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Elsa AACN > Ch 27 Delirium > Flashcards

Ch 27 Delirium Flashcards

1
Q

Delirium definition

A

Reversible, acute onset condition that develops over a short period of time.

Results in fluctuating and transient global cognitive dysfunction

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2
Q

Is delirium considered a syndrome or a specific disease process or disorder?

A

Syndrome because of the many causes of delirium

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3
Q

Diagnostic criteria for delirium

A

Disturbance of attention and awareness.
Acute onset and fluctuation.
Other cognitive impairments.

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4
Q

Disturbance of attention and awareness means?

A

Reduced ability to direct, focus, sustain, shift attention. Reduced orientation to the environment

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5
Q

Acute onset in fluctuation means?

A

Hallmark features

Three subtypes. Hyperactive, hypoactive, mixed.

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6
Q

Other cognitive impairments means?

A

Additional disturbance in cognition:

Perception disorders, delusions, hallucinations, Psychosis.

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7
Q

Difference between encephalopathy and delirium.

A

used interchangeably
But encephalopathy describes both acute and chronic conditions.

Delirium is an acute condition

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8
Q

Delirium differential diagnosis acronym

A

I WATCH DEATH

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9
Q

DELIRIUM ACRONYM I WATCH DEATH MEANS

A 
Infection. 
Withdrawal. 
Acute metabolic. 
Trauma. 
CNS pathology. 
Hypoxia. 
Deficiencies. 
Endocrine northeast. 
Acute vascular. 
Toxins or drugs. 
Heavy metals.
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10
Q

Contributions to delirium

A

Neurotransmitter system dysfunction.
CNS response to inflammation.
Hypothalamic pituitary adrenal axis dysregulation.
Direct cerebral insults or injury.

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11
Q

Dysfunction related to delirium occurs at what level

A

Cellular and neurotransmitter level

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12
Q

Which mechanisms are most likely being disrupted in delirium

A

Reticular activating system, subcortical, cortex

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13
Q

Neurotransmitters involved in delirium

A

Acetylcholine

  • for attention, memory, arousal.
  • High level of Acetylcholine is related to delirium

Dopamine

  • excess dopamine causes hallucination.
  • Bupropion can exacerbate delirium
  • Levodopa can cause hallucination, agitation

Serotonin
- disruption or over excitation of serotonergic systems can cause hallucination and emotional lability

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14
Q

Risks factors for delirium

A 
Predisposing factor. 
Old age, 
dementia, 
severity of physical illness, 
multi drugs, 
metabolic disturbances, 
depression, 
sensory loss,
respiratory problems, 
myocardial infarction,
infection
Sleep deprivation, 
sensory impairment,
mobility, 
functional decline, 
dehydration, pain, 
medical comorbidity.
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15
Q

Independent risk factor associated with delirium

A

Age is an independent risk factor

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16
Q

Precipitating factors for delirium

A

Surgery, side effects of drugs, drug withdrawal, infection, metabolic derangement, pain.

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17
Q

Prevalence of delirium

A

14% age 85 and above

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18
Q

Types of delirium and prevalence in critical care settings

A

Most common is

  1. mixed type delirium,
  2. hypoactive,
  3. hyperactive
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19
Q

Type of delirium and prevalence and non-critical care setting

A

Hypoactive delirium is more common

20
Q

Common causes of delirium in elderly

A

Infection

21
Q

Cause of delirium in young adults

A

drug abuse and withdrawal

22
Q

Common causes of delirium and children

A

Medication side effects

23
Q

Percentage of people experiencing permanent cognitive impairment following resolution of delirium

A

Up to 50%

24
Q

Other morbidity of delirium

A

Impulsively, picking up skinner clothes, agitation all leading to an unintentional injury

25
Q

Chance of death who survived delirium

A

35 to 40%

26
Q

Presentation of delirium - two general courses

A
  1. Abrupt immediate onset.
    Can occur with moderate or severe TBI or stroke.
    Neurological event causes confusion and behavioral change.
2. Slow onset or fluctuating course
prodromal period, symptoms develop over hours or days. 
islands of lucidity
Syndromes wax and wane. 
Mild to moderate cognitive impairment.
27
Q

What do EEG findings show in delirium

A

Typically abnormal EEG especially in metabolic delirium

28
Q

What is an important cognitive function to assess for in differentiating delirium

A

Attention and sustained attention.

