Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

6P > Delirium > Flashcards

Delirium Flashcards

1
Q

Prognosis of geriatric delirium

A

increased mortality in hospital/2 years post
increased morbidity
more cognitive deficits: up to 30-60% at 1 month
lingering impairment at 6 months post-cardiac surgery
less likely to achieve pre-delirium cognitive/functional baseline status, longer course of delirium
Independent risk factor to mortality/morbidity in and after hospitalization
persistent cognitive/functional deficits common in geriatric delirium
GA may lead to lingering cognitive impairments (POCD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Delirium DSM5 criteria

A

A: disturbance in attention and awareness
B: develops over a short period of time, tends to fluctuate in severity during the day
C: additional disturbance in cognition
D: Disturbances in A/C are not better explained by another disorder
E: evidence that disturbance is a direct physiological consequence of another general medical condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hyperactive delirium

A

agitate

differentiate from anxiety, dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hypoactive delirium

A

apathetic
differentiate from depression
less sleep-wake reversal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Delirium clinical features

A 
Poor attention/vigilance
Clouding of consciousness
DIsorientation
Diffuse cognitive impariment
Poor memory
Delusions
Perceptual changes/hallucinations
Language disorder
Disorganized thinking/thought disorder
mood lability
sleep disturbances
psychomotor changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diagnostic process of geriatric delirium

A 
24 hour observation including sleep-wake
anxiety
new incontinence
unsteady gait, falls
dysarthria/incoherence
mood/affect lability
subtle paranoia and hypervigilance
sleep disturbance - vivid dreams/nightmares!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Subjective experience of delirium

A

“Being in a dream”
mental content more related to internal fantasy than external reality
passive
timelessness, sequence loss
loss of “self-consciousness”
loss of self-reflective awareness
Losso f appraisal of self to environment by drawing upon experience in memory
Retrospectively viewed as distressing usually, if recalled
may lead to anxiety, paranoia, and even PTSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Screening for delirium

A

under-recognized esp in those >80 with hypoactive delirium with visual impairment and/or pre-existing dementia
NO reliable screening tool to differentiate delirium and dementia
practically: look for acute-onset/fluctuation in cognition, behaviour, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Confusion Assessment Method

A 
Acute onset and fluctuation AND
inattention AND
disorganized thinking OR
altered LOC
excellent sensitivity, good specificity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pathophysiology of delirium general

A 
Hypotheses:
oxygen deprivation
NT dysfunction
inflammation and cytokines
Physiologic stress on BBB/HPA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Generalized cortical disturbance in delirium

A

reduced cerebral oxidative metabolism/blood flow
Electroencephalographic showing:
- decreased alpha (fast) waves
- increased slow waves - theta, delta

degree of slowing correlates with severity of cognitive dysfunction (except alcohol withdrawal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Delirium tremens cortical activity

A

alcohol withdrawal
increased cerebral metabolism
increased noradrenergic response
EEG: low to moderate voltage fast activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cortical arousal in delirium

A

Reticular activating system: ACh, NE, 5HT
Hypothalamus: his
Basal forebrain: ACh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Autonomic arousal in delirium

A

Sympathetic output (NE) - increased in delirium tremens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Neurochemical dysfunction in delirium

A

ACh: anticholinergic can induce delirium, reversed by physostigmine
DA: dopamine agonists can induce delirium - antipsychotics can treat
NE increased

?GABA decreased
?Serotonin, histamine
?Glutamate increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Delirium Tremens clinical features

A

cessation/reduction in heavy use of alcohol
>=2 features developing within several hours - few days:
- autonomic hyperactivity
- increased hand tremor
- insomnia
- nausea/vomiting
- transient hallucinations/illusions: usually visual, may be auditory (Lilliputian hallucination)
- psychomotor agitation
anxiety
- grand al seizures

Watch for concurrent medica lillness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Alcohol withdrawal time course

A

Symptoms within:
12-24 h for withdrawal
24-48 seizures
72-96 delirium tremens

18
Q

CIWA-Ar

A 
delirium tremens screening
N/V
Headache
Anxiety
Paroxysmal sweats
tremors
agitation
disorientation/clouding of sensorium
visual disturbances
tactile disturbances
auditory disturbances
19
Q

Delirium vs dementia

A

onset
attention usually intact in dementia
fluctuation seen in delirium
EEG markedly slowed in delirium (except alcohol)

