Agitation and Delirium

Question 1

Pre-Disposing Risk Factors for Delirium :
1. Age ?
2. Sex
3. Multiple ___
4. Specific comorbidities such as? (4)
5. ___ impairment such as ? (2)
6. History of ?
7. M
8. ___ impairment
9. History of ___

Answer 1

1. > 65 yrs
2. males
3. comorbidities
4. dementia/cog impairment
   -hx of stroke
   -depression
   -HTN
5. Sensory , hearing and vision
6. Alcohol abuse
7. Malnutrition
8. functional
9. delirium

Question 2

Precipitating Risk Factors :
W, P, Severe ____, Acute ____
H, H,S,H

___ and ___ distrubances
___ changes
S, A, admission to ____
Use of ____
Use of ____
M___

Answer 2

Withdrawal , pain, severe acute illness, ifxn

Hypoxia, head trauma, sleep disturbances, HYPERThermia

Metabolic/Electrolyte
Environmental
Surgery , Anesthesia, ICU
Physical restraints
bladder catheter
medications

Question 3

Meds associated w/Delirium
1. B
2. Z Drugs such as?
3. Opioid Analgesics such as
4. F
5. Systemic ____
6. Meds w/strong ____ effects

Answer 3

1. BZD’s
2. Eszopiclone, zaleplon, zolpidem
3. fentanyl, hydromorphone, meperidine, morphine
4. Fluoroquinolones (moxi, levo, cipro)
5. Corticosteroids
6. ANticholinergic (antihistamines, antiparkinsonian agents, bladder antimuscs, GI antispasmodics, TCA’s, muscle relaxants, antiemetics, antipsych)

Question 4

1. Define Dementia

For both Delirium and Dementia, describe each disease state’s characteristics

1. Onset
2. Duration
3. reversability
4. Course
5. attention
6. Consciousness
7. alertness
8. speech
9. perceptions

Answer 4

1. Progressive loss of memory and other cognitive functions (attention, thinking, judgement) severe enough to interfere w/daily life

Delirium:
Acute
hours to weeks
typically reversible
fluctuating
impaired
altered
impaired
incoherent, rapid or slowed
hallucinations

Dementia
Insidious
Months to years
Irreversible
progressive
normal except in advanced stages
usually clear
normal
Word finding difficulty
Intact until advanced stages

Question 5

Hyperactive Delirium Characteristics?

What about Hypoactive ?

Answer 5

1. Agitated, combative, restless, hallucinations, delusions
2. Quiet, withdrawn, apathetic, lethargic, slowed speech

Question 6

Delirium Prevention Strategies :

1. Frequent ____
2. Maintain ___ and __
3. Normalize ___
4. Promote ____
5. ___ management
6. its an ___ approach
7. Address ___ for delirium
8. Provide ___ w/ ___ at night
9. Foster ___
10. Minimize ___

Answer 6

1. Reorientation
2. mobility and self care ability
3. Sleep wake cycle
4. Nutrtition and hydration
5. Pain
6. Interprofessional
7. risk factors
8. quiet room , low level lighting
9. familiarity
10. invasive procedures and remove invasive devices

Question 7

Pharmacologic Therapy Principles
1. Are any meds FDA approved for tx of delirium?
2. Pharm TX should be reserved for which subset of patients?
3. Carefully weigh ?
4. Use ___ for __
5. Make sure meds are not

Answer 7

1. NO!
2. Pt’s with severe agitation such that they are at risk of interrupting essential medical care, harming themselves, harming staff
3. Risks vs benefits of pharm tx
4. Lowest effective dose for shortest possible time
5. Inadvertently continued during TOC

Question 8

Pharm Therapy : Antipsychotic Agents
1. 1st gen antipsychotics such as ?
2. Second gen such as? (3)
3. BBW for ?
4. AE”s of antipsychotics?
-E, N, Q

Answer 8

1. Haloperidol
2. Olanzapine , Quetiapine , Risperidone
3. Incr mortality in elderly pt’s with dementia related psychosis
4. EPS , Neuroleptic malignant syndrome , QTC prolongation ,

Question 9

1. What’s the place in therapy for Dexmedetomidine (Precedex) ? (IV)
2. Place in therapy for Dexmedetomidine (Igalmi) Film , PO?

Answer 9

1. Intubated patients when agitated delirium interferes with extubation
2. Acute tx of agitation associated w/schizo or bipolar I or II disorder in adults