Term
| What are the two theories of the pathogenesis of DELIRIUM? |
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Definition
1. Cholinergic Deficiency with Dopaminergic excess
3. Stress Response/Neuroinflammation |
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Term
| What are the characteristics of DELIRIUM? |
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Definition
1. Impaired Attention/Focus
2. Disorganized THINKING
3. Disturbed consciousness
4. Memory Impairment |
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Term
| What are the three psychomotor subtypes of delirium? |
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Definition
1. Hyperactive
2. Hypoactive
3. Mixed |
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Term
| What are the clinical presentations of DELIRIUM? |
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Definition
1. RAPID onset
2. FLUCTUATES
3. VARIABLE course
4. Generally evidence of underlying condition (ESP DEHYDRATION) |
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Term
| What are the Associated features of DELIRIUM? |
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Definition
1. Sleep/wake disturbance
2. Disturbed psychomotor activity (hypo/hyper or mixed)
3. Illusions
4. Euphoria
5. tremor/tone changes |
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Term
| Which psychomotor clinical presentation is most likely to be missed? |
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Definition
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Term
| What are the most common risk factors for delerium? |
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Definition
1. Dementia
2. MALE gender
3. 65+
4. Illness
- Dehydration
- Hx falls
- polypharmacy |
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Term
| What routine observations and systematic screening tools comprise the assessment perimeters for delirium? |
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Definition
- Validated instruments (CAM, NEECHAM)
- H&P, labs |
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Term
| What are the 4 features looked at the CAM assessment? |
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Definition
1. ACUTE onset/Flux
2. Inattention
3. Disorganized thinking
4. Altered LOC (arousal or stupor) |
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Term
| What is required for a CAM dx of delirium? |
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Definition
1 AND 2 (onset AND inattention)
PLUS 3 OR 4 (disorganized/LOC) |
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Term
| What are some drugs that can cause delirium? |
|
Definition
1. Antihistamines (Benadryl)
2. Antiemetics (Phenergan)
3. Analgesics (Demerol)
4. H2Agonists (Tagamet) |
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Term
| What is the general delirium treatment strategy? |
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Definition
Treat the underlying cause!!
-- IF non-pharmacologic measures don't work and their behaviors interfere wtih tx then treat with drugs |
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Term
| What is the first line drug for tx of delirium? |
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Definition
| Haldol; monitor for cardiac effects |
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Term
| What are some non-pharma tx for delirium? |
|
Definition
-- PROMOTE SLEEP AT NIGHT (Cluster care, low lights, reduce noise, day time activity, bedtime relaxation)
-- Maintain consistency of care givers
-- oxygenate their brain as much as possible (nutrition, hydration, pain management) |
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