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Clinical Disciplines II-Exam #1 > Delirium/Dementia > Flashcards

Delirium/Dementia Flashcards

1
Q

What is considered an “Abnormal” score on a Mini Mental Status Exam (MMSE)

A

<24

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2
Q

What MMSE indicates increased odds of dementia? What level of education is this?

A

<21

Abnormal for 8th grade education

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3
Q

What MMSE range is considered NO cognitive impairment?

A

24-30

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4
Q

What is the risk of death in hospitals associated with delirium?

A

10 fold risk

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5
Q

List the 3-5 fold increased risks associated with delirium (other than death)

A
  1. Nosocomial complications
  2. Prolonged stay
  3. Post-acute NH placement
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6
Q

How long following discharge are patients at an increased risk for poor functional recovery and increased risk of death following their delirium?

A

2 years

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7
Q

What % of delirium is recognized by nurses? by physicians?

A

Nurses=50%

MD’s=20%

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8
Q

Clinically, what do we use to diagnose delirium?

A

Confusion Assessment Method (CAM)= 95% sensitivity and specificity

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9
Q

What is the MC type of delirium

A

HYPOactive delirium=50%

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10
Q

What is the other type of delirium? %?

A

HYPERactive delirium=25%

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11
Q

What type of delirium has a poorer prognosis ? Why?

A

HYPOactive delirium:

  1. Less recognized
  2. Not appropriate tx
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12
Q

List the two Neuropathophysiology causes for delirium

A
  1. Cholinergic deficiency

2. Inflammation

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13
Q

Delirium Etiology in cholinergic deficiency? Treatment?

A

Anticholinergic Drug OD

Tx: Physostigmine

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14
Q

What increases with inflammation associated delirium?

A
  1. C-Reactie Protein
  2. IL-1B
  3. TNF
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15
Q

What patients does inflammation delirium especially affect?

A
  1. Postop pt’s
  2. CA pt’s
  3. Sepsis pt’s
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16
Q

List some predisposing factors to delirium

A
  1. Male
  2. Hx of Etoh abuse
  3. Sensory impairment: decreased vision/hearing
  4. Advanced age
  5. Functional impairment in ADL’s
  6. Dementia
  7. Medical Comorbidity
17
Q

List some precipitating factors

A
  1. Acute cardiac/pulmonary event
  2. Fecal impaction
  3. Urinary retention
  4. Infections: Urinary and Respiratory
  5. Drug Withdrawal
18
Q

List the top 3 surgeries that increase the incidence of post delirium. By how much?

A
  1. Cardiac surgery
  2. AAA repair
  3. Hip repair

Increased by 50%

19
Q

How many pre-op risk factors significantly increase incidence of dementia? by how much?

A

3+ RF’s

50%

20
Q

What postop day is peak onset for delirium?

A

2nd

21
Q

What opiod is especially associated with post-op delirium?

A

Meperidine

22
Q

What is the BEST treatment in delirium?

A

Prevention

23
Q

What diagnostic studies are RARELY helpful in the assessment of delirium?

A
  1. Cerebral imaging: Except in head trauma or new focal neuro findings
  2. EEG and CSF: Except in seizure activity and meningeal signs
24
Q

What is the most successful management of delirium?

A

Multifactorial approach

25
Q

What is the appropriate behavioral management of delirium?

A

“Social Restraint”= Sitter

26
Q

Who should receive Lorazepam?

A
  1. Sedative and Alcohol withdrawal

2. Hx of Neurleptic malignant signdrome

27
Q

What do you need to assess/monitor for IF you give a patient Haloperidol?

A
  1. Akathesia
  2. Extrapyramdial effects
  3. QT prolongation
  4. Torsades
  5. Withdrawal dyskinesias
28
Q

List some rehab management in delirium

A
  1. Orienting stimuli: clock
  2. Socialization
  3. Appropriate use of eyeglasses and hearing aids
  4. Mobilize ASAP
  5. Adequate fluids and nutrition
  6. PT/Family education

Clinical Disciplines II-Exam #1 (5 decks)

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