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Geriatrics Exam 2 > Delirium > Flashcards

Delirium Flashcards

1
Q

is delirium a syndrome or a disease/disorder

A

syndrome

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2
Q

DSM-5 for delirium

A
  • disturbance in attention
  • develops over short period of time and fluctuates
  • change from baseline
  • disturbance in cognition
  • not better explained by another preexisting disorder (dementia)
  • evidence that it is caused by medical condition, substance intoxication or withdrawl, or medication side effect
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3
Q

3 different types of delirium

A

hyperactive, hypoactive, mixed

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4
Q

most commonly missed type of delirium

A

hypoactive

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5
Q

how many adults admitted to general medical service get delirious

A

1/3

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6
Q

who has higher rates of delirium - medical patients or surgical patients

A

surgical - specifically post-op hip fracture and post-op cardiac patients

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7
Q

percentage of ICU admissions who get delirium

A

70-80%

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8
Q

delirium prognosis

A

more institutionalization
persistence of cognitive symptoms
higher 2 year mortality

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9
Q

risk factors/predisposing factors for delirium

A
  • age >70
  • dementia
  • functional ADL impairments
  • high medical co-morbidity
  • EtOH abuse or history of
  • male
  • sensory impairment
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10
Q

precipitating factors for delirium

A
  • acute cardiac events
  • acute pulmonary events
  • bed rest
  • sedative or EtOH withdrawl
  • fluid/lyte abnormalities
  • **infections
  • ** meds
  • intracranial events
  • anemia
  • uncontrolled pain
  • urinary retention
  • indwelling devices
  • restraints
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11
Q

life threatening causes of delirium

A 
Wernicke's 
Hypoxia
Hypoglycemia
Hyper or hypo thermia 
Intracerebral hemorrhage 
Meningitis/encephalitis
Poisoning 
Status epilepticus
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12
Q

why is delirium more common with increasing age

A
  • more CNS disease and less CNS reserve

- age and disease related cardiac, pulmonary, renal, hepatic dysfunction

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13
Q

drugs associated with delirium

A
  • antipsychotics
  • antidepressants
  • anticholinergics
  • H2 blockers
  • cardiac drugs
  • sedative hypnotics
  • narcotics
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14
Q

what should you be thinking of when someone presents with delirium

A
  • metabolic problems
  • medications
  • infection
  • iatrogenic
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15
Q

focal neurologic mimics of delirium

A
  • temporal-parietal (Wernicke’s)
  • occipital (Anton’s syndrome)
  • frontal (tumor, trauma)
  • non-convulsive status-epilepticus
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16
Q

first 3 steps in assessing delirium

A
  1. assess baseline level of function
  2. determine level of consciousness
  3. formal cognitive assessment
17
Q

how to determine baseline level of function

A
  • distinguish pre-existing cognitive dysfunction from delirium
  • obtain additional history on baseline level of function from family, friends, PCP
18
Q

how to assess level of consciousness

A

RASS (Richmond Agitation Sedation Scale)

GCS (doesn’t factor in agitation)

19
Q

what to do if RASS is -4 or -5

A

stop and reassess pt at a later time –> we are watiting for a fluctuation in function

20
Q

what is the formal cognitive assessment used in delirium

A

CAM or CAM-ICU (confusion assessment method)

21
Q

What makes up the CAM score

A

has to have both: 1) acute onset & fluctuating course; 2) inattention
has to have at least one of: 3) altered level of consciousness; 4) disorganized thinking

22
Q

how to assess inattention

A
  • digit span test
  • say day of week backwards
  • say months of year backwards
23
Q

how to assess disorganized thinking

A
  • rambling speech

- repeating things over and over again

24
Q

3 main steps for delirium management

A
  1. PREVENTION!
  2. treat underlying disorder
  3. manage symptoms
25
Q

steps to prevent delirium

A
  • repeated orientation
  • early walking/mobilization
  • cognitive stimulation 3x/day
  • early removal of catheters, lines, restraints
  • optimize sensory input
  • correct dehydration
  • environmental/behavioral changes before antipsychotics
26
Q

patient-care program to prevent delirium

A

Hospital Elder Life Program (HELP)

27
Q

things to consider when managing the underlying disorder

A
  • EtOH, benzo, opiate withdrawl?
  • meds?
  • infections?
  • fluids/electrolytes?
  • hypoxia?
  • metabolic disorders
28
Q

pharmacological symptom management

A
  • correct psychological abnormalities 1st
  • antipsychotics - agents of choice
  • HALOPERIDOL best data and safest
  • start low, go slow!!!**
29
Q

what drugs should you avoid in management of delirium

A
  • benzos

- Benadryl

Geriatrics Exam 2 (1 decks)

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