Which patient has the highest risk of developing delirium?

Appeared in: UP NHM CHO 7 Sept 2022 (Shift-2)

Explanation

Epidemiological studies show that patients with AIDS have a 30% to 40% incidence of delirium during hospitalization.
This rate is the highest among the given options, surpassing post-cardiotomy (30%), severely burned (21%), and general surgery (10-15%) patients.
The high risk in AIDS patients is multifactorial, stemming from direct HIV effects on the brain, opportunistic CNS infections, and the systemic burden of the disease.

Option A: While post-cardiotomy patients have a very high risk of delirium (30%), primarily due to cardiopulmonary bypass, the incidence range for AIDS patients (30-40%) is higher.
Option C: General surgery patients have the lowest risk of delirium (10-15%) among the choices, as these procedures are typically less physiologically stressful than cardiac surgery, major burns, or advanced systemic diseases.
Option D: Severely burned patients have a significant risk of delirium (21%) due to factors like sepsis, pain, and metabolic stress, but this incidence is lower than that for both post-cardiotomy and AIDS patients.

Clinical Relevance

Nursing practice connection: Use the key finding related to Risk factors and epidemiology of delirium to guide bedside assessment, documentation, and the next nursing action.
Nurses must be vigilant in assessing for delirium in all high-risk populations, not just postoperative patients. The Confusion Assessment Method (CAM) is a standard tool for this purpose.
Early identification and management of the underlying causes of delirium (e.g., infection, hypoxia, electrolyte imbalance) can improve patient outcomes and reduce mortality.
What if? If the question asked for the highest risk among surgical patients only, the 'Post-cardiotomy patient' would be the correct answer, as their 30% risk is significantly higher than the 10-15% risk for general surgery patients.

How to Approach the Question

First, identify the core of the question: it asks to compare the 'highest risk' for a specific condition (delirium) among different patient groups.
Recognize that this is a factual recall question based on epidemiology. You need to know the relative incidence rates.
Systematically evaluate each option. Think about the major physiological stressors associated with each condition: cardiopulmonary bypass for cardiotomy, systemic inflammation for burns, CNS infections for AIDS, and general anesthesia for surgery.
Compare the severity of these stressors. While all are significant, advanced systemic diseases like AIDS often present a complex, multifactorial risk that can be higher than acute surgical stress.
Select the option with the highest documented incidence rate of delirium.

Concept Tested & Keywords

Q977kYT98SAA-e3mn1XY4I

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 749-751

Practise the full UP NHM CHO 7 Sept 2022 (Shift-2)

Attempt every question from this paper in a timed mock, then review the full solution for each one.