Aurelio, Lyca Mae M.

BSN III-D
Activity 1
1. Which medication(s) may have contributed to Ms. Espinoza’s altered mental status?
Sleeping medicine before going to bed (Zolpidem 5mg)
Zolpidem is a non-benzodiazepine drug Z that can be used as a sedative and hypnotic. Zolpidem
is a type A GABA receptor agonist of the imidazopyridine class. It increases the role of GABA in
the central nervous system by binding to GABA receptors at the same position as
benzodiazepines. Its half-life is usually two to three hours. It can also relax and calm people in a
state of high levels of anxiety.
This drug using main side effect are,

 A change vision
 Feeling drowsy or sleeping
 Abnormal dream
 Confusion
 Depression
 Memory loss
 Double vision
 Generalized weakness
 Muscle pain
 Constipation
 Dry mouth
 Urinary tract infection
 Vomiting

2. In addition to the drug regimen, does Ms. Espinoza have any other risk factors for altered
mental status?
History of Strokes
Most strokes do not impact a patient's LOC or mental state; however, some strokes can cause
altered mental status.[7] Thus, include stroke in the differential diagnosis of any geriatric
patient presenting to the ED for confusion.
Occlusion of the distal portion of the basilar artery can manifest with LOC change. Bilateral
thalamic infarcts can also affect the LOC or cause sudden-onset memory loss. A vertical gaze
palsy may provide a clue to the diagnosis. Strokes in the occipital lobe or nondominant parietal
lobe can present as confusion. An abrupt onset of confusion (within minutes) should raise
suspicion for stroke. Many of these strokes are amenable to reperfusion therapy and
endovascular intervention if identified quickly.
Hypertension
Hypertension can overwhelm protective autoregulation mechanism leading to diffuse vasogenic
edema with vasospasm and arterial ischemia ,when persistent, the syndrome recognized as
hypertensive encephalopathy may develop resulting in altered mental status, headache and
vomiting.
3. Would you alter her drug regimen in any way? If so, how?
I will integrate the following:
 Educate the patient about what expect
 Nurture relationships with patient
 Help the patient customize their support tools.
 Synchronized medications.
 Provide the activities with resting period
 Reorient the patient again and again
 Provide the adequate lightening.
 Encourage use of safety devices
 Help the patient day to day activities
 Help to the patient have normal sleep.
Aurelio, Lyca Mae M. BSN III-D
Activity 2
1. How is this situation best handled?
Mr. Bowen may be advised counseling by a psychotherapist for cognitive behavior therapy
(CBT), a talking therapy that can help Mr. B manage his problems by changing the way he thinks
and behaves.

2. Does Mr. Bowen have the right to refuse to eat and take medications when he is clearly not
in an end-of-life situation?
Normally, Mr. B has the right to refuse to eat and take medications, even when he is clearly not
in an end-of-life situation. However, in this case, Mr. B may not be able to exercise his right to
autonomy, because he is in a state of depression, and is not in a position to make informed
decisions about personal matters.

3. How does the team resolve the situation when the depression is so prevalent and he refuses
treatment for it?

So long as Mr. B is not actively trying to kill or harm himself, he cannot be forced into
treatment. Mr. Bowen can be advised to undergo cognitive behavior therapy (CBT), and help
him change the way he thinks and behaves. CBT cannot cure the problem, but help to deal with
it in a more positive way

4. Will you be able to care for Mr. Bowen if his wishes are granted?
Yes and I will always try to upholds, defends, and strives to protect the health and interests of
the patient.