Delirium

Question 1

What is delirium? S+S

Answer 1

Acute and fluctuating cognitive disorder. S+S are confusion ,agitation, restless, inattentiveness, disorganized thinking, altered LOC.

Question 2

What can cause delirium in elderly (6 reasons)

Answer 2

1. Infection (sepsis, UTIs), temperature should be 36.5-37.5, look at blood cultures for elevated WBC, positive urine cultures
2. Hypoxia- low SPO2, agitation is a sig
3. Opioid- too much opioids in elderly cause them to go into a delirious state
4. Hyponatremia- low sodium, anything below 135, normal range is 135-145
5. Hypoglycemia- low sugars, normal 3.5-5.5
6. Post op, extended length of stay in hospital

Question 3

What is alzheimer’s disease?

Answer 3

Memory loss/ confusion, amyloid plaques/neurofibrillary tangles/gradual loss of connections.

Question 4

What is vascular dementia?

Answer 4

Caused by impaired blood flow to brain, 2nd most common type

Question 5

Dementia with lewy bodies?

Answer 5

Type of dementia caused by abnormal deposits by lewy bodies in the brain which leads to problems with thinking/mood/balance/movement.

Question 6

What is frontotemporal dementia?

Answer 6

frontal/temporal brains are affected. Start to shrink and neuron’s get damaged which will cause lack of judgment/missed social cues…

Question 7

What is creutzfeldt-jakob disease?

Answer 7

Caused by protein deposits/or infection (but rare). Protein will affect the neurons in your brain.

Question 8

Risk factors for delirium (modifiable and non modifiable)?

Answer 8

Predisposing (can’t change it)- 75+, cognitive status, decreased functional status, drugs, dehydration, sensory impairment, comorbidities

Precipitating- drugs, neurological diseases, surgery, intercurrent illness, environment, prolonged sleep deprivation

Question 9

Amnesia?

Answer 9

Inability to recall, forgetful

Question 10

Aphagia?

Answer 10

Loss of expression/understanding of written or spoken word

Question 11

Agnosia?

Answer 11

Inability to recognize common objects

Question 12

Apraxia?

Answer 12

Loss of ability to initiate purposeful movement

Question 13

Apathy?

Answer 13

Loss of drive/initiative

Question 14

Anosgnosia?

Answer 14

Loss of ability to realize there’s a problem with memory or functioning

Question 15

How to diagnose delirium/what tools to use?

Answer 15

Know health history, physical exam, blood work, MMSE, MOCA test, CAM (confusion assessment method- best)

Question 16

What is haldol?

Answer 16

Given to severely agitated patients, IM, monitor for side effects, can drop their BP, closely monitor patient.

Question 17

True or false: make sure elderly have adequate nutrition and are eating well

Answer 17

True

Question 18

Risk factors for delirium?

Answer 18

Advanced age, alcohol abuse, new prescribed medications, chronic kidney disease.

Question 19

True or false: risk for dehydration in seniors is high because they tend to have decreased thirst and less body water content

Answer 19

True

Question 20

8 Risk factors for falls?

Answer 20

Altered elimination (Urinary incontinence), altered mental status (impulsivity), confusion, symptomatic depression, dizzy/vertigo, anti epileptics/benzodiazepines, gender (male), and decreased ability to rise from a chair.