usmle6789
Forum Senior
Topics: 33
Posts: 49
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75 yr old man with a 3 yr history of progressive cognitive impairment due to, dementia, Alzheimer’s type, has had nocturnal disorientation for 2 weeks. He lives at home with his wife. He is otherwise healthy and takes no meds. Physical examination normal. He is disoriented to time, place. Has poor short term memory. Unable to do simple arithmetic and has a poor understanding of general information. Most appropriate initial step in the management?
1] Increase in home night time lighting
2] Prescription for chloral hydrate
3] Prescription for diazepam
3] Prescription for haloperidol
4] Use of night time mechanical restraints
My answer is 1 here.
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| ELM
Forum Guru
Topics: 28
Posts: 936
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Probably 1 first....but if you need to do.. do 5 afterwards.
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ELM
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| lucky
Forum Guru
Topics: 23
Posts: 505
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i'd go for 1 too.
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| mdwannabe
Forum Guru
Topics: 37
Posts: 1,133
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1 for now. Use of 5 is illegal, unless patient prents danger to self or others. Being disoriented is not a threat. Next step after 1 is night time sitter or continuos supervision in the NH, to protect the patient.
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| Veer-Zaara
Forum Elite
Topics: 16
Posts: 268
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I think its 1 too.
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| alenka
Forum Elite
Topics: 22
Posts: 330
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they advise to increase the lights in case of delirium-cause patients get very scared.
but in case of Alzheimers i'd go for restraints.
what do you,guys,think?
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