1/23. Successful palliation of hypoactive delirium due to multi-organ failure by oral methylphenidate.delirium is frequently observed in terminally ill cancer patients, but complete remission is often difficult to achieve. Therefore, symptom palliation is of great importance to improve patients' quality of life. Although it has been suggested that psychostimulants would be beneficial to patients with hypoactive delirium, there have been very few empirical reports so far. We report on a terminally ill cancer patient with hypoactive delirium caused by multi-organ failure, in whom methylphenidate was effective in improving the ability to maintain communication. This case highlights the efficacy of methylphenidate for hypoactive delirium in terminally ill cancer patients.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/23. diagnosis and management of delirium near the end of life.delirium is a common and distressing symptom that constitutes a significant challenge for end-of-life care. However, reliable techniques are available for the diagnosis of delirium, and effective therapies exist as well. This consensus paper uses a case-based format that begins with an overview of the definition and presentation of delirium. Next, strategies for diagnosis are suggested, with attention to the unique challenges that clinicians face in pursuing a diagnostic work-up for patients near the end of life. The paper concludes with a review of therapeutic options.- - - - - - - - - - ranking = 6keywords = life (Clic here for more details about this article) |
3/23. Steroid-induced delirium in a patient with asthma: report of one case.Systemic steroids are highly effective for patients with moderate-to-severe asthma exacerbations. Steroid-induced psychosis is known to be one of the adverse effects of steroid therapy, although infrequent. However, there is no reliable method of predicting steroid psychosis. We experienced the case of a 40-year-old asthmatic man who had previously taken steroids without any psychological side effect, but became acutely delirious after receiving some doses of steroids, higher than the previous doses, under a condition of emotional stress. The mean dose of prednisolone administered was 82 mg/day (1.37 mg/kg/day) for 10 days but the patient had taken two courses of steroids (0.82 mg/kg/day and 0.5 mg/kg/day, respectively) for asthma exacerbations without any psychiatric episodes during the previous year. At this time, the patient was under a condition of emotional stress related to family reasons. The asthmatic exacerbation of this case may be precipitated from sudden emotional stress and the following treatment with a high dose of steroida should be used cautiously due to the possibility of psychotic side reactions.- - - - - - - - - - ranking = 13.836266748886keywords = family (Clic here for more details about this article) |
4/23. delirium in the elderly resulting from azithromycin therapy.BACKGROUND: azithromycin, a semi-synthetic azalide antibiotic, is a macrolide that thus far has not shared the neuropsychiatric side effects of other macrolides such as erythromycin and clarithromycin. methods: We now report significant delirium associated with conventional dosing of azithromycin in two geriatric patients who were being treated for lower respiratory tract infection. RESULTS: The onset of delirium was apparent within 72 hours of initiating azithromycin therapy and lasted 48 to 72 hours after discontinuing treatment with the drug. CONCLUSIONS: In contrast to the adverse central nervous system symptoms associated with clarithromycin, those induced by azithromycin seem to take longer to resolve, perhaps based upon the longer elimination half-life of the latter antimicrobial, particularly in geriatric women.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/23. Successful treatment of wernicke encephalopathy in terminally ill cancer patients: report of 3 cases and review of the literature.Although wernicke encephalopathy has been reported in the oncological literature, only one terminally ill cancer patient with wernicke encephalopathy has been reported. wernicke encephalopathy, a potentially reversible condition, may be unrecognized in terminally ill cancer patients. In this communication, we report three terminally ill cancer patients who developed wernicke encephalopathy. Early recognition and subsequent treatment resulted in successful palliation of delirium. Two of the three patients did not show the classical triad of Wernicke encephalopathy. Common clinical symptoms were delirium and poor nutritional status. Intravenous thiamine administration dramatically improved the symptoms of delirium in all three patients. In terminally ill cancer patients, clinicians must remain aware of the possibility of wernicke encephalopathy when patients with a poor nutritional status present with unexplained delirium. Early intervention may correct the symptoms and prevent irreversible brain damage and the quality of life for the patient may improve.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
6/23. pain management at the end of life in a patient with renal failure.literature indicates that an essential element of a 'good' death is the absence of pain. Achieving a pain-free death for the patient who discontinues dialysis is a goal shared by patient, family and care providers. pain management at end of life can be challenging, especially in the setting of renal failure. Aspects of assessment and pharmacological management of pain in the dying patient are explored through the use of a case study. Through investment in ongoing relationships with their patients, and striving to build knowledge and skills in pain management, nephrology nurses promote excellence in end-of-life patient care.- - - - - - - - - - ranking = 19.836266748886keywords = family, life (Clic here for more details about this article) |
7/23. Psychological implications of admission to critical care.Admission to critical care can have far-reaching psychological effects because of the distinct environment. critical care services are being re-shaped to address long-term sequelae, including post-traumatic stress disorder, anxiety and depression. The long-term consequences of critical illness not only cost the individual, but also have implications for society, such as diminished areas of health-related quality-of-life in sleep, reduced ability to return to work and enjoy recreational activities (Audit Commission, 1999; Hayes et al, 2000). The debate around the phenomenon of intensive care unit (ICU) syndrome is discussed with reference to current thinking. After critical care, patients may experience amnesia, continued hallucinations or flashbacks, anxiety, depression, and dreams and nightmares. nursing care for patients while in the critical care environment can have a positive effect on psychological well-being. Facilitating communication, explaining care and rationalizing interventions, ensuring patients are oriented as to time and place, reassuring patients about transfer, providing patients,where possible, with information about critical care before admission and considering anxiolytic use, are all practices that have a beneficial effect on patient care. Follow-up services can help patients come to terms with their experiences of critical illness and provide the opportunity for them to access further intervention if desired. Working towards providing optimal psychological care will have a positive effect on patients' psychological recovery and may also help physical recuperation after critical care.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
8/23. The last 48 hours of life.This paper arosefrom a personal nursing reflection in which I was given the privilege of working with and nursing a patient in her last 48 hours of life. Caring for a patient dying of cancer can, at times, be extremely difficult. Sarah was 39 years old when she died, survived by her husband and two children aged 6 and 4. During the weeks leading up to her death, Sarah held extensive discussions with family and the multi-disciplinary team. Her goal was to live the remainder of her lastfew hours as comfortably as possible and to die a 'peaceful death'. terminal care is an important phase of life, one in which individuals have the right to expect quality of care to ensure that their death occurs with dignity. This paper provides an insight into the remaining few hours of Sarah's life discussing psychological and psychosocial support as well as management of symptoms as they arose. Sarah practiced buddhism on a daily basis. Issues of spirituality, serenity and peacefulness in dying were very important to her to ensure a good rebirth. The last days of life are uniquefor each person. They are very personal and private. Dying people are usually less interested in the outside world and they want the closeness of only a few people--to comfort them. I felt extremely privileged to be a part of Sarah's dying expeience.- - - - - - - - - - ranking = 21.836266748886keywords = family, life (Clic here for more details about this article) |
9/23. Does delirium need immediate medical referral in a frail, homebound elder?BACKGROUND AND PURPOSE: This case report describes the clinical decision making process of a physical therapist whose examination of a home bound elderly woman led to a referral for hospitalization. We illustrate how the use of a comprehensive systems screen and thorough examination identified a patient with treatable conditions that required medical care. CASE DESCRIPTION: The patient was a frail 93-year-old woman. She was referred for home-care physical therapy with multiple medical comorbidities and functional decline following a short hospitalization for fall-related injuries. Her function improved after several visits, but upon resuming treatment after a 2- week hiatus, the patient demonstrated major decline in cognitive and physical function. OUTCOMES: The comprehensive systems screen revealed that the patient had increased pallor, loose and frequent bowel movements, urinary incontinence and increased frequency of micturition, confusion and apathy, and extreme fatigue. Her examination showed large declines in scores for Functional Independence Measures, Mini Mental Status Examination, Berg Balance Test, and Timed Up and Go. These results were consistent with indicators for delirium, dehydration, and anemia. The findings were reported to the patient's physician and family members agreed to have the patient evaluated in the local emergency room. CONCLUSIONS: This case report illustrates how knowledge of the pathologies associated with delirium and thorough examination can assist the physical therapist in making clinical decisions when homecare patients require prompt medical referral.- - - - - - - - - - ranking = 14.16022764353keywords = family, member (Clic here for more details about this article) |
10/23. Development of wernicke encephalopathy in a terminally ill cancer patient consuming an adequate diet: a case report and review of the literature.Malignancy-associated primary thiamine deficiency has been documented in several experimental tumors, clinical case reports, and in patients with fast growing malignancies. We report a terminally ill cancer patient who developed delirium. Close examination of the patient demonstrated that delirium was caused by thiamine deficiency, although she had been consuming an average of 990 cal/day for the past 3 weeks. Malabsorption or consumption by the tumor was considered the mechanism of thiamine deficiency. Early recognition and subsequent treatment resulted in successful palliation of delirium. In terminally ill cancer patients, clinicians must remain aware of the possibility of Wernicke's encephalopathy, when the patients develop unexplained delirium, even if the patient has been consuming adequate amounts of food. Early intervention may correct the symptoms and prevent irreversible brain damage, and the quality of life for the patient may improve.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
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