NURSING ORDERS: Altered Mental Status- Why What is Ordered, is Ordered

NURSING ORDERS: Altered Mental Status- Why What is Ordered, is Ordered

Here is a handy reference sheet to help medical professionals & students understand orders for altered mental status patients. Have you ever wondered why you are given orders that you are give? This reference sheet answers some of those questions, specifically for orders related to patients with altered mental status.

 

It is important to note that other orders are given (see below), this is just an overview. Every provider is different and depending upon what is suspected (including from the review of systems and physical exam), other tests may be ordered.

 

 

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OTHER POSSIBLE ORDERS FOR AMS PATIENTS:

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EEG
Especially if hyponatremia or concerns seizure
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Naloxone
Specifically if respiratory depression and suspect narcotic related
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1:1
Patients w/AMS often pull at lines, fall, and do other things that could potentially harm themselves or others
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Restraints
This is always consider a last choice option.
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Seizure precautions
If suspect seizure or patient has severe hyponatremia, ETOH withdrawal
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Blood pressure parameters
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Pharmacy Med Review
Medications could potentially be contributing to the AMS
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CIWA & Benzo
If suspect or know of ETOH withdrawal

DIFFERENTIAL DIAGNOSIS FOR AMS

Stroke

TIA

Hypoglycemia

DKA

Trauma to head

Meningitis

Myxedema coma

Seizure (post-ictal)

Hypoxia

ETOH intoxication

Narcotics/sedatives

Hepatic encephalopathy

Hyperammonia

Renal failure (especially if patient takes narcotics-builds up)

And many, many, more causes (these are just a few)

REFERENCES:

1) Up to Date https://www.uptodate.com/contents/ischemic-stroke-treatment-beyond-the-basics
2) Oxford Academic https://academic.oup.com/ehjcimaging/article/11/6/461/2397032

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