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N232 > Module 7: Delirium > Flashcards

Module 7: Delirium Flashcards

1
Q

Delirium (del) vs Dementia (dem):

What are the onsets?

A 
Del = Acute
Dem = Insidious
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2
Q

Delirium vs Dementia:

What are the durations?

A 
Del = Days to weeks
Dem = Months to years
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3
Q

Delirium vs Dementia:

What does the course the disease look like?

A 
Del = Fluctuating 
Dem = Slowly progressive
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4
Q

Delirium vs Dementia:

What does their consciousness look like?

A 
Del = Impaired/fluctuating 
Dem = Clear until illness progresses
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5
Q

Delirium vs Dementia:

What does their memory/attention look like?

A 
Del = inattentive, Poor memory without marked inattention 
Dem = Difficulty concentrating, memory intact minimally impaired until disease progresses
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6
Q

Delirium vs Dementia:

What id their affect?

A 
Del = Variable
Dem = Variable
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7
Q

Why are morning/baseline assessments extremely important for delirium?

A

Because if you know the patients norm, you will be able to identify whether or not this is an episode of delirium or something else

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8
Q

1/3 people have some degree of diagnosed dementia at __ years of age

A

85

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9
Q

What is dementia?

A

A gradual, progressive, irreversible disease that cause cognitive, social, and overall l/o Fx

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10
Q

What are some symptoms of dem?

know at least 4

A
  • Memory loss
  • Inability to learn or remember new information
  • Difficulty with planning and organizing
  • Difficulty with coordination & motor function
  • Personality changes
  • Inability to reason
  • Incontinence
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11
Q

What are some more severe symptoms of dem?

know at least 4

A
  • Disinhibition
  • Poor insight/judgment
  • Inappropriate behavior
  • Aggression
  • Repetitive behavior (wandering, calling out)
  • Paranoia
  • Agitation
  • Hallucinations
  • Difficulty communicating
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12
Q

What is receptive aphasia?

A

Inability to understand what is said

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13
Q

What is expressive aphasia?

A

Inability to express themselves verbally

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14
Q

What percent of elderly pts in the hospital will experience delirium?

A

Up to 60%

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15
Q

How many elderly in the hospital will die from their del?

A

Up to 33%

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16
Q

What is the prognosis for those who do survive? Why?

A

Poor d/t:

  • Poor functional outcomes
  • Higher institutionalization rates
  • Increased risk of cognitive decline
  • Higher mortality rates within following year
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17
Q

Describe del

A

An acute confusional state that is common, serious, often preventable, usually treatable

18
Q

Criteria for del according to the DSM-IV

A
  • Disturbance of consciousness (reduced clarity of awareness) with reduced ability to focus, sustain, or shift attention
  • Change in cognition (memory, disorientation, language) or the development of a perceptual disturbance
  • Disturbance develops over short time period, fluctuates
19
Q

What are the 2 main presentations of del?

A

1) Hyperalert-hyperactive (15-47%)

2) Hypoactive-hypoalert (19-71%)

20
Q

Can a pt present w both hyper and hypo?

A

Yes

21
Q

What are some socio-demographic factors that put someone at a higher risk for del?

A
  • Advanced age
  • Male
  • Residence in an institution
  • Little contact with relatives
22
Q

What are some mental status factors that put someone at a higher risk for del?

A
  • Cognitive impairment (dementia)

- Depression

23
Q

What are some medical problems and medsthat put someone at a higher risk for del?

A
  • Severe medical illness
  • Fracture on admission
  • Polypharmacy
  • Hypotension
  • Fever
24
Q

What are some physical factors that put someone at a higher risk for del?

A
  • Vision and/or hearing impairment
  • Functional impairments/disability
  • Limited activity level
25
Q

What are some lab factors that put someone at a higher risk for del?

A
  • High urea/creatinine ratio
  • Na and/or K abnormalities
  • Hypoxia
26
Q

What are some surgical factors that put someone at a higher risk for del?

A
  • Cardiac thoracic surgery
  • Aortic aneurysm repair
  • Unplanned surgery
  • Immobility after surgery
27
Q

What are some other factors that put someone at a higher risk for del?

A
  • Alcohol abuse
  • Urgent admission to hospital
  • Frequent admissions over the previous two years
28
Q

What are the 2 biggest causes of del?

A
  • Cognitive impairment (dem)

- Polypharmacy

29
Q

What drugs might cause del?

A
  • Sedative-hypnotics
  • Anticholinergics
  • Opiods
  • Anticonvulsants
  • Anti-parkinsonians
  • withdrawl from benzodiazipines
30
Q

What types of infections can often result in del?

A
  • Lower respiratory tract infection

- Urinary tract infection

31
Q

Can dehydration and/or hypovolemia result in dem?

A

No, but these can result in del

32
Q

What kinds of cardiac problems can result in del?

A
  • Congestive heart failure
  • Pulmonary edem
  • Shock
  • Respiratory failure
33
Q

What kinds of intracranial problems can result in del?

A
  • Stoke
  • CHI
  • Cerebral edema
  • Subdural hematoma
  • Meningitis
  • Seizures
34
Q

What drugs are high-risk of causing del?

the classes

A
  • Sedative-hypnotics
  • Narcotics
  • Drugs w anticholinergic effects
  • Histamine-2 blocking agents
  • Anticonvulsants
  • Antiparkinsonians
35
Q

A del pt may be…

A
  • Restless & upset
  • Not make any sense
  • Act differently
  • Drift between sleep & wakefulness
  • Have trouble concentrating
  • See & hear imaginary things
  • Be unaware of surroundings
  • Mix up days & nights
  • Be forgetful
36
Q

Ways to stop/prevent del:

A
  • Discontinuation of unnecessary meds and equipment (eg catheters, restraints )
  • Early detection and management of post-operative complications
  • Early mobilization
  • Adequate hydration and nutrition
  • Use of sensory aids
  • Normal sleep cycle
  • Pain control
  • Cognitively stim activities
37
Q

What is Risperidone used for?

A

T manage schizophrenia, mania, aggression or psychosis associated w dem. A tranquilizing effect in pts who are psychotic

38
Q

What is Haloperidol used for?

A

Acute psychosis of schizophrenia and mania, sever aggression or agitation. A tranquilizing effect

39
Q

What is Quetiapine used for?

A

Schizophrenia, depressive episodes with bipolar disorder, acute manic episodes.

40
Q

What should you monitor for when your pt is on antipsychotics?

A

Monitor their level of consciousness and BP

41
Q

Should you give Ativan to a pt w del?

A

Nope, never, this will make it worse

N232 (9 decks)

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