Delirium Lecture Powerpoint Flashcards
Confusion
A problem with coherent thinking, characterized by confused patients unable to think with normal speed, clarity, or coherence, an essential component of delirium
Acute confusion state
Refers to acute state of altered consciousness with disordered attention, diminished speed, clarity, and coherence of thought. Delirium is a special type of confusional state
Delirium
An acute confusional state associated with varying picture of agitation, hallucinations, convulsions, tremor, delusions, and inability to sleep. Often also has psychomotor behavioral disturbances such as hypoactivity/hyperactivity, variable emotional disturbances, and similar symptoms to dementia
5 Key characteristics that define delirium
1) distrubance in attention and awareness
2) short period of time development change from baseline and tends to fluctuate
3) disturbance in cognition such as memory deficit or disorientation
4) cannot be explained by another pre-existing condition (such as dementia)
5) evidence from history/PE/lab findings indicate a causal factor
3 types of altered memory seen in delirium
1) Retrograde (past)
2) antegrade (create new memories)
3) confabulation (misinterpretation or fabrication)
Nearly __% of older medical patients experience delirium at some point during hospitalization, with even higher rates in surgical patients
30%
Delirium vs dementia
Delirium affects mainly attention, vs dementia affects mainly memory
Delirium vs dementia onset
Sudden with definitive beginning vs gradual with unknown beginning
Delirium vs dementia duration
Days to weeks vs permanent
Delirium vs dementia cause
Almost always 2nd to a acute condition vs chronic brain disorder
Delirium vs dementia course
Reversible usually vs slowly progressive
Delirium vs dementia effect at night
Both usually worsen
Delirium vs dementia attention
Greatly impaired vs unimpaired until end stage
Delirium vs dementia orientation
Varied vs always impaired
Delirium vs dementia language use
Slow and incoherent and inappropriate vs sometimes difficutly to finding right word
Delirium vs dementia memory
Varies vs lost especially for recent events
Delirium vs dementia medical attention
Immediate vs required but less urgent
Most common causes of delirium
- Drugs/toxins
- infections
- metabolic derangement
- brain disorders (seizures, head injury)
- systemic organ failure
- physical trauma (burn, hypothermia)
Dementia is or is not a cause of delirium?
is NOT a cause of delirium
Stroke is or is not a cause of delirium?
is typically
Sun downing
A type of delirium, occurs because with less light, broken routine, many unfamiliar faces, a person may not be able to cognitively compensate when their brain is already compromised such as an alzheimer’s patient resulting in a delirious state worsened in the evening
Common causes of post operative delirium (3)
- use of pre op and post op meds
- intraoperative events such as hypoxia or hypotension
- pre-existing unrecognized alcohol or drug use
The bed side chat
A conversation with a patient assessing attentiveness, degree of arousal, etc. by asking them simple questions part of the neurological exam
Confusion Assessment Method (CAM)
A supplemental type of assessment used in patients who there is concern for delirium, not commonly used and not necessarily standard
Neuroimaging is rarely positive following a neurological exam of a patient with ___ findings
non-focal
Differential diagnosis of delirium (4)
- depression
- schizophrenia/psychosis
- dementia
- malingering (faking it to get out of work or obligations)
Delirium treatment (5)
- Room near a nursing station allows for greater observation and socialization
- social visits
- avoidance or minimizing restraints (posey bed cover like at porter or pillowcase tying of extremities like something we’d do at a sleepover)
- haldol (haloperidol) antipsychotic
- Ativan (lorazepam) benzos
Delirium treatment (haldol and ativan) ADR’s (3)
- dystonia
- torsades de pointes
- anticholinergic effects
