Your mom has several issues here, any one of which could be causing a transient confusion, like she is experiencing.
1. Aortic dissection-one of the most serious of medical conditions, one that many people don't survive. The aorta is the largest blood vessel in the body, when it gets a tear, the blood loss is generally enormous and quick. That type of blood loss can cause hypoxia(decreased oxygen)and one of the places that hypoxia affects with the most consequence is the brain, hence the confusion or vagueness that she is experiencing.
2. Poor kidney function-you indicated that your mom is on dialysis. Is this new since this hospitaliztion or was she a dialysis patient before this latest episode? The kidneys' function is to filter the bloodstream of impurities, and metabolize them into urine, which we then excrete. A dialysis patient's kidneys do not have that ability, hence the need for dialysis. While dialysis is a wonderful,life-saving treatment for many people, it does not exactly mimic kidney function, therefore the possibility that the Morphine has built up in her system is great, and it may take quite some time for her body to process it and then the dialysis to remove it. Also, between dialysis treatments waste products that the body produces also build up in the bloodstream, which can affect mental status as well. How long ago was the Morphine stopped? You say she was fine Tuesday....was it stopped after Tuesday? If so, then 5 days or less is probably not enough time for the drug to have been entirely excreted from her system, given all the variables.
3. Anesthesia from 2 major surgeries-anesthesia basically slows down all the processes in the body, including brain function, kidney function , liver function. Combine the slowing down from anesthesia with the poor kidney function to begin with, and it increases the possibility that the Morphine is just taking a long time to clear out of her system. For that matter, the anesthesia may also be taking a long time to clear out of her system, for the same reason...poor kidney function. If she has a collapsed lung, then her respiratory status is also impaired. We do excrete a certain small amount of "waste product" through our respiratory system, so again, if the respiratory system isn't functioning at 100%, then waste excretion isn't going to be 100%.
4. Prolonged hospitalization- your mother was fine Tuesday, but I have cared for patients who have done the same thing...been fine one day and beome confused the next. It is common during a prolonged hospitalziation for some older folks to develop what's informally called "hospitalitis". Think of it...you take someone out of their environment, whack them with 2 major surgeries, a ton of medications,dialysis,unfamiliar people, and the myriad of other things that being in a hospital entails, and it's no wonder they get confused at times.
I guess what I am trying to say is that based on the information you have shared, your mom's mental state being impaired is not highly unusual, and may just be a case of letting time take its course, as her body slowly returns to its normal. Her primary care doctor may want to consider ordering a CT Scan or MRI of the brain, to rule out a stroke or a cerebral(brain)bleed, especially since she has several reasons why she 'could have' had one or the other. But you may find that there has been no one factor that is causing this mental status change...it may be a combination of factors.
I hope I have been helpful. If you have any questions, or there is anything I can help you with, please feel free to PM me.
Good luck. I will keep you and your family, and especially your mother, in my prayers.
