F. Delirium

Question 1

What are the alarm symptoms that point towards delirium?

Answer 1

Sudden onset
Fluctuating Cognition
Inattention 
Disorganized thinking
Altered level of consciousness

Question 2

Why is early detection so important for delirium?

Answer 2

If caught early can treat

Delirium can be the first sign of serious medical conditions such as overmedication/withdrawal, drug interaction, infection, dehydration/electrolyte imbaance, stroke/seizure or renal failure

Question 3

What can Delirium be mistaken as?

Answer 3

Dementia
Depression
Anger
Anxiety
Insominia
Psychosis

Question 4

Why is the elderly brain intrinsically more susceptible to delirium?

Answer 4

Decreased brain reserve
More permeable BBB
Increased inflammatory response

Question 5

What is the pathophysiologic cause of delirium?

Answer 5

Neurochemical imbalance

Question 6

What poor outcomes is Delirium associated with?

Answer 6

Longer hospital stays
Higher chance for hospital bounce back
Higher chances of needing assisted living
Higher healthcare cost
Death

Question 7

Delirium is often superimposed on what other medical condition?

Answer 7

Dementia

Question 8

What is the typical scenario for developing Delirium?

Answer 8

Patient with risk factors has an unrelated medical emergency –>hopital stay worsens condition –> develops delirium (Global brain failure)

Question 9

How do hospital stays alter the liklihood of getting delirium? Why?

Answer 9

2 fold increase during hospital stay

Meds & surgeries
Catheters
Bed Rest & physical restraints
NPO
Noise, lights & blank walls

Question 10

What is the Confusion Assessment Method (CAM)?

Answer 10

Way of diagnosing delirium

Acute onset of altered mental status (confusion, memory or disorientation) & inattention
Plus either disorganized thoughts or altered level of consciousness (arousability or response to stimuli)

Question 11

What are the 2 main ways delirium can present?

Answer 11

Hyperactive (25%) = aggressive, hallucinations & agitation

Hypoactive (75%) = more fatal, confusion, decreased alertness & somnolence (drowsiness)

Question 12

What are the 3 Ds of cognitive impairment?

Answer 12

Delirium
Dementia
Depression

Question 13

How is delirium different than dementia and depression?

Answer 13

Acute onset

Decreases level of consciousness

Question 14

Features of Delirium?

Answer 14

Acute onset
Decreased LOC
Altered sleep/wake
Reversible

Question 15

Features of Dementia?

Answer 15

Insidious onset
Alert & LOC intact
No change in sleep
Irreversible

Question 16

Features of Depression?

Answer 16

Insidious onset
Alert & LOC intact
Altered sleep
Irreversible

Question 17

Similarities among Delirium, Depression & Dementia?

Answer 17

Decreased memory
Impaired judgment, decision making & cortical function
Disorientation

Question 18

How care for somebody presenting with cognitive impairment should be approached?

Answer 18

Treat for delirium until can prove it isn’t

Use non-pharm interventions & utilize a multidisciplinary team (Some drugs are used, but not FDA approved)

Question 19

Treatment of Delirium?

Answer 19

Work with nurses, speech therapist, OT & PT

Be active early, structured setting, restore senses (hearing & vision), minimize meds, remove catheter/restraints, get family involved, correct dehydration & malnutrition

Question 20

How to prevent Delirium?

Answer 20

Same things as treatment

Question 21

What type of care does a patient need if they can’t perform ADLs?

Answer 21

Nursing home

Covered by medicaid but not medicare

Question 22

What type of care does a patient need if they have intact ADLs but not IADLS?

Answer 22

Assisted living

Not covered by medicare or medicaid

Question 23

What type of care does a patient need if IADLS are intact & family is available to help?

Answer 23

Home healthcare

Nursing, OT & PT

Covered by medicare

Question 24

What type of care does a patient need if they had intact ADLs before entering the hospital but now do not?

Answer 24

Short term rehab (Acute rehab hospital or short term nursing home)

Covered by medicare for a couple weeks