29
Q

Characteristics of hallucinations and delusions associated with delirium

A

Delirium, hallucinations and delusions are unsystematic, variable, can be formed and unformed.

In psychosis. they are typically formed with distinct shapes, objects, people, scenes.

30
Q

Examples of hallucinations and delusions in delirium

A

Formication hallucination.

  • Feeling of bugs crawling over the skin.
  • Suggest drug withdrawal delirium.
31
Q

acute interventions at the ED with delirium?

A

IV fluids
thiamine
glucose

32
Q

examples of medications used in delirium

A

benzos - counter alcohol withdrawal
neuroleptics - address hallucination and sleep problems
GABA targeted drugs for agitation

33
Q

charles bonnet syndrome

A

visual hallucination in people who lose eyesight.
perception of faces, small objects, people
aware that they are not real

34
Q

Autonomic storms

A

reaction to autonomic nervous system to severe injury, metabolic disturbance, overstimulation
HTN, tachycardia, diaphoresis

common cause - SCI, substance use, meds side effects, TBI

35
Q

neuroleptic malignant syndrome

A

complication following neuroleptic use

  • muscle rigidity
  • pallor
  • dyskinesia
  • hyperthermia
  • incontinence
  • unstable blood pressure
  • tachycardia
  • pulmonary congestion
36
Q

Delirium tremens

A

global confusion
hallucination
autonomic hyperactivity

37
Q

Wernicke’s encephalopathy

A

confusion
(ocular) abnormalities.
ataxia of the eye - cannot control eye voluntarily

AOC - cortez

38
Q

serotonin syndrome symptoms

A 
tremor
diarrhea
diaphoresis
mental status changes
hyperreflexia
fever
incoordination
39
Q

Vitamin b12 deficiency sx

A

Anemia, weakness, fatigue, mood changes, memory loss, disorientation. Impaired recognition of pressure, difficulty walking, tingling or numbness, irritability, depression, impaired attention, hallucinations, impaired proprioception

40
Q

definition of embolic shower

A

pattern of multiple, acute cortical strokes in different vascular territories

41
Q

Coronary artery bypass graft
cardiac valve replacement surgery
are usually associated with what condition

A

Embolic shower

42
Q

Hyponatremia

A

electrolyte disturbance
sodium concentration low
water accumulates in the body at a faster rate than it can be excreted
can lead to cerebral edema (e.g. congestive heart failure, polydipsia)
25% cases are postoperative

43
Q

What factor is most predictive of persistent cognitive impairment and complications of delirium

A

Length of delirium

44
Q

Hyperatremia

A

electrolyte disturbance
sodium concentration too high
caused by dehydration or conditions that result in excessive water loss (.e.g diarrhea, gastroenteritis)
causes dehydration –> delirium

45
Q

types of hallucinations

A

formication - bugs crawling over skin
hypnagogic - when falling asleep
hypnopompic - in the process of awakening, together with sleep paralysis
lilliputian - formed visual hallucination, objects seen smaller than in real life
metamorphorsia - one’s body changing in shape or size (alice in wonderland)
misidentification - objects, people being duplicated
peduncular - vivid, motion filled. perception of small objects. pleasant and entertaining (POSTERIOR STRUCTURES)
Release - occurs 2/2 sensory loss (Charles bonnet, phantom limb)
Visceral - sensations stemming from internal organs, unpleasant, hard to localize

Elsa AACN (35 decks)

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