A case presentation on cancer patient with delirium

1. Name of Case Presenter : Merilyne Msmawii Beiho
Designation : Psychiatric Nurse
Organizational Affiliation : District Hospital Siaha
CASE PRESENTATION

2. PATIENT DETAILS
AGE: 65yrs GENDER: Male
DIAGNOSIS:
Squamous cell Carcinoma of the Head and neck metastasis to lungs, liver and lymph nodes with
agitated delirium

3. PRESENTING COMPLAINTS
-Pain
-Mild confusion
-Agitated delirium
-Pace for hours
-Slept in 1-2 hour stretches
-Irritable with interaction

4. HISTORY OF ILLNESS
-Chain smoker for nearly 30 years
-Series of depression in the past 5 years
-Diagnosed with Head and neck cancer 1 year ago during check-up for tumour in his neck.

5. EXAMINATION
On examination
- The patient vital signs are within normal range
- Patient was conscious
- Patient used feeding tube
- Patient was restless, confused and irritated while trying to interview him

6. TREATMENT AND SIGNIFICANT INVESTIGATION
• After diagnosis with current illness the patient received chemotherapy and
radiation within the previous 6 months.
• Results of latest blood work are as follows
• WCC- 14.1
• Neut- 9.7
• Hb- 11
• Sodium- 126 mmol/L
• Potassium- 4.4 mmol/L
• Urea- 3.8 mg/dl
• Creatinine- 42 mg/dl
• Calcium- 14mg/dl

7. MEDICATIONS
• His active medication are as follows
• Mirtazine 30mg ODHS
• Warfarin 5mg OD
• Dexamethasone 16mg OD
• Oxycodone 10mg SOS
• Fentanyl patch every 72 hours
• Inj. Haloperidol every 28 days

8. PSYCHOSOCIAL ASPECTS
The patient had a well established family support system, who were actively engaged
and involved in the patient daily care.
Since the patient resisted any form of social engagement and interaction even with his
family, this causes more burden and stress to his family members.


9. MAIN CONCERN
The most important and immediate concern for the patient is providing a safe
environment for him and the staffs as he sometime become violent and
agitated.
Finding out the possible cause of delirium is also important, as the patient is
on corticosteroid; a known drug that can cause mental status changes in
patient. Stopping or reducing the dosage can be beneficial for the patient.
Educating the patient family regarding his delirium can be beneficial in order
for the family members to understand the patient condition better and to
reduce care giver burden and stress.

10. SUMMARY
Delirium affects an enormous number of patients at end of life and entails great
physical, emotional, Caregiver and financial burdens. This case presentation
tried to highlight the possible cause, management and treatment of delirium.

11. DISCUSSION POINTS (Points to be discussed in class based on the
patient’s story)
1. What are the possible causes of delirium in patient who are in palliative care?
2. What are the possible management of agitated delirium?

12. <Merilyne Msmawii Beiho>
<Psychiatric Nurse>