Neurocognitive Disorders - Delirium Flashcards
delirium settings
Commonly seen on inpatient medical/surgical units and in extended care facilities
1/3 of hospitalized medical patients older than 70
15% of patients older than 70 presenting to ED
Under-Recognized by health care professionals
delirium
a MEDICAL ILLNESS, an ACUTE confusional state, caused by the direct physiological consequences of a general medical condition (typically multiple fx).
- often (not always) accompanied by perceptual/emotional disturbances.
- usu lasts days-weeks, may persist
- most common complication of hospitalized elderly patients
- source of patient and caregiver distress
- inc morbidity/mortality/institutionalization/dementia
- inc health care costs (inc length of stay)
delirium clinical features
- acute onset
- fluctuating course
- inattention
- disorganized thinking
- altered level of consciousness
- cognitive deficits
- perceptual disturbances
- psychomotor disturbances (hypO or hypER active)
- altered sleep-wake cycle
- emotional disturbance
delirium risk fx
Dementia Older age Immobility Sensory impairment (visual/hearing) Dehydration/malnutrition Alcohol abuse Treatment with many drugs (esp. psychoactive) Underlying severe medical illness (renal, hepatic, cardiac, etc.)
delirium precipitating factors (drugs)
Benzodiazepines Narcotics Anticholinergics* Steroids Elevated levels (e.g. digoxin) Anticonvulsants Alcohol/drug withdrawal
elderly are sensitive
anticholinergic side effects
RED as a BEET - flushed skin
DRY as a BONE - dry skin/membranes, urinary retention
BLIND as a BAT - mydriasis
HOT as a HARE - fever
MAD as a HATTER - mental status change
precipitating fx of delirium
Infections/fever Post-operative states Metabolic disorders Cardiovascular disorders Hypoxia Sleep deprivation Use of physical restraints or catheters CNS disorders (subdural hematoma)
delirium EEG findings
usually diffuse slowing
delirium tremens –> low-voltage fast-activity waves
hepatic encephalopathy - triphasic waves
May help distinguish atypical delirium from a primary psychiatric disorder
Can ID occult seizure disorder
Longer delirium duration and severity associated with increased incidence of _____
Longer delirium duration and severity associated with increased incidence of DEMENTIA
Delirium prevention
Address risk fx
Provide orienting communication (use family)
Encourage early mobilization
Use visual and hearing aids
Prevent dehydration
Provide uninterrupted sleep time
Prophylactic meds (?) – benzos to prevent delirium tremens in alc w/d, antipsychotics to prevent post-operative delirium
delirium management
medical eval/stabilization
remove physiologic stressors
some may not be able to fully stabilize
quiet room, lights in AM, dark PM
avoid xs sensory stim
orientation cues (clock, pics)
hearing aids, eyeglasses
exercise
trained sitters/nurse
pharmacologic management of delirium
antipsychs may help decrease delirium severity/duration
- can decrease the effects of irreversible dementia that may result
cholinesterase inhibitors for delirium
trials have been disappointing
delirium is characterized by which NT changes?
increased DA, decreased ACh
T/F
When the underlying medical abnormality causing delirium is successfully addressed, the associated cognitive difficulties will always fully resolve.
Ideally, true.
