Delirium

Question 1

What is the core symptom of delirium?

Answer 1

Disturbed consciousness with decreased attention and environmental awareness

Question 2

Is delirium a rapid or gradual onset?

Answer 2

Rapid onset! hours to days

Question 3

There is often a prodromal phase before delirium sets in – what does it look like?

Answer 3

Fatigue, decreased concentration, irritability, restlessness/anxiety, mild cognitive impairment

Question 4

Are delirium symptoms typically worse during the day or at night?

Answer 4

Night

Question 5

There are three clinical variants of delirium – what are they?

Answer 5

1. Hyperactive – restless, agitated, aggressive
2. Hypoactive – lethargic, apathetic, quiet, confused
3. Mixed – combo of the above

Question 6

Age greater than ____ is risk factor for delirum

Answer 6

65

Question 7

Anitcholinergics, benzodiazepines, alcoho, CV meds (digoxin, diuretics), lithium, opioid analgesics, infection, metabolic disorders can all be causes of?

Answer 7

Delirium

Question 8

What are signs of infection of physical exam?

Answer 8

Fever, tachypnea, pulmonary consolidation, heart murmur, stiff neck

Question 9

If you have patient with an unexplained fever or nuchal rigidity what test should you do?

Answer 9

Lumbar puncture

Question 10

What is delirium so concerning?

Answer 10

it is associated with substantial morbidity and mortality

Question 11

Approximately _____ percent of older medical patients experience delirium at some point during hospitalization

Answer 11

30

Question 12

What three things decrease ACH synthesis?

Answer 12

Hypoxia, hypoglycemia, and thiamine deficiency

Question 13

when is the only time we should use pharmacologic treatment in a delirious patient?

Answer 13

only when the patient is at risk of harming him/herself or others

Question 14

What medication has to be used, what is the DOC for delirium?

Answer 14

Haldol

Question 15

If you prescribe haldol, what else must you monitor?

Answer 15

Get an EKG because you have to monitor QTc due to risk of prolongation

Question 16

If your patient has lewy body dementia, parkinson disease, or AIDS-related dementia, what medication should we use?

Answer 16

Quetiapine

Question 17

When delirium is due to EtOH or benzo withdrawal, how should we treat?

Answer 17

Benzo’s titrated to effect

Question 18

what can we do to prevent delirium?

Answer 18

identify those at risk, provide a calm supportive approach, provide staff/environmental consistency, involve friends and family in patient care, provide meaningful activities to patients, and provide education about delirium

Question 19

Is delirium reversible?

Answer 19

Yes – but may require weeks to months to fully resolve

Question 20

Should we just normalize lethargy to old age?

Answer 20

obviously not