05-19-2008, 05:49 PM
Option D (Discontinue ranitidine) is correct.
Acute confusional state (delirium) is a frequent postsurgical complication (42% following orthopaedic surgery). This should be considered a medical emergency and is associated with increased morbidity and mortality. Histamine-2 blockers are known to cause medication-induced delirium. Stress ulcer prophylaxis in the noncritically ill postoperative patient with H2 blockers is not absolutely contraindicated, but recent studies provide little support for this pharmacotherapy.
Option A (Administer Benadryl) is incorrect. Anticholinergics are associated with increased incidence of acute confusional state (delirium). The patient™s signs and symptoms are consistent with this diagnosis. Benadryl is likely to exacerbate the condition.
Option B (Administer lorazepam) is incorrect. Short-acting benzodiazepines are appropriate for treatment of delirium caused by alcohol or sedative hypnotic withdrawal. They can cause respiratory depression in elderly patients and are themselves a potential cause of medication-induced delirium.
Option C (Discontinue enoxaparin) is incorrect. Low-molecular-weight heparin is not associated with increased incidence of acute confusional state except as a contributing factor to a hemorrhage. Without evidence for an intracranial hemorrhage or hypovolemia, discontinuation of enoxaparin is not recommended. Postsurgical deep venous thrombosis (DVT) is significantly reduced in hip-fracture patients receiving this medication for thromboprophylaxis.
Option E (Substitute meperidine for morphine sulfate) is incorrect. Opiate analgesia is a possible contributing factor to the patient™s acute confusional state. Some form of pharmacologic pain management is essential in a postsurgical hip fracture patient. Meperidine is a poor choice for substitution because it has a higher association with medication-induced delirium compared with morphine sulfate.
Acute confusional state (delirium) is a frequent postsurgical complication (42% following orthopaedic surgery). This should be considered a medical emergency and is associated with increased morbidity and mortality. Histamine-2 blockers are known to cause medication-induced delirium. Stress ulcer prophylaxis in the noncritically ill postoperative patient with H2 blockers is not absolutely contraindicated, but recent studies provide little support for this pharmacotherapy.
Option A (Administer Benadryl) is incorrect. Anticholinergics are associated with increased incidence of acute confusional state (delirium). The patient™s signs and symptoms are consistent with this diagnosis. Benadryl is likely to exacerbate the condition.
Option B (Administer lorazepam) is incorrect. Short-acting benzodiazepines are appropriate for treatment of delirium caused by alcohol or sedative hypnotic withdrawal. They can cause respiratory depression in elderly patients and are themselves a potential cause of medication-induced delirium.
Option C (Discontinue enoxaparin) is incorrect. Low-molecular-weight heparin is not associated with increased incidence of acute confusional state except as a contributing factor to a hemorrhage. Without evidence for an intracranial hemorrhage or hypovolemia, discontinuation of enoxaparin is not recommended. Postsurgical deep venous thrombosis (DVT) is significantly reduced in hip-fracture patients receiving this medication for thromboprophylaxis.
Option E (Substitute meperidine for morphine sulfate) is incorrect. Opiate analgesia is a possible contributing factor to the patient™s acute confusional state. Some form of pharmacologic pain management is essential in a postsurgical hip fracture patient. Meperidine is a poor choice for substitution because it has a higher association with medication-induced delirium compared with morphine sulfate.