Ger 6 Delerium Flashcards
What is a patients risk for delirium defined by?
The sum of predisposing and precipitating factors
If there are more predisposing factors present for delirium, what does this mean in regards to precipitating events?
There are fewer precipitating events required to cause delerium
What are the predisposing factors for delirium?
- Advanced age
- Preexisting dementia
- History of stroke
- Parkinson disease
- Multiple cormorbid conditions
- Impaired vision
- Impaired hearing
- Functional impairment
- Male sex
- History of alcohol abuse
What are precipitating factors for delirium?
- New acute medical problem
- Exacerbation of chronic medical problem
- Surgery/anesthesia
- New psychoactive medication
- Acute stroke
- Pain
- Environmental change
- Urine retention/fecal impaction
- Electrolyte disturbances
- Dehydration
- Sepsis
What is the briefest method used to evaluate delirium?
The confusion assessment method (CAM)
What are the 4 key features of delirium that CAM examines?
- Acute change in mental status and fluctuating course
- Inattention
- Disorganized thinking
- Abnormal level of consciousmess
What does the diagnosis of delirium by CAM requires?
Features of (1) acute change in mental status and fluctuating course and (2) inattention
AND EITHER
(3) Disorganized thinking OR (4) Abnormal level of consciousness
What are 6 risk factors for delirium that the Hospital Elder Life Program (HELP) targets?
- Cognitive impairment
- Sleep deprivation
- Immobility
- Visual impairment
- Hearing impairment
- Dehydration
When are the 6 factors for delirium that HELP targets assessed?
At admission
If patients have 1 or more risk factors according to the HELP for delirium, what is done?
They receive targeted interventions to address them (warm milk, back rubs, soothing music at bedtime)
What is the most effective, proven approach to prevent delirium?
Proactive, multifactorial, nonpharmacological intervention (like HELP)
When should risk factors for delirium be assessed?
On admission to the hospital
How often should high-risk patients be screened and using what methods?
On admission and at least daily
-You ca use methods like CAM
During H&P what is important to determine with regards to mental status changes?
It is important to determine the timeline of mental status changes
Are acute (sudden) onset changes more consistent with delirium?
YES
What else with regards to mental status is important to note?
Whether the mental status has fluctuated since onset
What must be evaluated with regards to potential cause for mental status changes?
Underlying causes like medication history, vital signs, ect.
Can lab testing, imaging, and EEGs substitute for H&P in the diagnosis of delirium?
NO
What might lab testing, imaging, and EEGs be useful for in the diagnosis of delirium?
To identify possible causes of delirium and contributing factors
When are medication used in delirium?
The are used for such symptoms of delirium as delusions or hallucinations that are frightening to the patient or for the patient behaviors that are dangerous to themselves or others
Why must pharmacologic intervention be used cautiously?
It may prolong delirium and increase the risk for complications by converting a hyperactive patient into a stupors one whose risk for a fall or aspiration is increased
What is considered the treatment of choice?
High potency antipsychotics
Why are high-potency anti psychotics considered the treatment of choice?
Because they have low anticholingergic potency and minimal risks for hypotension or respiratory depression
What are some of the drugs used for delirium?
- Haloperidol
- Olnzapine
- Quetiapine
- Risperidone
- Lorazepam
What is the % range of post-op delirium rates among seniors after elective surgery like a total joint replacement?
15-25%
What is the % range of post-op delirium rates among seniors after a high-risk procedure like a hip fracture or cardiac surgery?
Over 50%
What % of delirium cases go unrecognized and undocumented by the treating clinical team?
50-80%
What is the timeline for patient with delirium who will probably fully recover?
Delirium that persists for less than 2 weeks
What is the timeline for patients with delirium who are much less likely to return to baseline function?
Delirium that lasts longer than 2 weeks