20
Q

Delirium vs depression

A

insight often present in depression

21
Q

Delirium vs Lewy Body Dementia

A

infrequent symptom fluctuation

parkisonism/neuroleptic sensitivity frequently seen in LBD

22
Q

Differential diagnosis of memory loss

A

Gradual onset with functional impairment> Dementia
Stepwise, sudden deterioration in cognition, slurred speech, confusion, aphasia, focal weakness: Cerebrovascular disease
Acute cognitive impairment: delirium
Complains of memory loss, decreased concentration, feeling of hopelessness: depression

23
Q

Clinical features of behavioural variant FTD

A

character change and disordered social conduct features intially and throughout disease course
Instrumental functions of perception, spatial skills, praxis, memory intact/relatively well-preserved

24
Q

FTD core diagnostic features

A

insidious onset, gradual progression
early decline in social interpersonal conduct
early impairment in regulation of personal conduct
early emotional blunting
early loss of insight

25
Q

Behavioural supportive diagnostic features of FTD

A 
decline in personal hygiene
mental rigidity, inflexibility
distractibility, impersistence
hyperorality, dietary changes
perseverative and stereotyped behaviour
utilization behaviour
26
Q

Physical supportive diagnostic features of FTD

A

primitive reflexes
incontinence
akinesia, rigidity, tremor
low and labile BP

27
Q

Speech and language supportive diagnostic features of FTD

A 
altered speech output - aspontaneity/economy of speech, pressure of speech
stereotypy of speech
echolalia
perseveration
mutism
28
Q

Investigations of FTD

A

Neuropsychology: significant impariment on frontal lobe tests in absense of severe amnesia, aphasia, or perceptuospatial disorder
Electroencephalopathy: normal on conventional EEG despite clinically evident dementia
Brain imaging: predominant frontal and/or anterior temporal abnormality

29
Q

Predisposing factors of geriatric delirium

A 
cognitive impariment
sleep deprivation
immobility
visual/hearing impariment
dehydration
30
Q

DDx of causes of delirium

A 
DIMS-R
Drugs
Infection
Metabolic disturbances
Structural insults
Retention problems
31
Q

Drug causes of delirium

A

prescribed (narcotics, steroids, anticholinergics, NSAIDs)
OTC (dimenhydrinate, diphenhydramine)
drug intoxication/withdrawal (alcohol, sedative-hypnotics, narcotics

32
Q

Infectious causes of delirium

A

urinary tract, lungs, skin blood

33
Q

Metabolic causes of delirium

A

fluid (dehydration, hypovolemia)
electrolyte disturbances
nutrition (malnutrition, thiamine deficiency, anemia)

34
Q

Structural causes of delirium

A

CV (angina, infarction, CHF)
CNS( stroke/ischemia, concussion)
pulmonary (hypoxia, e.g. COPD)
GI (bleeding with anemia, C. diff, colitis)

35
Q

Retention causes of delirium

A

Urinary

constipation

36
Q

Reducing the medication load in delirium

A

Discontinuing/substituting anticholinergic medications
- benadryl, gravol, hydroxyzine
benztropine
Urinary anticholinergics
AVOID amitriptyline - nortriptyline better tolerated
Avoid cimetidine in elderly
Monitor effects of steroids
Switch narcotics to: hydromorphone, oxycodone, fentanyl

37
Q

Non-pharmacologic measures of delirium management

A 
Minimize use of:
- physical restraints
- catheters
- room transfers
Maintain adequate nutrition, hydration
Optimize sensory input
maintain orientation
decrease enviornmental stimuli
increase mobility earlier
consider family/1:1 sitter
detect, manage pain
38
Q

Physical restraints and delirium

A

Restraints necessary to prevent morbidity?
BUT can increase risk of developing delirium by 4.4 x
Additional morbidities/mortality risk
Avoid limb restraints in frail elderly!

39
Q

Perpetuating factors of delirium in long-term care

A 
Severity predicted by:
Absence of:
- reading glasses
- aids to orientation
- family member
- glass of water
Presence of bed rails/otehr restraints
prescription of >=2 new meds
40
Q

Practical tips in delirium

A 
ask specifically about vivid dreams/nightmares
visual/hearing aids
optimize sensory input
carry voice amplifier
urinary retention/bladder scanner

6P (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions