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Communication: a person-centred approach
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Acute confusion is usually defined as having a rapid onset and is characterised by changeable levels of consciousness often with an impaired ability to think and concentrate. NHS UK suggests that individuals who have sudden confusion (delirium) may have difficulty thinking or speaking clearly. They may feel disorientated and struggle to attend to their surroundings and some people also have hallucinations – seeing or hearing things that are not there (www.nhs.uk/conditions/confusion). Sudden confusion can be caused by a number of conditions for example low blood sugar, some medications, infection, alcohol or head injury. It is therefore crucial that thorough assessment is carried out and ensuring appropriate communication skills are applied sensitively.
Cerebral
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
Memory loss is a distressing and perilous symptom for both sufferers and caring relatives. It may be due to organic or non-organic causes. Memory is classified into immediate, short-term (or recent) and long-term (or remote) memory. The type of loss varies according to the cause. Memory loss is also a feature of any cause of acute confusion; this problem is covered elsewhere (see Acute confusion, p. 80).
Cerebral
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
Memory loss is a distressing and perilous symptom for both sufferers and caring relatives. It may be due to organic or non-organic causes. Memory is classified into immediate, short-term (or recent) and long-term (or remote) memory. The type of loss varies according to the cause. Memory loss is also a feature of any cause of acute confusion; this problem is covered elsewhere (see Acute confusion, p. 68).
A case of Sβ+ sickle cell disease diagnosed in adulthood following acute stroke: it’s 2021, are we there yet?
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Ava Runge, Danielle Brazel, Zahra Pakbaz
A 29-year-old African American female was brought to a local emergency department (ED) by her mother after being found unresponsive at home in decorticate posture, profusely diaphoretic with urinary incontinence. While in the ED, she developed hypotension, hypothermia, and respiratory failure with an oxygen saturation of 80% and agonal respirations. She was subsequently intubated and admitted to the ICU for management of possible seizure and sepsis. The patient’s mother reported that she had experienced flu-like symptoms for two weeks prior to presentation, for which she had been taking over-the-counter cold medications. Earlier on the day of admission, she had demonstrated acute confusion and later became unresponsive. During history taking, her mother also mentioned that the patient had ‘sickle cell trait and beta-thalassemia trait.’
Beyond Cognition: Psychological and Social Transformations in People Living with Dementia and Relevance for Decision-Making Capacity and Opportunity
Published in The American Journal of Bioethics, 2020
John Noel Viaña, Fran McInerney, Henry Brodaty
While Bertrand et al. (2017) reported that depression can have a positive effect on decision reasoning, suggesting that those experiencing depression can still make realistic judgements regarding treatment options, the opposite can occur. For example, Walsh (2020) mentions the case of Mr O’Connor, who guided by strong religious convictions makes an advance care directive that he would always want life-saving treatment. Subsequently he develops dementia, his wife dies, and he decides he does not want to live anymore. Walsh argues that his transformative cognitive experience suggests that “we take this (the overriding of his advance care directive) seriously”. Another view is that Mr. O’Connor has a potentially treatable clinical depression from which he may recover and change his view again. Similarly, delusions such as of persecution or nihilism can subvert rational decision-making, and most clinicians would instigate treatment before acquiescing to an irreversible advance care directive. Another example is delirium, an acute confusional state often in the context of an infection or medical event, which often resolves when the underlying cause is treated. People with dementia are very prone to develop delirium, and clinicians would generally pay less heed to decisions made during this acute confusion. These examples illustrate how critical it is to differentiate the effects of reversible state phenomena from those of a progressive and irreversible dementia.
Case fatality of acute coronary events is improving even among elderly patients; the FINAMI study 1995–2012
Published in Annals of Medicine, 2018
Heli Koukkunen, Aki S. Havulinna, Seppo Lehto, Matti Ketonen, Juha Mustonen, Juhani K. Airaksinen, Olavi Ukkola, Y. Antero Kesäniemi, Veikko Salomaa
In the Euroheart ACS survey in 2000–2001, the majority of patients presented with typical angina pain, but less frequently in elderly age-groups [27]. Heart failure complicated MI more frequently and a coronary angiogram was performed less frequently with increasing age. Among patients aged 85 years or older presenting with ST-elevation within 12 h, only a minority was treated with primary reperfusion. These results are well in line with our study. As shown in Figure 1(b), atypical symptoms were common among elderly patients with MI, especially women. These patients had atypical pain, acute failure of left ventricle (pulmonary oedema), shock or syncope not explained by other conditions than ACS. Furthermore, atypical pain was described as short of duration or intermittent (but each episode of pain lasting for <20 min) or placed atypically (such as upper arm, epigastrium, jaw, nape of the neck). In elderly patients, acute confusion with no other explanation than ACS was classified as atypical symptom.