Delirium

Question 1

What are 5 key characteristics which are used to clinically Dx a PT with Delirium?

Answer 1

1. Disturbance in attention and awareness
2. Short onset (hrs to days)
3. Cognition disturbance (memory deficit / disorientation)
4. Does not fit criteria of any other neurocognitive disorder
5. Any causal factor (medical condition, substance intox, medication SE)

Question 2

If you were trying to educate your PT’s family on the differences between dementia and delirium; how would you explain it to them?

Answer 2

DEMENTIA affects MEMORY
~~~Permanent, slow onset, worse at night
DELIRIUM affects ATTENTION
~~~Reversible, quick onset, altered level of consciousness, worse at night

Question 3

Between delirium and dementia; which requires immediate medical attention?

Answer 3

Delirium!!

Question 4

You suspect your 68 y/o PT is suffering from delirium; what potential causes may have led to this PTs condition?

Answer 4

Drugs (abuse, withdrawal, toxins)
Infections (sepsis)
Metabolic Disturbances
Brain disorder
~~~Epilepsy, TBI, Psych Disorder, Encephalopathy
Systemic Organ failure
Physical disorders (burns, electrocution, hypo/hyperthermia, etc)

Question 5

Your 68 y/o PT presents to your family clinic with baseline cognition changes which came on over the past couple days; what studies should you consider ordering?

Answer 5

Blood culture
Urine culture
CXR (All three of these will r/o infxn)

EKG r/o MI / Silent MI
Lumbar puncture –> r/o meningitis
Pulse Ox / ABGs

Question 6

What should you differential include as you’re working up a PT with suspected delirium?

Answer 6

Depression
Schizophrenia (co-observed together) / Psychosis
Dementia
Malingering

RULE OUT INFECTIONS, ELECTROLYTE IMBALANCES, AND STROKES!!!!

Question 7

What Rx therapy would you consider to manage a PT’s delirium?

What is the Rx’d dosage?

Answer 7

Haldol (haloperidol) 0.5 to 1 mg PO (or IM) q12hrs PRN for AGITATION

Ativan (Lorazepam) 0.5 to 1mg PO (or IM) q6hrs PRN for AGITATION

Question 8

Your 68 y/o PT is suffering from delirium and you are going to Rx them Ativan (lorazepam) or Haldol (haloperidol); what adverse side effects should you educate your PT about?

Answer 8

Torsades de points (IV haloperidol)

Extrapyramidal reactions

Dystonic reactions

Anticholinergic effects

Worsened delirium