Module 7: Delirium Flashcards
Delirium (del) vs Dementia (dem):
What are the onsets?
Del = Acute Dem = Insidious
Delirium vs Dementia:
What are the durations?
Del = Days to weeks Dem = Months to years
Delirium vs Dementia:
What does the course the disease look like?
Del = Fluctuating Dem = Slowly progressive
Delirium vs Dementia:
What does their consciousness look like?
Del = Impaired/fluctuating Dem = Clear until illness progresses
Delirium vs Dementia:
What does their memory/attention look like?
Del = inattentive, Poor memory without marked inattention Dem = Difficulty concentrating, memory intact minimally impaired until disease progresses
Delirium vs Dementia:
What id their affect?
Del = Variable Dem = Variable
Why are morning/baseline assessments extremely important for delirium?
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
1/3 people have some degree of diagnosed dementia at __ years of age
85
What is dementia?
A gradual, progressive, irreversible disease that cause cognitive, social, and overall l/o Fx
What are some symptoms of dem?
know at least 4
- 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
What are some more severe symptoms of dem?
know at least 4
- Disinhibition
- Poor insight/judgment
- Inappropriate behavior
- Aggression
- Repetitive behavior (wandering, calling out)
- Paranoia
- Agitation
- Hallucinations
- Difficulty communicating
What is receptive aphasia?
Inability to understand what is said
What is expressive aphasia?
Inability to express themselves verbally
What percent of elderly pts in the hospital will experience delirium?
Up to 60%
How many elderly in the hospital will die from their del?
Up to 33%
What is the prognosis for those who do survive? Why?
Poor d/t:
- Poor functional outcomes
- Higher institutionalization rates
- Increased risk of cognitive decline
- Higher mortality rates within following year
Describe del
An acute confusional state that is common, serious, often preventable, usually treatable
Criteria for del according to the DSM-IV
- 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
What are the 2 main presentations of del?
1) Hyperalert-hyperactive (15-47%)
2) Hypoactive-hypoalert (19-71%)
Can a pt present w both hyper and hypo?
Yes
What are some socio-demographic factors that put someone at a higher risk for del?
- Advanced age
- Male
- Residence in an institution
- Little contact with relatives
What are some mental status factors that put someone at a higher risk for del?
- Cognitive impairment (dementia)
- Depression
What are some medical problems and medsthat put someone at a higher risk for del?
- Severe medical illness
- Fracture on admission
- Polypharmacy
- Hypotension
- Fever
What are some physical factors that put someone at a higher risk for del?
- Vision and/or hearing impairment
- Functional impairments/disability
- Limited activity level
What are some lab factors that put someone at a higher risk for del?
- High urea/creatinine ratio
- Na and/or K abnormalities
- Hypoxia
What are some surgical factors that put someone at a higher risk for del?
- Cardiac thoracic surgery
- Aortic aneurysm repair
- Unplanned surgery
- Immobility after surgery
What are some other factors that put someone at a higher risk for del?
- Alcohol abuse
- Urgent admission to hospital
- Frequent admissions over the previous two years
What are the 2 biggest causes of del?
- Cognitive impairment (dem)
- Polypharmacy
What drugs might cause del?
- Sedative-hypnotics
- Anticholinergics
- Opiods
- Anticonvulsants
- Anti-parkinsonians
- withdrawl from benzodiazipines
What types of infections can often result in del?
- Lower respiratory tract infection
- Urinary tract infection
Can dehydration and/or hypovolemia result in dem?
No, but these can result in del
What kinds of cardiac problems can result in del?
- Congestive heart failure
- Pulmonary edem
- Shock
- Respiratory failure
What kinds of intracranial problems can result in del?
- Stoke
- CHI
- Cerebral edema
- Subdural hematoma
- Meningitis
- Seizures
What drugs are high-risk of causing del?
the classes
- Sedative-hypnotics
- Narcotics
- Drugs w anticholinergic effects
- Histamine-2 blocking agents
- Anticonvulsants
- Antiparkinsonians
A del pt may be…
- 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
Ways to stop/prevent del:
- 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
What is Risperidone used for?
T manage schizophrenia, mania, aggression or psychosis associated w dem. A tranquilizing effect in pts who are psychotic
What is Haloperidol used for?
Acute psychosis of schizophrenia and mania, sever aggression or agitation. A tranquilizing effect
What is Quetiapine used for?
Schizophrenia, depressive episodes with bipolar disorder, acute manic episodes.
What should you monitor for when your pt is on antipsychotics?
Monitor their level of consciousness and BP
Should you give Ativan to a pt w del?
Nope, never, this will make it worse
