CHAPTER 24 CONFUSION AND DELIRIUM Flashcards
it is a mental and behavioral state of reduced comprehension, coherence and capacity to reason
confusion
acute state of confusion
delirium
terms used to describe px with delirium
encephalopathy
acute brain failure
acute confusional state
postoperative ICU psychosis
what is the hallmark of delirium
attention deficit
associated symptoms of delirium
altered sleep wake cycle
perceptual disturbances such as hallucinations or delusions
affect chages
autonomic findings such as heart rate and blood pressure instability
what are the two subtypes of delirium
hyperactive and hypoactive
example of hyperactive delirium
severe alcohol withdrawal (delirium tremens)
characteristics of severe alcohol withdrawal
hallucinations
agitations
hyperarousal
characteristics of severe alcohol withdrawal
hallucinations
agitations
hyperarousal
example of hypoactive subtype
benzodiazepine intoxication
characteristics of hypoactive
withdrawn
quiet
prominent apathy
psychomotor slowing
risk factors for delirium
older age >65 low baseline cognitive dysfunction sensory deprivation malnutrition underlying medical and neurologic illness
what population that delirium is most common
elderly px undergoing hip surgery
pathogenesis of delirium
attention deficit due to diffuse localization within the brainstem, thalamus, prefrontal cortex and parietal lobes,
neurotransmitters that has a role in delirium
acetylcholine and dopamine
anticholinergic medications can cause delirium
true
alzheimer’s disease, dementia with lewy bodies and parkinsons disease dementia are all associated with cholinergic deficiency due to degeneration of acetylcholine producing neurons in basal forebrain
true
criteria in Confusion Asessment method
acute onset and fluctuating course
inattention accompanied by either disorganized thinking or an altered level of consciouness
a course that fluctuates over hours and days and worsen during the night
sundowning
what are the three most important pieces of history in px with delirium
patient’s baseline cognitive function
time course of the present illness
current medications
most common cause of delirium
medications such as compounds with anti-cholinergic or sedative properties
what to include in physical examination of px with delirium
screen for signs of infections such as fever, tachypnea, pulmonary consolidation, heart murmur and meningismus
signs that signify attentional problem
tangential speech
fragmentary flow of ideas
inability to follow complex commands
how to test for neuropsychological aspect of the px
use the digit span forward
how do you do the digit span?
patients are asked to repeat successively longer random strings of digits beginning with 2 digits in a row
example: say 4-3 and repeat after me
result of digit span with delirium
falters <3 digits
result of digit span in normal healthy adult
7 digits before faltering
result of confusion assessment in px with delirium
positive for feature 1 (acute onset and fluctuating course) and feature 2 (inattention)
another test to use in assessing px with delirium that provides information regarding orientation, language, and visuospatial skills
mini-mental status examination
cause of delirium in younger patients
illicit drugs and toxins and alcohol abuse
how do infections can cause delirium such as septic encephalopathy most commonly seen in ICU
due to the release of proinflammatory cytokines which has diffuse cerebral effects
what do you call the onset of delirium at the end of life in palliative care settings
terminal restlessness
