Post Early Morning Question & Answer Guide (With Explanation)

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What This Question Is About

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How to Approach This Question

Break the problem into smaller parts and analyze each logically.

Key Explanation

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Original Question

Post op day 1 Early in the morning the overnight nurse attempts a voiding trial with RS, but she unfortunately fails and the foley catheter is replaced. Bloodwork was also taken resulting in a hemoglobin of 10.5 g/dL and a hematocrit of 33%. RS is encouraged to get out of bed with assistance. She refuses each attempt made by the staff throughout the day. She reports too much pain and feeling too tired to try. She transitioned to oral oxycodone 5mg 1 to 2 tabs every 4-6 hours with IV morphine 2mg as needed for breakthrough pain. Throughout the day she has required 2 tabs of oxycodone every 4 hours and has had 4 breakthrough doses of morphine. Per the orthopedic team she is started on Lovenox every 12 hours for prevention of DVTs. In the evening RS becomes disoriented and falls while trying to get out of bed unassisted. She states she was getting up to use the bathroom and she had forgotten that she needed to call for help first. After falling she reported tenderness over her left knee and elbow, both of which have noticeable bruising. She denies increased pain of the right hip. The surgical dressing remains intact and without excessive drainage. X-rays are taken of the left elbow, left knee, and right hip. There is no change to the surgical hip and the left knee and elbow show no fractures. Post op day 2 The staff place RS on bed alarm after the fall the prior evening. RS has become more confused and attempts to get out of bed multiple times throughout the morning. When the medical team rounds on her, she is found to be lethargic despite her multiple attempts to get out of bed. They also note that she is unable to stay focused during their conversation and would abruptly ask if her dog was coming to visit her today. Morning bloodwork results show a hemoglobin of 9.7 g/dL and a hematocrit of 31%. She continues to have a foley catheter in place and there has been no changes made to her current medication regimen. She continues to complain of pain and require every dose of oxycodone and breakthrough IV morphine. What signs and symptoms would lead you to believe the patient is suffering from delirium? What assessment method is most effective in making this diagnosis? How would you most effectively treat her delirium? (Include pharmacologic and nonpharmacologic interventions)

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