That's what I was thinking...

[Esme12, ASN, BSN, RN]

They do very much! It is such a complicated disease... and it doesn't help that everyone expects me to know all of the different causes, as well as signs, symptoms etc.

All of this is very new to our family, so it looks like I have some reading to do!

Thanks :)

You're welcome...

[Dazglue, ADN, BSN, MSN, RN]

UPDATE TIME! Sorry it took me so long but I unfortunately had a miscarriage last week and I haven't been back to work, until last night. Anyways, I remember the last time I had this pt I contacted the MD concerning the new anti-depressant that she was on, and this was the only new thing added to her daily regimen. So he d/c this medicine but her "talking out" was still going on the next day when I came back. So, I looked this drug up and the half-life was 35 hours! As of last night when I went back to work, she was back to her normal self.