Chapter 8 Pt 2 Flashcards
what are the typical symptoms of delirium
short attention span disorientation fluctuations in level of consciousness visual hallucinations impairment in recent memory
what are the criteria for delirium
disturbances in ATTENTION and AWARENESS
disturbances in an ADDITIONAL COGNITIVE DOMAIN
develops ACUTELY over hours to days, represents a CHANGE from baseline, and tends to FLUCTUATE
NOT better accounted for by ANOTHER NEUROCOGNTIIVE DISORDER
NOT occurring during a COMA
evidence from history, physical, or labs that the disturbance is a DIRECT CONSEQUENCE of ANOTHER MEDICAL CONDITION, SUBSTANCE INTOXICATION/WITHDRAWAL, exposure to TOXIN, or due to multiple etiologies
what is a useful evaluation tool for a patient with suspected delirium
the CONFUSION ASSESSMENT METHOD (CAM)
delirium is diagnosed a patient with INATTENTION (distractibility or difficulty maintaining focus) of ACUTE ONSET and/or FLUCTUATING COURSE along with either DISORGANIZED THINKING (derailment or loose associations) or ALTERED CONSCIOUSNESS (can be vigilant to lethargic)
once delirium is diagnosed who should be done
FIGURE OUT CAUSE
Blood glucose, pulse ox, arterial blood gas, and ECG can quickly provide useful data at bedside
what labs are typically obtained in a delirium workup
BMP
CBC w/ diff
UA and culture
UDS, blood alcohol level, therapeutic drug levels, hepatic panel, thyroid hormone level, CXR may be warranted depending on clinical presentation
what should be done if focal neurological deficits are present or a cause of delirium cannot be identified in initial workup
HEAD IMAGING
EEG
LUMBAR PUNCTURE
how is delirium treated
TREAT UNDERLYING CAUSE
address potential exacerbating factors: mobility limitations, sensory deficits, sleep cycle disruption, constipation, urinary retention, dehydration and electrolyte abnormalities, uncontrolled pain, use of unnecessary medications
encourage family members to stay at bedside
maintain supervision and reorient patient on a regular basis
what is indicated for treatment of agitation that places the patient or others at risk
D2 ANTAGONISTS- HALOPERIDOL i the preferred agent
restraints should be avoided in delirium but if they are required what should be done
use LEAST restrictive means appropriate for the situation and REMOVE AS SOON AS POSSIBLE
benzos should only be used to treat delirium due to what
alcohol or benzos
can cause, worsen or prolong delirium in other cases (paradoxical disinhibition or over sedation)
individuals with Mild NCDs (aka mild cognitive impairment) experience difficulty with what
some of the more complex activities of daily living but are able to maintain independence
patients with MAJOR NCDs require assistance with
independent actives of dialing living, such as paying bills, managing medications, or shopping for groceries
over time, basis activities of daily living are affected, leading to total dependence
what is a screening test for Mild and Major Neruocognitive disorders
the Mini Mental Status Exam (MMSE) due to speed and ease of administration
cognitive impairment with stepwise increase in severity + focal nerulogic signs is likely due to what
Vascular disease
head CT/Brain MRI is diagnostic testing
cognitive impairment + cogwheel rigidity + resting tremor is likely due to what
Parkinsons disease
Lewy Body Disease
these care diagnosed clinically
