Delerium Flashcards
What are the characteristics of delerium?
- Acute changes in mental status
- Waxing and waning course
- Usually attributable to other medical factors
- Primary disturbance in attention and awareness (altered consciousness with reduced ability to focus, sustain, or shift attention)
- Is a medical syndrome(with behavioral symptoms), not a disease
- Often mistaken for psychiatric illness
- Can be viewed as a failure of brain to maintain homeostasis
(T/F) Delirium can increase mortality rates in affected patients. Approximately 10% of patients affected by delirium experience mortality within 1 year if the delirium is ongoing
Delerum does increast mortality rates. However, approximately 50% of patients experience mortality within 1 year.
What are some of the most common signs of delirium in a patient?
- Disorientation (shows up first, unlike dementia)
- Lapses in short and long-term memory
- Confusion
- Hyper- or hypoactive motor function
- Reduced comprehension, word-finding difficulties, mumbling, muteness
- Circadian rhythm abnormalities
- Dysphoria
- Illusions and hallucinations (mainly visual, unlike schizophrenia)
- Delusions (usually paranoia)
- Distractibility, poor attention/focus, losing train of thought
(T/F) Delirium symptoms in a patient are constant and persistent once they appear.
False. Delirium symptoms are waxing and waning
What is the mnemonic used for possible causes of delirium?
“I WATCH DEATH”
- Infection
- Withdrawal
- Acute metabolic (acidosis/alkalosis, electrolyets, hepatic/renal failure)
- Trauma
- CNS pathology
- Hypoxia
- Deficiencies (Cobalamin (B12), Folate (B9), Niacin (B3), Thiamine (B1))
- Endocrinopathies
- Acute vascular
- Toxins or drugs
- Heavy metals
The biggest risk factor for delirium is _________.
Age, others include:
- Dementia
- CNS injury
- Mutiple medical problems
- Multiple meds
- Malnutrition
- Low serum albumin
- Alchol/drug use
- Visual/hearing impairment
- Immobilization
- Sleep deprivation
What medications in particular should you look for when assessing a patient suspected of delirium?
- Anticholinergics
- Opiates
- Benzodiazepines
What class of medications is considered the most“deliriogenic”?
- Anticholinergics
- Antipsychotics
- Benzodiazepines
- Opiates
- Anticholinergics
- ACh is primary NT of CNS
- Messes up homeostasis
- Benedryl (diphenhydramine) is most common
(T/F) Delirium occurs when there is a failure to maintain homeostasis in a patient with a “vulnerable brain”.
True. Any significant change from baseline in the body may cause delirium.
What antipsychotic medication is most often used in patients with delerium?
Haloperidol
- Few anticholinergic side effects
- Few acitve metabolites
- Adverse effects:
- EPS and QTc prolongation
(T/F) You should avoid giving benzodiazepines to a delirium patient at all costs.
True.
Resolution of delirium can lag (days to weeks/months to years) behind resolution of the medical causes.
Days to weeks
What are some ways to prevent delirium on admission?
- Be mindful of vulnerable patients when using “standard order” drugs
- Prevent urinary tract infections (Minimize use of foley catheters)
- Review med list and decrease unneeded and high-risk meds
- Maintain orienting cues and encourage family presence
What is another diagnosis, other than delirium, that commonly presents with mental status changes and hallucinations 24-72 hours after admission to the hospital?
- Pancreatitis
- Congestive heart failure
- Meningitis
- Alcohol Withdrawal
- Alcohol Withdrawal (Delirium Tremens)
* Treat with benzodiazepines (unlike delerium)
Besides haloperidol, delirium may also be treated with the _______________ group of antipsychotics.
Atypical antipsychotic
