You are called to a local residence for a 72-year-old man who presents with an altered mental status. As you arrive on scene you notice the home is maintained well, with no immediate threats are present. Your patient is sitting at the kitchen table on a chair and appears in no acute distress however his wife is very anxious and tells you he woke up this morning acting confused. He has purposeful movements as you approach and introduce yourself. In a clear voice he attempts to acknowledge your introduction but is easily distracted by the commotion of people and fails to tell you what is wrong. You note his airway is clear, he is breathing easily and his pulse is strong and regular. You notice his face has a superficial laceration consistent with a shaving accident. The bleeding has stopped on its own. Your partner prepares the stretcher to transport him to the hospital while you ask his wife about his history and assess vital signs. She states that last night he went to bed without complaint but woke up later than usual this morning and had trouble getting himself cleaned, shaved and dressed. She stated that he only ate a small amount of breakfast which was not unusual for him. He seems to be more confused and disoriented since waking up this morning. He has a history of hypertension, depression, gastroesophageal reflux disease, and a herniated cervical disk. She reports his medications include amlodipine, bupropion, lansoprazole, tramadol, sertraline, aspirin and metformin. She corrects herself and states the metformin is hers not her husbands.
On physical examination, his temperature is 37.1°C (98.4°F), blood pressure 132/90 mm Hg, heart rate 82 beats per minute, and respiratory rate of 16 breaths per minute sating 96% on room air. He is not in any acute distress but appears to be fumbling with the newspaper on the table as if he doesn’t recognize what it is. His pupils are equal and reactive bilaterally. He is unable to follow commands to complete a FAST exam for stroke. His skin is pink, warm and dry. He appears slight in frame weighing approximately 80 Kg.
Answer the following questions based on this case study.
On the basis of the information presented thus far, what is your working diagnosis for this patient?
What additional assessment or diagnostic information would you want about this patient?
What are potential interactions, side effects and complications for his medications?