The patient is experiencing symptoms of delirium. She has an acute onset of paranoia, disorientation, and confusion. Delirium is an acute state of confusion with compromised awareness (Mayo Clinic, 2019). The old lady is affected by the hyperactive type of delirium. This is confirmed by her agitation, paranoia, and restlessness. The precipitating factors for the development of this condition include severe pneumonia, a history of hypothyroidism, and hearing impairment (Mayo Clinic, 2019).
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As delirium is a medical emergency, the initial step in management includes the identification of the cause of the state of confusion. For the patient, the tests will be used to identify the possible precipitating factors in this case. In a geriatric patient, the diagnosis is made through the Confusion Assessment Method (Rosen et al., 2015). It considers four factors: acute onset of the condition, altered level of consciousness, disorganized thought processes, and inattention. For one to be diagnosed, he/she must show the first and last factors as well as either the second or third factors (Rosen et al., 2015).
Interventions that can be used on the patient include reorientation of the patient through effective communication, restoration of her hearing aids, and the use of pharmacotherapy (Rosen et al., 2015). Reorientation involves the medical personnel providing orienting information with every chance of interaction. This enables the patients to regain awareness of their environment. Impairment of the senses aggravates delirium. It worsens the disorientation as the patient’s perception of the environment is reduced. Restoring her hearing aids will revert her hearing to normal, quickening her recovery from delirium. Pharmacotherapy is necessary when environmental strategies fail. Antipsychotic medications such as haloperidol and olanzapine are used to calm the patient.
- Mayo Clinic. (2019). Delirium – Symptoms, and causes. Web.
- Rosen, T., Connors, S., Clark, S., Halpern, A., Stern, M., & DeWald, J.,… Flomenbaum, N. (2015). Assessment and management of delirium in older adults in the emergency department. Advanced Emergency Nursing Journal, 37(3), 183-196. doi: 10.1097/tme.0000000000000066