Delirium Lecture Powerpoint

Question 1

Confusion

Answer 1

A problem with coherent thinking, characterized by confused patients unable to think with normal speed, clarity, or coherence, an essential component of delirium

Question 2

Acute confusion state

Answer 2

Refers to acute state of altered consciousness with disordered attention, diminished speed, clarity, and coherence of thought. Delirium is a special type of confusional state

Question 3

Delirium

Answer 3

An acute confusional state associated with varying picture of agitation, hallucinations, convulsions, tremor, delusions, and inability to sleep. Often also has psychomotor behavioral disturbances such as hypoactivity/hyperactivity, variable emotional disturbances, and similar symptoms to dementia

Question 4

5 Key characteristics that define delirium

Answer 4

1) distrubance in attention and awareness
2) short period of time development change from baseline and tends to fluctuate
3) disturbance in cognition such as memory deficit or disorientation
4) cannot be explained by another pre-existing condition (such as dementia)
5) evidence from history/PE/lab findings indicate a causal factor

Question 5

3 types of altered memory seen in delirium

Answer 5

1) Retrograde (past)
2) antegrade (create new memories)
3) confabulation (misinterpretation or fabrication)

Question 6

Nearly __% of older medical patients experience delirium at some point during hospitalization, with even higher rates in surgical patients

Answer 6

30%

Question 7

Delirium vs dementia

Answer 7

Delirium affects mainly attention, vs dementia affects mainly memory

Question 8

Delirium vs dementia onset

Answer 8

Sudden with definitive beginning vs gradual with unknown beginning

Question 9

Delirium vs dementia duration

Answer 9

Days to weeks vs permanent

Question 10

Delirium vs dementia cause

Answer 10

Almost always 2nd to a acute condition vs chronic brain disorder

Question 11

Delirium vs dementia course

Answer 11

Reversible usually vs slowly progressive

Question 12

Delirium vs dementia effect at night

Answer 12

Both usually worsen

Question 13

Delirium vs dementia attention

Answer 13

Greatly impaired vs unimpaired until end stage

Question 14

Delirium vs dementia orientation

Answer 14

Varied vs always impaired

Question 15

Delirium vs dementia language use

Answer 15

Slow and incoherent and inappropriate vs sometimes difficutly to finding right word

Question 16

Delirium vs dementia memory

Answer 16

Varies vs lost especially for recent events

Question 17

Delirium vs dementia medical attention

Answer 17

Immediate vs required but less urgent

Question 18

Most common causes of delirium

Answer 18

• Drugs/toxins
• infections
• metabolic derangement
• brain disorders (seizures, head injury)
• systemic organ failure
• physical trauma (burn, hypothermia)

Question 19

Dementia is or is not a cause of delirium?

Answer 19

is NOT a cause of delirium

Question 20

Stroke is or is not a cause of delirium?

Answer 20

is typically

Question 21

Sun downing

Answer 21

A type of delirium, occurs because with less light, broken routine, many unfamiliar faces, a person may not be able to cognitively compensate when their brain is already compromised such as an alzheimer’s patient resulting in a delirious state worsened in the evening

Question 22

Common causes of post operative delirium (3)

Answer 22

• use of pre op and post op meds
• intraoperative events such as hypoxia or hypotension
• pre-existing unrecognized alcohol or drug use

Question 23

The bed side chat

Answer 23

A conversation with a patient assessing attentiveness, degree of arousal, etc. by asking them simple questions part of the neurological exam

Question 24

Confusion Assessment Method (CAM)

Answer 24

A supplemental type of assessment used in patients who there is concern for delirium, not commonly used and not necessarily standard

Question 25

Neuroimaging is rarely positive following a neurological exam of a patient with ___ findings

Answer 25

non-focal

Question 26

Differential diagnosis of delirium (4)

Answer 26

• depression
• schizophrenia/psychosis
• dementia
• malingering (faking it to get out of work or obligations)

Question 27

Delirium treatment (5)

Answer 27

• Room near a nursing station allows for greater observation and socialization
• social visits
• avoidance or minimizing restraints (posey bed cover like at porter or pillowcase tying of extremities like something we’d do at a sleepover)
• haldol (haloperidol) antipsychotic
• Ativan (lorazepam) benzos

Question 28

Delirium treatment (haldol and ativan) ADR’s (3)

Answer 28

• dystonia
• torsades de pointes
• anticholinergic effects