Delirium Flashcards
delirium
*disturbance of consciousness with reduced ability to focus, sustain, or shift attention
*a change in cognition or the development of a perceptual disturbance that is not better accounted for
*the disturbance develops over a short period of time and FLUCTUATES
delirium vs dementia
*abrupt onset can help distinguish (dementia is a chronic condition)
*level of attention in demented patients is better, and they are less globally dysfunctional and chaotic
*prolonged or unresolvable delirium is basically a new dementia, however
clinical features of delirium
*poor attention/vigilance
*clouding of consciousness
*disorientation
*diffuse cognitive impairment
*poor memory
*delusions
outcomes of delirium
*causes distress in patients, family, and caregivers
*increased risk for medical complications (self-injury, pneumonia, ulcers, etc)
*may have long-term impact on affect and cognition
*excess mortality
why is delirium more prevalent in elderly patients
*they have more deteriorated organ systems, resulting in less well integrated “inter-organ mechanics”
*they have less reserve (brain cells, pulmonary, cardiac, renal, hepatic function, etc) to make up for the losses or “hits”
*homeostasis is MUCH harder to maintain; systems far from equilibrium respond to smaller insults
pathology of delirium
*DECREASED ACETYLCHOLINE and EXCESS DOPAMINE
*excess dopamine may be a source of the agitation, delusions, and psychosis
*GABA, histamine, serotonin, and cytokines may also be involved
diagnostic work-up for delirium - history
*obtain collateral info on baseline mental status
*ascertain TIME of ONSET of sx
*review medications, esp recent med changes and potential drug interactions
diagnostic work-up for delirium - physical exam
*vital signs (+/- anesthesia records, if pt is post-op)
*pertinent physical findings of systemic disease (cyanosis, thyromegaly, rales, JVD, etc)
*neuro exam
diagnostic work-up for delirium - mental status exam
*emphasize the cognitive exam:
-orientation
-memory
-ability to follow commands
-Mini Mental Status Exam
-draw a clock test
-attention (months in reverse order, etc)
differential dx for delirium (I WATCH DEATH)
I - infection
W - withdrawal
A - acute metabolic
T - trauma
C - CNS pathology
H - hypoxia
D - deficiencies
E - endocrinopathies
A - acute vascular
T - toxins/drugs
H - heavy metals
diagnostic work-up for delirium - lab workup
*CBC
*chem-20
*serum drug levels
*ABG
*urinalysis and culture
*urine drug screen
*EKG
*CXR
*RPR (for syphilis)
*B12
*HIV
*thyroid function tests
*LP
*CT/MRI
*EEG
treatment for delirium
*correct underlying cause!
*high potency antipsychotics (haloperidol) good to help with agitation with minimal sedation
*avoid benzos
*avoid anticholinergics
*provide familiar clues
*facilitate reality
environmental factors that may help treat delirium
*frequent reorientation
*moderate level of sensory stimulus
*minimize caregiver changes
*provide hearing aids/glasses
*family available
*quiet at night (avoid VS, meds, etc)
*avoid restraints
*AMBULATE! emphasize FUNCTION!
