Mental status

ACYCLOVIR When given IV, acyclovir can cause crystal-luria (presence of crystals in the urine) and mental confusion. The nurse helps the patient maintain adequate hydration to prevent crystalluria by encouraging the patient to drink 2000 to 3000 mL of fluid each day (if the disease condition permits). In addition, the nurse should give careful attention to assessing the mental status of the patient. 

A patient receiving an antianxiety drug may be treated in the hospital or in an outpatient setting. Before starting therapy for the hospitalized patient, the nurse obtains a complete medical history, including mental status and anxiety level. In the case of mild anxiety, patients may (but sometimes may not) give a reliable history of their illness. 

Therapeutic results obtained from the administration of a peripheral vasodilating drug may not occur immediately. In some instances, results are minimal. The nurse assesses involved extremities daily for changes in color and temperature and records die patient s comments regarding relief from pain or discomfort. The nurse should monitor die blood pressure and pulse one to two times per day because tiiese dru may cause a decrease in blood pressure The anticipated result of tiierapy for cerebral vascular disease is an improvement in die patient s mental status. When die drug is taken for intermittent claudication, the nurse assesses the patient for increased walking distance without pain. 

D Disturbed Thought Processes related to adverse reactions (depression, psychosis, other changes in mental status)... 

The symptoms of hypothyroidism and hyperthyroidism are given in Table 51-1. A severe form of hyperthyroidism, called thyrotoxicosis or tiiyroid storm, is characterized by high fever, extreme tachycardia, and altered mental status. Thyroid hormones are used to treat hypothyroidism and antithyroid... 

If the male or female patient is being treated for a malignancy, the nurse enters in the patient s record a general evaluation of the patient s physical and mental status. The primary health care provider may also order laboratory tests, such as serum electrolytes and liver function tests. 

Accurate diagnosis of patients with inhalant use disorders may require a variety of methods, including psychiatric history and mental status examination, physical examination and laboratory testing, neuropsychological testing, and neurophysiological testing. 

Though a recent facial impact injury may have caused additional diffuse cerebral damage, the total performance seemed more indicative of chronic PCP and alcohol abuse. Specifically, the NP profile was characteristic of deficits in frontal lobe-mediated adaptive abilities. While the severity of these deficits seemed slight as compared with the mental status of others of similar... 

Although it has not been proven that acidification of the urine to increase PCP excretion alters the duration of the symptoms of psychosis, it appears appropriate to facilitate excretion of PCP from the adipose tissue in which it is stored in any PCP user (Done 1980). Maintaining the urine pH at an acid level for several weeks, even though the mental status is normal, is advised. It is important to test the pH of the urine to ensure compliance with the acidification. We have found that PCP becomes detectable in acidified urine for a time, even after being undetectable in alkaline urine, in previously intoxicated individuals. We have not found a change in mental status to result from such acidification treatment and resultant enhanced PCP excretion. 

Assess for the presence of the following clinical features ° Agitation, altered mental status, delirium, diaphoresis,... 

Utilize 3% saline for severe signs and symptoms (i.e., altered mental status, coma, and seizures)... 

Monitor for adequate perfusion of vital organs through assessment of mental status, creatinine clearance, liver function tests, and a stable HR between 50 and 100 beats per minute. Additionally, adequate skin and muscle blood perfusion and normal pH is desirable. 

Fibrinolytics Bleeding, especially intracranial hemorrhage Clinical signs of bleeding3 baseline CBC and platelet count mental status every 2 hours for signs of intracranial hemorrhage daily CBC... 

Organ dysfunction reversal evident by increased urine output to greater than 0.5 mL/kg per hour (1.0 mL/kg per hour in pediatrics), return of mental status to baseline, and normalization of skin color and temperature over the first 24 hours ... 

Mental status changes may indicate impending respiratory failure. 

Patients with SBP may present with fever, abdominal pain, and changes in mental status. 

Evaluate for signs and symptoms of hepatic encephalopathy. Mental status changes may be subtle questioning family members or caregivers about confusion or personality changes may reveal mild hepatic encephalopathy even if the patient is unaware of the deficits. 

TBW depletion (often referred to as dehydration ) is typically a more gradual, chronic problem compared to ECF depletion. Because TBW depletion represents a loss of hypotonic fluid (proportionally more water is lost than sodium) from all body compartments, a primary disturbance of osmolality is usually seen. The signs and symptoms of TBW depletion include CNS disturbances (mental status changes, seizures, and coma), excessive thirst, dry mucous membranes, decreased skin turgor, elevated serum sodium, increased plasma osmolality, concentrated urine, and acute weight loss. Common causes of TBW depletion include insufficient oral intake, excessive insensible losses, diabetes insipidus, excessive osmotic diuresis, and impaired renal concentrating mechanisms. Long-term care residents are frequently admitted to the acute care hospital with TBW depletion secondary to lack of adequate oral intake, often with concurrent excessive insensible losses. 

The clinical scenario and the severity of the volume abnormality dictate monitoring parameters during fluid replacement therapy. These may include a subjective sense of thirst, mental status, skin turgor, orthostatic vital signs, pulse rate, weight changes, blood chemistries, fluid input and output, central venous pressure, pulmonary capillary wedge pressure, and cardiac output. Fluid replacement requires particular caution in patient populations at risk of fluid overload, such as those with renal failure, cardiac failure, hepatic failure, or the elderly. Other complications of IV fluid therapy include infiltration, infection, phlebitis, thrombophlebitis, and extravasation. 

TO, a 77-year-old male nursing home resident is admitted to the hospital with a 3-day history of altered mental status. The patient was unable to give a history or review of systems. On physical examination the vital signs revealed a blood pressure of 100/60 mm Hg, pulse 110 beats per minute, respirations 14/minutes, and a temperature of 101°F (38.3°C). Rales and dullness to percussion were noted at the posterior right base. The cardiac exam was significant for tachycardia. No edema was present. Laboratory studies included sodium 160 mEq/L (160 mmol/L), potassium 4.6 mEq/L (4.6 mmol/L), chloride 120 mEq/L (120 mmol/L), bicarbonate 30 mEq/L (30 mmol/L), glucose 104 mg/dL (5.77 mmol/L), BUN 34 mg/dL (12.14 mmol/L), and creatinine 2.2 mg/dL (194.5 pmol/L). The CBC was within normal limits. Chest x-ray indicated a right lower lobe pneumonia. 

Other diagnostic tests to consider for differential diagnosis erythrocyte sedimentation rate, urinalysis, toxicology, chest x-ray, heavy metal screen, HIV testing, cerebrospinal fluid (CSF) examination, electroencephalography, and neuropsychological tests such as the Folstein Mini Mental Status Exam. 

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