next step in PREVENTING delirium in hospitalized patient...expln plz - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 05-29-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Psyche next step in PREVENTING delirium in hospitalized patient...expln plz

An 80-year old woman living in a nursing home with history of dementia is admitted to the
hospital with pneumonia. In the emergency department, a peripheral intravenous line was
inserted, appropriate antibiotics were initiated, she was given oxygen by nasal cannula, and a
urinary catheter was placed.
On physical examination, temperature is 38.3C (101.0F), blood pressure is 140/88 mm Hg,
pulse rate is 100/min, and respiration rate is 16/min. Pulmonary auscultation reveals left
lower lobe crackles. Cardiac examination is normal. Moderate cognitive impairment is noted
but no inattention or focal neurologic deficits.
She is provided access to her glasses and hearing aid, and a large clock and night light are in
place in her room.
Which of the following additional steps should be taken to prevent delirium in this
patient?
(A) Administer benzodiazepine, as needed
(B) Administer diphenhydramine for sleep
(C) Administer haloperidol twice daily
(D) Check vital signs every 4 hours through the night
(E) Remove her urinary catheter
Reply With Quote Quick reply to this message
The above post was thanked by:
dryogi (05-29-2012), salam kasim (10-03-2013)



  #2  
Old 05-29-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

remove urinary cath
Reply With Quote Quick reply to this message
  #3  
Old 05-29-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

(E) Remove her urinary catheter
Reply With Quote Quick reply to this message
 
  #4  
Old 05-29-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

why is it urinary cathetar removal?/
Reply With Quote Quick reply to this message
  #5  
Old 05-29-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default

QBank says it's a risk factor. Why? Can't find clear expln. I know USMLE is really after urinary catheter and there willbe some q like this.
Reply With Quote Quick reply to this message
  #6  
Old 05-29-2012
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 270
Threads: 34
Thanked 224 Times in 119 Posts
Reputation: 234
Default

UTI leading to sepsis leading to delerium.

Personally I don't like the way this question was written at all.
Reply With Quote Quick reply to this message
  #7  
Old 05-29-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 460 Times in 289 Posts
Reputation: 470
Default

Quote:
Originally Posted by tyagee View Post
An 80-year old woman living in a nursing home with history of dementia is admitted to the
hospital with pneumonia. In the emergency department, a peripheral intravenous line was
inserted, appropriate antibiotics were initiated, she was given oxygen by nasal cannula, and a
urinary catheter was placed.
On physical examination, temperature is 38.3C (101.0F), blood pressure is 140/88 mm Hg,
pulse rate is 100/min, and respiration rate is 16/min. Pulmonary auscultation reveals left
lower lobe crackles. Cardiac examination is normal. Moderate cognitive impairment is noted
but no inattention or focal neurologic deficits.
She is provided access to her glasses and hearing aid, and a large clock and night light are in
place in her room.
Which of the following additional steps should be taken to prevent delirium in this
patient?
(A) Administer benzodiazepine, as needed
(B) Administer diphenhydramine for sleep
(C) Administer haloperidol twice daily
(D) Check vital signs every 4 hours through the night
(E) Remove her urinary catheter

answer is E.......infection risk...
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
  #8  
Old 05-30-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 246
Threads: 18
Thanked 142 Times in 86 Posts
Reputation: 152
Default

Sun-downing is a poorly understood phenomenon that tends to occur in elderly demented patients in hospitals or long-term care facilities.
Patients become increasingly agitated during the evening hours, but return to baseline during the day. Symptoms frequently occur during shift changes.
Avoid restraints, sedatives, and neuroleptics to control agitation. Instead, first-line measures are conservative:
• Minimize confusion: structured activities, frequent calming and re-orientation.
• Environment: increased sunlight, increased clocks, and decreased ambient noise in the room.
Minimize use of catheters and IV lines.
Rule out delirium in patients who do not follow the classic pattern of sun-downing.

ques "She is provided access to her glasses and hearing aid, and a large clock and night light are in
place in her room" and its better to remove the indwelling cath to minimize the risk of infection like what said above
Reply With Quote Quick reply to this message
The above post was thanked by:
K06100 (05-30-2012), mbbs2010 (05-30-2012), Novobiocin (05-30-2012)
  #9  
Old 05-30-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

Quote:
Originally Posted by K06100 View Post
answer is E.......infection risk...
infection risk true for DEMENTIA.... (ppt by UTI)
question asks about DELIRIUM..

is that also true for delirium?? ppt by UTI?

Reply With Quote Quick reply to this message
  #10  
Old 05-30-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

Quote:
Originally Posted by mbbs2010 View Post
infection risk true for DEMENTIA.... (ppt by UTI)
question asks about DELIRIUM..

is that also true for delirium?? ppt by UTI?

I think you got it upside down. Never heard of Dementia being precipitated by UTI but Delirium is known to be precipitated by UTI or for that matter any infection/sepsis.
Reply With Quote Quick reply to this message
  #11  
Old 05-30-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 460 Times in 289 Posts
Reputation: 470
Default

Quote:
Originally Posted by mbbs2010 View Post
infection risk true for DEMENTIA.... (ppt by UTI)
question asks about DELIRIUM..

is that also true for delirium?? ppt by UTI?

yeah same as novobiocin said.......

refer to pg 443 FA 2011 step 1.......
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
  #12  
Old 05-30-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 646
Threads: 52
Thanked 762 Times in 256 Posts
Reputation: 773
Default

sorry my bad
Reply With Quote Quick reply to this message



Reply

Tags
Psychiatry-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
next step after pleural tap...expln plz tyagee USMLE Step 2 CK Forum 7 05-29-2012 06:50 AM
COPD exacerbation...what is the next step ? plz give expln tyagee USMLE Step 2 CK Forum 12 05-28-2012 11:45 PM
left leg pain and swelling...what is her next step? expln plz tyagee USMLE Step 2 CK Forum 7 05-28-2012 06:04 PM
lupus patient...next step in mx...EXPLN PLZ tyagee USMLE Step 2 CK Forum 4 05-26-2012 07:01 PM
Transient Ischemic Attack, preventing recurrence in a hypertensive patient? docoftheworld USMLE Step 2 CK Forum 4 05-29-2011 07:51 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)