OSSSC Nursing Officer-2023
Medical & Surgical Nursing
Hard
60 years old man had undergone cardiac bypass surgery 2 days back. Now he started forgetting things and was not able to recall names and phone numbers of his relatives. What is the probable diagnosis?
Appeared in: OSSSC Nursing Officer-2023
Explanation
- The patient's presentation of acute memory impairment just two days after cardiac bypass surgery is a classic scenario for Postoperative Cognitive Dysfunction (POCD).
- POCD is a recognized complication of major surgery, especially cardiac procedures, and is more common in older adults.
- The symptoms described (forgetting things, inability to recall names/numbers) directly align with the cognitive deficits seen in POCD.
- Unlike delirium, POCD primarily involves cognitive decline without the hallmark fluctuating consciousness and inattention.
Why Other Options Were Wrong
- Option A: Depression can cause cognitive symptoms (pseudodementia), but its onset is typically more gradual and not acutely triggered two days after surgery. The primary symptoms would also include persistent low mood and anhedonia, which are not mentioned.
- Option B: Post-traumatic psychosis is not a standard diagnosis in this context. The patient's primary symptoms are cognitive (memory loss), not psychotic (hallucinations or delusions).
- Option D: Alzheimer's disease is a chronic, progressive neurodegenerative disorder with an insidious onset over months to years. It does not appear acutely after a surgical procedure.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Postoperative Cognitive Dysfunction (POCD) following cardiac surgery to guide bedside assessment, documentation, and the next nursing action.
- Nurses play a vital role in the early detection of POCD by performing regular cognitive assessments on postoperative patients, especially those at high risk.
- Early identification allows for prompt intervention, including ruling out other reversible causes of confusion (like infection or electrolyte imbalance) and implementing supportive care strategies.
- Patient and family education is crucial. Reassuring them that POCD is a known complication and often improves over time can reduce anxiety.
How to Approach the Question
- First, analyze the clinical vignette for key information: patient demographics (60-year-old man), clinical context (2 days post-cardiac bypass surgery), and presenting symptoms (acute memory loss).
- Evaluate the timeline. The acute onset of symptoms after a specific event (surgery) is a major clue that points towards a postoperative complication.
- Consider each option in the context of the timeline and symptoms. Ask yourself, 'Is the onset and presentation of this condition consistent with the patient's story?'
- Eliminate options with inconsistent timelines. Alzheimer's is chronic and progressive, not acute. Depression's onset is typically not this abrupt.
- Differentiate between the most likely postoperative complications. The primary symptoms are cognitive deficits (memory), not fluctuating consciousness (delirium) or psychosis.
- Select the option that best fits the entire clinical picture. 'Cognitive dysfunction' is the most fitting diagnosis, specifically representing Postoperative Cognitive Dysfunction (POCD).
Concept Tested & Keywords
- Concept Tested: Postoperative Cognitive Dysfunction (POCD) following cardiac surgery.
- Stem keywords: cardiac bypass surgery, 60 years old, forgetting things, recall names
- Lead-in keywords: probable diagnosis
- Clinical cues: The patient's age (60 years) and the type of surgery (cardiac bypass) are significant risk factors for POCD.
- Clinical cues: The acute onset of symptoms (2 days post-op) points towards a postoperative complication rather than a chronic condition.
Question ID
QCOk4Dp288i3mlOnTFAH_Z
Reference Book
E6 Medicine Harrison 22e Part 2 p. 252-254
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 7943-7945
E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 626-628
Practise the full OSSSC Nursing Officer-2023
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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