Altered Mental Status

Question 1

AMS is appropriate for a diagnosis when?

Answer 1

admission…NOT discharge

Question 2

what is a common reason for presenting to the ER?

Answer 2

AMS

Question 3

what is derangement of arousal?

Answer 3

either hypervigilant or obtunded or in between

Question 4

what is PVS?

Answer 4

persistent vegetative state-may be either coma type or stupor type (no upper level cognition)

Question 5

what is evidence of psychosis?

Answer 5

they are crazy-usually have hx of psychotic event
acute process
may be gradual decompensation or stress trigger (most common)

Question 6

what type of process is dementia?

Answer 6

progressive

may worsen with delirium

Question 7

what is characteristic of depression?

Answer 7

intact cognition, but may be slow or disengaged

-can remember three words, but are sad

Question 8

what is the definition of psychosis?

Answer 8

loss of contact with reality (delusions, hallucinations, disorganized thinking)

Question 9

which type of hallucination is more common?

Answer 9

auditory

Question 10

depression is a comorbidity with what?

Answer 10

MI, CVA, PD, CA

Question 11

what is an important question for depressed patients?

Answer 11

have you considered committing suicide?

do you have a plan in place?

Question 12

symptoms of depression vary how?

Answer 12

either agitated or lethargic
eat everything or nothing
hopeless

Question 13

how does patient usually find out that they are demented?

Answer 13

they get lost a lot, otherwise they won’t know they are declining

Question 14

what are primary problems of dementia?

Answer 14

short term memory 
understanding or following complex instructions
poor driving (take the keys away!!!!), hygiene or grooming

Question 15

what factor improves long term mental health?

Answer 15

education

Question 16

what is the acronym for treatable causes of confusion?

Answer 16

D-dehydration, depression
E-endocrine, electrolyte, environment
M-medications, metabolic
E-eye and ear problems
N-nutritional deficiencies, normal pressure hydrocephalus, neurosyphilis
T-toxicity
I-infection, impaction (cerumen, fecal), ischemia, insomnia
A-anemia, alcohol, anoxia, anesthetic (off-gasing)

Question 17

what is the definition of delirium?

Answer 17

acute, confused state that occurs to a response to an identifiable trigger
REVERSIBLE
specific organic factor

Question 18

what is dysphoria?

Answer 18

disquiet, restlessness, malaise, depression

Question 19

in pts who are in delirium, what do you have to rely on?

Answer 19

physical exam

they won’t be able to tell you what hurts, so rule out everything!!!!

Question 20

what are signs of bacteremia?

Answer 20

tachycardia
dilated pupils
diaphoresis

Question 21

what as the #1 cause of delirium?

Answer 21

infection of the chest or urinary tract

Question 22

what was the 2nd leading cause of delirium?

Answer 22

stroke, drugs, MI, fracture

Question 23

what does pulmonary embolis masquerade as?

Answer 23

pneumonia

Question 24

why is delirium tricky to treat?

Answer 24

1/4 pts have multiple factors that cause the problem

Question 25

pts who fall require what type of testing?

Answer 25

bleeding assessment

Question 26

what should be considered with metabolic encephalopathy?

Answer 26

alcohol
hepatic
water
electrolyte 
uremic

Question 27

how does a hypertensive crisis present?

Answer 27

severe headache
N/V
visual disturbances
convulsions

Question 28

what is critical about taking hx with delirium/dementia?

Answer 28

give them choices, but don’t lead them into the answer

take a full hx including THOROUGH medication review

Question 29

what is the No#1 reason for sleeping in the recliner?

Answer 29

can’t breathe when they lie down bc of heart failure

Question 30

what is the only way to get a good sputum culture?

Answer 30

bronchoscopy with sedation

Question 31

who is most at risk for silent MI?

Answer 31

females

Question 32

what is a major drawback of MRI?

Answer 32

takes a long time, pt has to be immobile for a long time

Question 33

what kind of EEG should you order for neurologic questions?

Answer 33

evoked potentials-attempts to promote seizure activity

Question 34

what nutritional deficits are likely to cause altered mentation?

Answer 34

folate and folic acid (can cause nerve damage)

“hang a banana bag”

Question 35

ER protocol if you don’t know whats going on

Answer 35

1. amp of narcan
2. amp of D50
3. banana bag

Question 36

why do you have to be patient with delirium?

Answer 36

it can take days to figure out what is going on

treat what you know is happening first and monitor