Case Study on Ella Robertson: 87yo Acute Confusion - Causes & Treatment

Introduction

Ella Robertson's case is chiefly based upon the increased confusion. The 87-year old woman lies down prone in her house most of the time. The patient most likely has developed an acute confusion, which might be a sign of sleeping disorder, especially among the older adults. However, there are several causes of confusion, especially among older adults. Some of the major causes include the presence of an infection in the urinary tract, an injury in the head, stroke, or a mini-stroke. Some forms of prescription medicines can also induce confusion, especially among older adults (Voigt-Radloff et al., 2015). In addition to that, when a patient takes some illegal drugs, they may become confused. Furthermore, confusion can also be as a result of a severe asthma attack that leaves the patient maimed and highly confused (Leonard et al., 2016).

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Just as Ella Robertson's case, it would be good to determine if the patient is merely confused or not. The most effective means of determining this is through determining if the patient cannot speak clearly and quickly, unable to capture the memory of things, feeling of disorientation, or even hallucinations. To elicit a response from Ella, I would take the following steps. First, I would try to asking her some of the most obvious questions, such as her name, the date today, or her age. Suppose the patient cannot manage to answer me, then I would know that she needs urgent medical attention. Since Ella responds eyes to voice (E3), inappropriate words (V3) and obeys commands (M6), her GCS score is 12. The GCS score of 12 means that the patient most likely has a moderate injury. Ideally, I need to reposition Ella on her back, but before doing so, the following considerations should be put in place. Ensure that there are no obstacles in sight that might cause further injuries to her, ensure that she has sufficient space to roll, and thirdly, obtain her consent to do so. This will enhance easier and efficient relocation to the desired position (Nowrangi et al., 2015). Apart from that, I would ensure that she is comfortable to avoid causing extra pain to her. While doing all these things, I would allow the patient to do most of these movements alone and only assist her whenever necessary. It is highly advisable to use a semi-rigid cervical collar on Ella. The cervical collar would prevent some of the potentially risky movements from affecting the cervical spine (Reynish et al., 2017). Therefore, it protects both the head and the cervical spine from potential injuries during movements (Hermann et al., 20150). I would ask Dane the following questions, being one of the staff members at the nursing home. This would enable me to determine potential causes of Ella's condition. First, I would inquire how long Ella has been showing such symptoms. I would inquire to know what kinds of medicines or prescription drugs she has taken recently (Nadkarni et al., 2017). Apart from that, I would also inquire about Ella's recent diagnoses to determine her previous treatment conditions at the nursing home. In addition to that, I would inquire about her food intake and the kind of medication she currently undertakes. Ella's medications can be attributed to dementia or confusion related to Alzheimer's disease (Sposato et al., 2015). Given the kind of medications to which Ella is currently subjected, her age, and conditions such as higher body temperatures than normal, high respiratory rate and rhythm, and decreased sounds in her right lung, I can say that the underlying cause for Ella's presentation today is the effect of the prescription medicines. This can lead to an increase in confusion because Ella, being aged, has a weak body which might not withstand the action of drugs administered (Carvalho et al., 2018).

Patient's Management Plan for Ella Robertson

The following would be the most appropriate patient management plan for Ella Robertson.

Pre-Hospital Care DRABCD

The following are the pre-hospital care DRABCD for managing Ella's condition.

• Eliminate danger by ensuring that the area where she stays is safe both for the patient, caregiver, and even others. This will minimize the potential of her being injured by obstacles in her surrounding environment.
• Boost her memory by helping her remember some of the basic information such as the date today, and even knowing the location where she is currently.
• Make her comfortable wherever she is and monitor her response.
• Monitor her breathing rate to ensure it is within the acceptable range.
• Make use of defibrillator whenever necessary.
• When her condition fluctuates, apply corrective measures and call an ambulance.

Paramedic Intervention

The following paramedic interventions will highly assist in managing the patient efficiently.

• Apply brain training techniques to help her deal with a poor memory as well as improve her cognitive functioning. To assist in this, the use of mnemonics and other computerized recall devices can be used.
• Ensure the patient eats a balanced diet, including plenty of vitamins and water to enhance balanced nutrient needs for the body.

Hospital Care

Hospital care involves the appropriate application of preventive medications that assist in controlling confusion and other symptomatic experiences. Some of the approved medical interventions include administration of cholinesterase inhibitors such as tacrine, galantamine, donepezil, and rivastigmine. Ensure proper administration of such drugs to effectively achieve proper control (Lichtner et al., 2015).

References

Carvalho, D. Z., Knopman, D. S., Boeve, B. F., Lowe, V. J., Roberts, R. O., Mielke, M. M., ... & Vemuri, P. (2018). Association of excessive daytime sleepiness with longitudinal v-amyloid accumulation in elderly persons without dementia. JAMA neurology, 75(6), 672-680.

Hermann, D. M., Muck, S., & Nehen, H. G. (2015). Supporting dementia patients in hospital environments: healthrelated risks, needs, and dedicated structures for patient care. European journal of neurology, 22(2), 239-e18.

Leonard, M., McInerney, S., McFarland, J., Condon, C., Awan, F., O'Connor, M., ... & Cullen, W. (2016). Comparison of cognitive and neuropsychiatric profiles in hospitalized elderly medical patients with delirium, dementia, and comorbid delirium-dementia. BMJ Open, 6(3), e009212.

Lichtner, V., Dowding, D., & Closs, S. J. (2015). The relative meaning of absolute numbers: the case of pain intensity scores as decision support systems for pain management of patients with dementia. BMC medical informatics and decision making, 15(1), 111.

Lichtner, V., Dowding, D., Allcock, N., Keady, J., Sampson, E. L., Briggs, M., ... & Closs, S. J. (2016). The assessment and management of pain in patients with dementia in hospital settings: a multi-case exploratory study from a decision making perspective. BMC health services research, 16(1), 427.

Nadkarni, N. K., Perera, S., Snitz, B. E., Mathis, C. A., Price, J., Williamson, J. D., ... & Lopez, O. L. (2017). Association of brain amyloid-v with slow gait in elderly individuals without dementia: influence of cognition and apolipoprotein E e4 genotype. JAMA neurology, 74(1), 82-90.

Nowrangi, M. A., Lyketsos, C. G., & Rosenberg, P. B. (2015). Principles and management of neuropsychiatric symptoms in Alzheimer's dementia. Alzheimer's research & therapy, 7(1), 12.

Reynish, E. L., Hapca, S. M., De Souza, N., Cvoro, V., Donnan, P. T., & Guthrie, B. (2017). Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: a prospective cohort study of 10,014 admissions. BMC medicine, 15(1), 140.

Sposato, L. A., Kapral, M. K., Fang, J., Gill, S. S., Hackam, D. G., Cipriano, L. E., & Hachinski, V. (2015). Declining incidence of stroke and dementia: coincidence or prevention opportunity?. JAMA neurology, 72(12), 1529-1531.

Voigt-Radloff, S., Ruf, G., Vogel, A., Van Nes, F., & Hull, M. (2015). Occupational therapy for the elderly. Zeitschrift fur Gerontologie und Geriatrie, 48(1), 52-72.