Examkin

Question

Difficulty: EasyEnd-of-Life and Palliative Care

A 71-year-old male patient with advanced prostate cancer is currently managed on home hospice. Over the past 48 hours, his family reports that he has become highly agitated, disoriented, and is experiencing visual hallucinations of strangers in his bedroom. He is frequently picking at his bedsheets and attempting to stand up unassisted. His current pain regimen includes a transdermal fentanyl patch, which has provided excellent relief; he has not required any breakthrough medication in the past week and denies pain when calmly asked. A physical examination by the visiting hospice nurse reveals stable vital signs, a soft abdomen with regular bowel movements, and a bladder scan showing no retained urine. Which of the following is the most appropriate next step in the management of this patient's current symptoms?

  1. Administer haloperidolAnswer
  2. B
    Administer lorazepam
  3. C
    Administer diphenhydramine
  4. D
    Increase the dose of the transdermal fentanyl patch
  5. E
    Transfer the patient to the emergency department

Answer

Administer haloperidol
The correct response addresses hyperactive delirium, a very common and distressing complication at the end of life. Once easily reversible causes (such as urinary retention, constipation, or uncontrolled pain) have been evaluated and ruled out, and non-pharmacologic measures are insufficient, the first-line pharmacologic management for distressing delirium in the palliative care setting is a typical antipsychotic, most commonly haloperidol.

Step-by-Step Solution

1
Identify the primary clinical syndrome.
The patient is experiencing acute hyperactive delirium, characterized by agitation, disorientation, and visual hallucinations.
Accurate syndrome recognition is required to select the correct palliative intervention.
2
Evaluate for underlying, easily reversible causes or uncontrolled symptoms.
Pain is well-controlled, and the physical examination rules out common culprits like urinary retention and constipation.
Reversible causes should be ruled out before initiating targeted, symptom-controlling pharmacologic therapy.
3
Select the most appropriate symptomatic pharmacologic agent.
Haloperidol is selected to manage the severe, distressing symptoms.
Typical antipsychotics are the standard first-line pharmacologic treatment for distressing hyperactive delirium at the end of life.

Key Concept

Pharmacologic management of terminal delirium
Rate this question

Topics

End-of-Life and Palliative Care

More questions from this topic