Dementia / Delirium / Movement Disorders Flashcards
_________ _____ is a more profound deficit that includes disorientation, bewilderment, and difficulty following commands.
A. Confusional State B. Lethargy C. Obtundation D. Stupor E. Coma
A. Confusional State
________ is a state similar to lethargy in which the patient has a lessened interest in the environment, slowed responses to stimulation, and tends to sleep more than normal with drowsiness in between sleep states.
A. Confusional State B. Lethargy C. Obtundation D. Stupor E. Coma
C. Obtundation
______ is a state of unarousable unresponsiveness
A. Confusional State B. Lethargy C. Obtundation D. Stupor E. Coma
E. Coma
________ consists of severe drowsiness in which the patient can be aroused by moderate stimuli and then drift back to sleep.
A. Confusional State B. Lethargy C. Obtundation D. Stupor E. Coma
B. Lethargy
____ means that only vigorous and repeated stimuli will arouse the individual, and when left undisturbed, the patient will immediately lapse back to the unresponsive state
A. Confusional State B. Lethargy C. Obtundation D. Stupor E. Coma
D. Stupor
______-__ syndrome is a rare form of paralysis due to injury to the anterior brainstem with sparing of the RAS.
These patients will be awake and aware, but limited in their ability to communicate.
Locked-In Syndrome
A ______ state, or severe ______, are both syndromes that inhibit the patients ability to respond appropriately due to limited brain impairment
Catatonic State
Abulia
In locked-in syndrome, patients will often have a ________ gaze.
Vertical
T/F: Abulic patients will have occasional spontaneous purposeful movements.
True
Which portion of the neurological examination is helpful when evaluating and differentiating coma, catatonic state, or neurologically brain dead?
Cranial Nerves
Should a comatose patient be capable of pushing the examiner’s hand away when they’re introducing painful stimuli?
No, this reaction would not be consistent with coma
In what clinical settings are patients most likely to experience delirium?
- ICU Admission (70%)
- Post-Op (10-50%)
- Hospice (42%)
- SNF (16%)
- ED (10%)
Delirium is often secondary to _________.
Infection
What common conditions result in delirium?
- Dehydration, Electrolyte Imbalance
- Infection (UTI)
- Withdrawal
- Hypoglycemia
- Post-op states
Would you expect to see focal neurological findings in a patient with delirium?
No, typical they have non-focal neurological findings
T/F: Excited Delirium is the lest common type of delirium
False
It is the most common..
Other than lab work, what tests/procedures could you preform if there was no obvious or determined cause of the patient’s delirium?
What may these things rule out?
- EEG (r/o seizures)
- LP (r/o meningitis)
- MRI (Infarcts, Leptomeningeal Disease)
How is delirium managed?
Treat Underlying Cause
Supportive Care
What ‘method’ is used to diagnose and evaluate delirium?
Confusion Assessment method (CAM)
What are preventative measures taken to help prevent or limit delirium?
- Orientation Protocols
- Stimulation
- Sleep Aids
- Early Mobilizations (limit Restraint Use)
- Avoid Problematic Medications
How can you differentiate delirium from dementia?
Delirium: Rapid Onset, Reversible
Dementia: Gradual decline and deterioration of cognitive function
When taking a good history and physical on a patient being worked up for dementia, it is important to establish what?
A baseline cognition
What is the most common form of dementia?
Second most common form?
First: Alzheimer’s Disease
Second: Vascular Dementia (ie: CVA)
Dementia is diagnosed using what?
Mini-Mental Status Exam
