An elderly man, aged 79, was admitted to the Emergency Department with an acute urinary tract infection, on examination, patient has a high fever, agitated, clouding of consciousness, and sleep-wake cycle disturbance. What is the diagnosis?

1. A

   Picks disease

2. B

   Amnesia

3. C

   Delirium

4. D

   Dementia

Appeared in: UP NHM CHO 7 Sept 2022(shift-1st)

Explanation

• Delirium is an acute confusional state characterized by a rapid onset (hours to days) and a fluctuating course.
• It is defined by disturbances in attention, awareness, and cognition, which are not better explained by a pre-existing neurocognitive disorder.
• Delirium is a direct physiological consequence of another medical condition, such as an infection (like the patient's UTI), metabolic disturbance, or drug toxicity.
• The patient's presentation of agitation, clouded consciousness, and sleep-wake cycle disturbance are all hallmark symptoms of delirium.

Why Other Options Were Wrong

• Option A: Pick's disease is a type of frontotemporal dementia. It has a slow, insidious onset and primarily causes progressive changes in personality, behavior, and language, not an acute confusional state.
• Option B: Amnesia is a specific deficit in memory formation or recall. It does not account for the patient's global disturbance in consciousness, attention, and perception.
• Option D: Dementia is a chronic, progressive neurocognitive disorder with a slow onset over months to years. While patients with dementia are at high risk for delirium, the acute presentation described is delirium itself, not dementia.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Differential diagnosis of acute confusion in an elderly patient in acute care settings.
• Nurses are often the first healthcare professionals to detect delirium. Prompt recognition, assessment (using tools like the CAM - Confusion Assessment Method), and reporting are critical as delirium is a medical emergency.
• Key nursing interventions for delirium focus on treating the underlying cause (e.g., ensuring antibiotics are administered for the UTI), managing the environment to reduce stimulation and provide safety, frequently reorienting the patient, and preventing complications like falls or pressure ulcers.
• What if the patient had a known history of dementia? The diagnosis would be 'delirium superimposed on dementia.' This is a very common scenario and is associated with accelerated cognitive decline, increased hospital stays, and higher mortality. Recognizing the new, acute change (the delirium) on top of the chronic condition (the dementia) is a crucial nursing skill.

How to Approach the Question

• First, analyze the patient's demographics and the setting (79-year-old man in the Emergency Department). This points towards a geriatric patient with an acute problem.
• Next, identify the key features of the clinical presentation. The most important clues are 'acute' urinary tract infection, 'high fever,' 'agitated,' 'clouding of consciousness,' and 'sleep-wake cycle disturbance.'
• Focus on the timeline. The acute onset (implied by the ED admission and acute infection) is the single most important factor to differentiate the condition.
• Evaluate the options based on their typical onset and course. Pick's disease and Dementia are chronic and progressive. Amnesia is a specific memory deficit.
• Conclude that Delirium is the only diagnosis that fits the acute, fluctuating, and physiologically-triggered disturbance of consciousness and cognition described in the scenario.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of acute confusion in an elderly patient
• Stem keywords: elderly man, acute urinary tract infection, high fever, agitated, clouding of consciousness, sleep-wake cycle disturbance
• Lead-in keywords: What is the diagnosis?
• Clinical cues: The patient's age (79) and the presence of an acute infection (UTI) are significant risk factors for developing delirium.

Question ID

Q25uhJxWZ1g-T9nsmR4WzH

Copy ID

Reference Book

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 13817-13819

E6 Nursing Fundamentals Potter Perry 12e Part 1 p. 212-214