Acute Confusion Scenario (Technician)

Question 1 of 15

1. Question

What complications can be commonly reported in patients shortly after surgery?

Wound infection

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Post operative delirium

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Thromboembolism

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Urinary tract infection

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Bleeding

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Ascites

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All answers

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Question 2 of 15

2. Question

You try to get a more in-depth history from the patient. They seem a bit better now and you can get a slow conversation going. The patient seems to be in quite a bit of pain with her arm but she’s not sure if that is normal. She is unsure why she is intermittently getting confused. The husband states these episodes of fatigue, lethargy and confusion usually last 1-3 hours and then the patient seems to improve and returns to normal. She is eating and drinking well once she gets back to her normal state. You start to look at the patients arm for any clues. What signs might you look for around the patients cast?

Any swelling, especially if it causes the cast to be too tight

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Cap refill distal to site

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Sensitivity around site

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Still able to move fingers

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Any warmth or redness indicative of infection

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Bleeding

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Question 3 of 15

3. Question

You can’t see any abnormal signs. You only query the pain she is experiencing but you are still unsure if this is normal. You gain observations to see if they help explain what’s going on. They are: 78HR, 14RR, 98% Sp02, 110/75 BP, GCS 15, 36.5 Temp and 5.1 BM. What is this patients NEWS score?

1

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2

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3

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0

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Question 4 of 15

4. Question

Your observations don’t give any indications. You are confident the patient is experiencing post-operative delirium, but you are unsure of the cause. What classification of delirium would you fit the patient’s symptoms under?

Hypoactive

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Hyperactive

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Mixed

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Question 5 of 15

5. Question

You are confident the patient is experiencing episodes of hypoactive delirium, so your next aim is to find why these episodes are happening. What can be some common causes? Tick all that apply.

Intoxication

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Withdrawal

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Constipation

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Urinary retention

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Infection

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Temperature fluctuations

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Dehydration

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Pain

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Question 6 of 15

6. Question

What test can be used in the pre-hospital setting to help diagnose delirium?

4 AT

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Curb 65

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GCS

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Self-administered Gerocognitive Exam (SAGE)

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Question 7 of 15

7. Question

The patient’s past medical history consists of only hypertension and hyperlipidaemia which she takes atorvastatin and Ramipril for. She is Retired, is usually very active and leads a healthy lifestyle. She is allergic to latex. She has been prescribed paracetamol, ibuprofen, oramorph and amoxicillin for management after surgery. What piece of information here may indicate need for further questioning as it could relate to the patient’s symptoms?

Oramorph prescriptions

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Amoxicillin prescription

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Usual Ramipril medication

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Latex allergy

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Question 8 of 15

8. Question

You ask about the patients pain prescriptions, in particular the Oramorph to see if she is following her prescription. You find that she is prescribed 10mg every four hours up to a maximum of 40mg a day. Following further questioning, you think she has been taking over double that amount at around 80mg a day.

When you query this, it seems like the penny drops with the husband and a link between the patient’s symptoms and the dose she is taking is linked. Does this therefore automatically require admission to hospital?

No

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Yes

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Question 9 of 15

9. Question

What resource can be used to help with decision making for overdosing patients?

JRCALC overdose decision tool for transfer to further care

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BNF

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National Institute on Drug Abuse

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WebMd

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Question 10 of 15

10. Question

The patient and the husband state that they have got the mg and ml mixed up on their prescription as the dose is 10mg/5mL. Therefore, they have been taking double the dose than required, it seems to be accidental overdosing. When considering the discharge of patients at home after accidental overdose. What points should be considered beforehand?

Toxbase reviewed for toxic dose

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Patient is well with no clinical concerns

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No safeguarding concerns

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Appropriate safety netting available

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Credible history of overdose

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Question 11 of 15

11. Question

You are happy that most of these criteria are met but you must first check Toxbase for their toxic dose. What is the toxic dose of morphine sulphate?

0.4mg/kg

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0.8mg/kg

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0.2mg/kg

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0.8mcg/kg

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Question 12 of 15

12. Question

You find that the toxic dose is 0.4mg/kg. The patient weighs 68kg. Does this mean the patient has been taking toxic doses each time?

No

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Yes

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Question 13 of 15

13. Question

The patient last took their Oramorph 7 hours ago and have not taken anymore as the call handler on the phone said to keep the patient nil by mouth. They feel better except for the increasing pain in their arm and the patient states they don’t feel drowsy. They are adamant that they’re not going to take any more Oramorph as now they lack confidence but are unsure what to do if the patient experiences more pain. What service could you refer them to for a medication review?

Own GP

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Senior clinical advice line

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Advanced Paramedic Practitioner

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Emergency Department

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Question 14 of 15

14. Question

Around what percentage of Oramorph is absorbed after first pass metabolism by the liver for therapeutic effect?

25-33%

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10-20%

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50%

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100%

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Question 15 of 15

15. Question

Around what percentage of post-operative patients will experience delirium?

15%

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1-2%

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33%

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5%

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Acute Confusion Scenario (Technician)

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