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CONFUSION

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PHYSICAL DATA

Vital signs
Neurological assessment, including any indicators of motor weakness,
facial weakness, lethargy, or significant change in functionality
Any indications of respiratory distress, O2 sat.
Indicators of nausea and vomiting
Blood sugar level (finger stick)
Signs of fluid discrepancy
Any signals or indications of acute infection (fever, chills, alterations
in urinary routine, etc. )
Indicators of bruising or other wounds
Pain assessment (location, nature, severity, etc. )
Examine and gather particulars of disposition, behavior orientation, and
alertness

HEALTH CARE BACKGROUND

Patient’s age and sex
Beginning, length of time, frequency of problem
Food and fluid ingestion habits over preceding 7 days
Full description of behavior in comparison to typical tendencies
All current prescription drugs, including any recent adjustments
Any history of acute or persistent psychiatric ailments
Current level of bowel and bladder function
Any recent background of fall, head trauma injury
Results from previous neurologic or psychiatric treatments
All present diagnoses
Any recent lab or diagnostic test results, including blood sugar,
if affected person is a diabetic

A commonly utilized instrument, the Confusion
Assessment Method (CAM) is based on
consideration of 11 different issues that lead to
answers to the following questions:
Is the change in mental status acute and does
it fluctuate all through the course of the day?
Does the patient have difficulty focusing
attention?
Is the patient’s speech disorganized or
incoherent?
Is the patient’s level of awareness altered?
The CAM Tool:
http: //conslutgerrin. org/uploads/File/trythis /
try_this_13. pdf.

Confusion among the elderly is a common problem. Delirium can be distinguished as having varying degrees of restlessness, agitation, confusion and possibly even abnormal behavior, hallucinations, delusions and illusions. Dementia has common features with delirium (disorientation, confusion, inability to stay focused, and coherent thinking). However, dementia is seen in those with a normal level of consciousness whereas those experiencing delirium have a clouding on consciousness. Other conditions such as depression and psychosis can also cause confusion, but disorientation and clouding of consciousness is not present. Clinicians must stay alert that agitated or aggressive behaviors may be associated with these conditions.

Be sure to see all confused patients immediately is they also have abnormal vital signs, their level of consciousness is decreased, there are agitated or are aggressive.

Questions:

Is the patient acutely confused, and in what way? Does the confusion fluctuate during the day?
Or is there a depressed level of consciousness?
What is the recent change in the level of consciousness?
What are the other vital signs?
Have there been previous similar episodes?
Is the patient aggressive?
Is there an obvious reason for the patient’s behavior?
Is the patient diabetic?
What measures have been tried to reason or calm the patient?
Are staff or patients at risk of injury, or actually injured?
What additional personnel are there to help now?

Possible causes of confusion or a decreased level of consciousness

Infection
Stroke
Tumor
Head Trauma
Seizures
Cerebral vasculitis
Wernicke encephalopathy
Vitamin B12 deficiency
Hypertensive encephalopathy
Primary dementias
Parkinson disease
Alcohol withdrawal
Narcotic and sedative drug excess or withdrawal. The elderly can experience confusion even with standard doses of these drugs.
Psychotropic medications
Miscellaneous (steroids, antihistamines, anticholinergics, NSAIDs)
Other poisoning (carbon monoxide, heavy metals, toxic alcohols, chronic silicylism)
Respiratory failure
Congestive heart failure
Renal failure
Liver failure
Hyperglycemia, hypoglycemia
Hypernatraemia, hyponatraemia
Hypercalcemia
Hyperthyroidism or hypothyroidism
Mania, depression, schizophrenia – altered behavior
Personality disorders or traits – aggressive behavior
Pain, cold, urinary retention, bowel impaction, sudden decrease in vision or hearing, unfamiliar surroundings, bereavement/separation

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