Week 5 Flashcards
Pancreatic Cancer at risk age group
Over 65
Other risk factors for Pancreatic Cancer
- Slightly more men than women are affected by pancreatic cancer.
- Cigarette smoking is one of the biggest risk factors for pancreatic cancer.
Detection and 5 year survival rate of Pancreatic Cancer
- Pancreatic cancer is seldom detected in the early, most curable stages, because it doesn’t
cause symptoms until it has spread to other organs. - Combined five-year survival rate for pancreatic cancer—is very low at just 5 to 10 percent.
Whipple procedure
- Primary surgical treatment for pancreatic cancer that occurs within the head of the gland.
- Removal of the head of the pancreas, most of the duodenum (a part of the small intestine), a
portion of the bile duct, the gallbladder and associated lymph nodes. - On average, the surgery takes six hours to complete.
- Most patients stay in the hospital for one to two weeks following the Whipple procedure
What are the main reasons/ underlying causes for confusion
in older people?
- Infection
- Hypoglycaemia
- Side effects of drugs
- Untreated pain
- Dehydration
- Hypoxia
- Anxiety, depression, psychosis
- Delirium
- Underlying pathophysiology: dementia
Is confusion a normal sign of ageing
no
Possible causes for your patient’s confusion?
Dehydration
Electrolyte imbalance – emotional stress
Lung, liver, heart, kidney, brain disorders
Infection, especially UTI, pneumonia, sepsis
Rx* drugs
Immobility
Untreated pain, unfamiliar environment
Metabolic disorders
DELIRIUM
What assessments do you need to perform for delirium
Comprehensive assessment: FANCAPES or similar
Full physical assessment
Vital signs and oximetry; lab results
Specific assessments:
Medications, mental and neurologic status
How should you respond to your patient with delirium?
- Calm and reassuring voice
- Reorient to time and place and surrounding environment (incl people in the
room) - Tell him that you are not experiencing the hallucination with his right now
(recognition that it is a hallucination not reality) - Ask how the hallucination is affecting him (validating his experience)
- Consider interventions that might be calming (music, or massage, sensory
box) but remember patient centred-ness
How would you document his report of what he is seeing?
Hallucinations (seeing/hearing/ feelings things that are not there)
Confusion Assessment Method - CAM (four features)
Four features for diagnostic algorithm:
Feature 1: Acute Onset and Fluctuating Course
Feature 2: Inattention
Feature 3: Disorganized Thinking
Feature 4: Altered Level of Consciousness
1+2 and either 3 or 4 are considered a diagnosis of delirium until proved
otherwise
Other symptoms of delirium
- disorganised thinking
- poor executive functioning
- disorientation
- anxiety
- agitation
- poor recall
- delusional thinking
Compared to dementia which are the signs unique to delirium?
- Irritability
- Incoherent speech
- Visual hallucinations
- Changing levels of consciousness
Delirium: misdiagnosis, lack of recognition and discrimination
- Frequently unrecognized or misdiagnosed in up to 70% of older patients.
- Often misdiagnosed as mood disorder or dementia
- Particular groups of people face additional delayed diagnosis and
misdiagnosis as a result of discrimination and systemic racism - The term “excited delirium” often used as a reason by police to restrain
racialized groups and reported as cause of death in police custody.
Three types of delirium
Hyperactive, hypoactive, mixed
Hyperactive
- Restless, agitated and aggressive
- They may hallucinate and removed tubes or fall out of bed
Hypoactive
- Inactive, withdrawn, quiet and sleepy
Mixed
Move between both states
Which medication are most likely related to his change in mental status?
Drug induced delirium is most likely linked to benzodiazepines, opiates, anti depressants and anticonvulsants
How would you explain to his family what is happening?
- Explain that he is experiencing delirium, explain what delirium is
- Explain the symptoms: unable to think clearly, inattention, not fully aware of
environment - Explain duration (a few hours to days)
- Usually only temporary and reversible if treated – treatment focuses on
cause of delirium and avoiding worsening delirium
Things to look at for this week
Posted delirium video, delirium and covid, experiences with delirium, delirium index
