An 82 year-old woman who underwent right knee replacement yesterday develops new symptoms. Right after surgery, she was agitated, awake all night and refused to eat or take postoperative medications. Today she is still agitated and not oriented to time and place. What is the most appropriate management at this point?
A- Restrain in bed and lorazepam administration
B- Restrain in bed and haloperidol administration
C- Sleep enhancement protocol and family support as well as haloperidol administration
D- Diphenhydramine to enhance sleeping
E- Refer to psychiatry department
This is a case of delirium. It is mild in this patient and she only needs support and normalizing sleep-wake cycle. Restrain in only recommended in cases of severe delirium to avoid hurting herself and others. Haloperidol is safe to improve agitation. Benzodiazepines enhance delirium and they are not recommended in this case. Refer to psychiatry department is premature in this mild case of delirium.
The correct answer is C