I always have a few butterflies before shift report, so I like to be early to go through my patients' charts. But no matter
how well I've prepared, I never know what to expect when I read a patient has been admitted due to a change in mental status.
The diagnosis covers a number of pathophysiologies—mental and physical, derived from either natural or manmade causes. These
patients often are oblivious to their state and need an advocate. I became such an advocate this spring, when my mother suffered
a change in mental status.
Change in mental status
At 87 years old, my mother has earned the right to a senior moment or two. But one morning, she called because she thought
she was in trouble. Five minutes later, I was at her house, and she appeared confused and disoriented. Convincing her to go
to the hospital was difficult, but she soon conceded. During the triage interview, my mother looked and sounded as if she'd
been on a bender. Her eyes were glassy and unfocused. She had nausea and a headache. She couldn't sign her name on a line.
Through slurred words, she tried to tell the nurse why she was there.
Dementia is the stereotypical diagnosis for confusion in the elderly. I recalled fellow nurses whispering about family members
being in denial of a parent's cognitive decline. That wasn't going to happen to us. I implored the triage nurse to write that
my mother plays bridge, takes care of her house, drives, and is totally independent. After several hours, the physician told
us she had severe hyponatremia and would be hospitalized for several days. A new role
As luck would have it, my clinicals had been in this hospital. I was familiar with the floor and comfortable with my mother
being there. However, I still needed to be her advocate. I could have told the floor nurses that I was on par with them as
a nurse, but I decided to remain an anonymous daughter. There's a fine line between being a nurse who's the daughter and someone's
daughter who is the nurse, but they both need to advocate for the patient.
The nurses who advocated the best for my mom acted like daughters—caring, supportive, and encouraging. For example, when she
was embarrassed because she couldn't manage a fork, the nurses didn't demean her. They supported her because she could finally
eat. In contrast, when my mother had a bad night, she said, "I don't like it here. I go to bed, and nobody says 'I love you.'"
I was surprised at her words. I don't tell her I love her before bed because we live in different houses. But she knows that
when she calls me, I won't ignore her, and if she needs me, I'll be there. That's what she wanted during those 13 days in
the hospital—to feel that she mattered and wasn't alone. Even with a change in mental status, my mother, your patient, can
teach us what's important.
Practice Tools
