You Are the Current "On Call Physician" for Your Group

question 706

Multiple Choice

You are the current "on call physician" for your group, when you receive a call regarding one of your nursing home patients. The nurse reports that one patient has been acting strangely for the last few hours and is agitated at times.  This patient is an 82-year-old female who has been in the nursing home for the last two years, and has always been very pleasant. You know her very well from your recent nursing home visit. She has a past medical history of hypertension, diabetes mellitus, osteoporosis, and Alzheimer's dementia. Her daily medications are amlodipine, metformin, calcium - vitamin D, and donepezil. You are concerned that something is not right with the patient.
The nurse calls you back in twenty minutes.  She states that she gave a dose of prn (as needed) medication which was ordered by a physician before.  She arranged an ambulance to transfer the patient to a nearby hospital.  Her temperature is 36.7 C (98 F) , blood pressure is 116/78 mmHg, pulse rate is 76/min, and respiratory rate is 18/min.  She is still agitated, and she is now disoriented to place and person.  She gets easily distracted, and she is having auditory hallucinations.  In the hospital, her physical examination is unremarkable.  What is the most appropriate next step in the management of her condition?

• A)Give haloperidol to calm the patient
• B)Order a stat psychiatry consult
• C)Order urine analysis and complete metabolic panel
• D)Order a head CT scan
• E)Order physical restraints to prevent injury to patient and nursing staff

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Definitions:

Systematic Desensitization

A therapeutic technique used to reduce phobia or anxiety responses by gradually exposing the person to the feared object or situation in a controlled manner.

Anxiety Hierarchy

A list of situations that provoke anxiety arranged in order from least to most anxiety-inducing, used in systematic desensitization therapy.

Deep Relaxation

A profound state of physical and mental calm achieved through techniques such as meditation, deep breathing, or yoga.

Behavioural Rehearsal

A technique used in therapy and training situations where individuals practice behaviors in a safe environment before applying them in real life.