F. Delirium Flashcards
What are the alarm symptoms that point towards delirium?
Sudden onset Fluctuating Cognition Inattention Disorganized thinking Altered level of consciousness
Why is early detection so important for delirium?
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
What can Delirium be mistaken as?
Dementia Depression Anger Anxiety Insominia Psychosis
Why is the elderly brain intrinsically more susceptible to delirium?
Decreased brain reserve
More permeable BBB
Increased inflammatory response
What is the pathophysiologic cause of delirium?
Neurochemical imbalance
What poor outcomes is Delirium associated with?
Longer hospital stays Higher chance for hospital bounce back Higher chances of needing assisted living Higher healthcare cost Death
Delirium is often superimposed on what other medical condition?
Dementia
What is the typical scenario for developing Delirium?
Patient with risk factors has an unrelated medical emergency –>hopital stay worsens condition –> develops delirium (Global brain failure)
How do hospital stays alter the liklihood of getting delirium? Why?
2 fold increase during hospital stay
Meds & surgeries Catheters Bed Rest & physical restraints NPO Noise, lights & blank walls
What is the Confusion Assessment Method (CAM)?
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)
What are the 2 main ways delirium can present?
Hyperactive (25%) = aggressive, hallucinations & agitation
Hypoactive (75%) = more fatal, confusion, decreased alertness & somnolence (drowsiness)
What are the 3 Ds of cognitive impairment?
Delirium
Dementia
Depression
How is delirium different than dementia and depression?
Acute onset
Decreases level of consciousness
Features of Delirium?
Acute onset
Decreased LOC
Altered sleep/wake
Reversible
Features of Dementia?
Insidious onset
Alert & LOC intact
No change in sleep
Irreversible
Features of Depression?
Insidious onset
Alert & LOC intact
Altered sleep
Irreversible
Similarities among Delirium, Depression & Dementia?
Decreased memory
Impaired judgment, decision making & cortical function
Disorientation
How care for somebody presenting with cognitive impairment should be approached?
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)
Treatment of Delirium?
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
How to prevent Delirium?
Same things as treatment
What type of care does a patient need if they can’t perform ADLs?
Nursing home
Covered by medicaid but not medicare
What type of care does a patient need if they have intact ADLs but not IADLS?
Assisted living
Not covered by medicare or medicaid
What type of care does a patient need if IADLS are intact & family is available to help?
Home healthcare
Nursing, OT & PT
Covered by medicare
What type of care does a patient need if they had intact ADLs before entering the hospital but now do not?
Short term rehab (Acute rehab hospital or short term nursing home)
Covered by medicare for a couple weeks
