Delirium Flashcards
Define delirium
acute decline in the cognitive processes of the brain
Why is delirium so hard to diagnose?
- changes fluctuate throughout the day; under recognition of these symptoms
- physicians use other terms rather than delirium
T/F: 2/3 cases of delirium go unreported …
if F, correct
TRUE
What is the A-E of Diagnostic criteria for delirium?
A. distubrance in attention and awareness
B. acute onset (fluctuates throughout the day)
C. disturbance in cognition
D. A & C not explained by another pre-existing condition
E. direct evidence (lab, history, etc) that disturbance is result of another medical condition, exposure to toxin, etc
Give 3 examples of cognitive disturbances..
memory deficit
- disorientation
- language
- visuospatial ability
- perception
T/F: perceptual deficits (illusions or hallucinations) are a common clinical feature of delirium…
(if F, correct)
TRUE
Which type of delirium is normally found with the elderly?
hypoactive
T/F: dementia, delirium and depression see diurnal effects (fluctuations throughout the day)
(if F, correct)
- F
- dimentia is progressive, and stable over time (no diurnal effects)
- delirium is usually worse at night and when waking
- depression is usually worse in the morning
T/F: Delirium sees fluctuations in alertness, whereas dementia and depression have normal alertness.
(if F, correct)
- TRUE (generally)
- people with delirium can be lethargic or hyper-vigilant
T/F: Memory is affected in all of delirium, dementia and depression.
(if F, correct)
- TRUE (generally)
- delirium sees recent and immediate memory impairment
- dementia sees recent and remote affected
- depression; memory can be patchy
What are characteristic traits of hyperactive delirium?
-restlessness
-constant movement
-agitation
-rapid speech
wandering
What is hyperactive delirium normally mistaken for?
- BD
- schizophrenia
- agitated dementia
What are characteristic traits of hypoactive delirium?
- slow movement
- unresponsiveness
- apathy
T/F: Hypoactive delirium is often mistaken for anxiety.
if F, correct
- F
- often mistaken for depression
What method is used delirium screening?
Confusion Assessment Method
CAM
What symptoms must a client have to have a positive CAM test?
- acute onset of symptoms and fluctuating course
- inattention
- disorganized thinking or altered level of consciousness
T/F: precipitating factors are considered predictive
if F, correct
- F
- predisposing are predictive
What is a predisposing factor (def)?
- any baseline characteristic that is present upon admission
- patient dependant
What are the major categories of predisposing factors? (7)
- demographic characteristics
- cognitive status
- functional status
- sensory impairment
- decreased oral intake
- drugs
- coexisting medical condition
Give 5 examples of predisposing factors..
(doesn’t have to be exactly these)
- dementia
- immobility
- history of falls
- alcohol abuse
- comorbid burden (stroke, depression, renal failure)
Define precipitating factor..
insults or factors related to hospitalization that contribute to a patient’s risk for delirium
What are the 6 categories of precipitating factors?
- drugs
- primary neurologic disease
- incurrent illness
- surgery
- environmental
- prolonged sleep deprivation
Give 6 examples of precipitating factors
- polypharmacy
- psychoactive drugs
- physical restraints
- abnormal lab findings
- meningitis
- intercranial bleeding
T/F: predisposing factors measure one’s vulnerability for delirium and precipitating factors measure the insults they encounter at the hospital
(if F, correct)
-TRUE
T/F: a highly vulnerable individual could only need one noxious insult to be exposed to delirium
(if F, correct)
-TRUE
T/F: there are also protective factors that make someone more vulnerable to experiencing dementia
(if F, correct)
- F
- make someone LESS likely
Give 3 examples of protective factors…
- younger age
- cognitive functioning
- good medical history and general functional status
What are the physiologic stressors related to the neurotransmitter dysregulation hypothesis of delirium? (2)
- cortisol
- hypoxia
T/F: lactic acidosis, hyper or hypoglycemia, IGF decrease, hypercapnia are all metabolic derangements that could lead to delirium
(if F, correct)
TRUE
What are the main electrolytes studied when discussing delirium? (3)
- sodium
- magnesium
- calcium
Which specific allele is associated with risk of delirium?
-e4 allele of apolipoprotein E
involved in the growth, maintenance and repair of myelin
True or false:
Systemic inflammation is a predominant part of many surgical conditions associated with delirium
TRUE
True or false:
there is not a strong link between delirium and inflammation
false
How do peripheral immune cells get to the brain
by altering expression of tight-junction proteins
What does higher blood levels of cytokines have to do with delirium?
patients with post-op delirium have higher levels than those without delirium
what is cascade effects of the brain being activated by peripheral immune cells?
causes cytokin production and neuronal cell proliferation
than the activation of HPA axis which can help to combat acute infection
These changes can contribute to delirium