Term
| why is it important to keep organic brain disorders in the ddx |
|
Definition
must exclude before diagnosing anxiety, psychotic, or mood disorders
treatment and prognosis are much different |
|
|
Term
| what are the 5 categories of causes od delirum |
|
Definition
metabolic/endocrine
substance intoxication and withdrawl
medications
infection
other |
|
|
Term
| what are 10 metabolic/endocrine causes of delirum |
|
Definition
| Na, K, Mg, Ca, anoxia, ketoacidosis, hepatic and uremia encephalopathy, thyroid/parathyroid disorders |
|
|
Term
| what are 6 intoxication/withdrawl causes of delirium |
|
Definition
| alcohol, sedatives, opoid OD, cocaine, amphetamines, phencyclidine intoxication |
|
|
Term
| what 9 medicatiosn can cause delerium |
|
Definition
| anticholinergics, BDZ, sedatives, opiates, anti-psychotics, anti-epileptics, seronergics, anti-virals, anti-fungals |
|
|
Term
| what 10 infections can cause delirium |
|
Definition
| pneumonia, encephalitis (viral or bacterial), sepsis, AIDS encephalopathy, TB, mycosis, toxoplasmosis, CMV, UTI esp with dementia |
|
|
Term
| what 13 other conditions cause delirium |
|
Definition
depression
dementia
dialysis dysequlibrium syndrome
hyperthermia
hypertensive crisis
wernicke's encephalopathy - alcoholic
CO poisoning
heavy metal poisoning
MS
SLE
postical confusion: partial/grand mal seizure
cushing syndrome
addisons disease |
|
|
Term
| what are the 8 risk factors for delirium |
|
Definition
| age, dementia, sleep deprivation, opiates, sedatives, restraints, rapid decline in function, severe illness (polypharmacy) |
|
|
Term
| what are the types of delirium and their prevelence |
|
Definition
mixed 46%
hyperactive 30%
hypoactive 24% |
|
|
Term
| what are the 6 general signs of delerium |
|
Definition
confusion
disorientation
short term memory loss
visual hallucinations and agitations
acute onset
rapid deterioration |
|
|
Term
| if someone has myoclonus their delerium could be from (3) |
|
Definition
|
|
Term
| if someone has asterixis their delirium could be freom (2) |
|
Definition
hepatic enceophalopathy
hypoxia |
|
|
Term
| if someone has hyporeflexia their delirium could be from (2) |
|
Definition
|
|
Term
| if someone has ataxia and nystagmus their delirium could be from |
|
Definition
| wernicke's encephalopathy |
|
|
Term
| if someone has lateralizing or focal signs their delirium could be from (2) |
|
Definition
|
|
Term
| if someone has tremor, ragidity, bradykinesia their deirium could be from (3) |
|
Definition
|
|
Term
| what does a mini mental status exam include |
|
Definition
|
|
Term
| what are the 5 parts to initial assessment of someone with delerium |
|
Definition
is the pt safe?
do they need emergency hold?
do they need restraints?
need observation 1:1
percautions for agitation, psychosis, suicide
ICU care with monitoring of vitals, O2, fluids |
|
|
Term
| what are important aspects of a medical history for a delirium pt |
|
Definition
ask nurses, pt family, friends, caretakers, previous physicians
review medical records and meds
previous labs and studies |
|
|
Term
| what labs should you order for dilirium |
|
Definition
CBC, CMP, urinalysis and drug screen, thyroid studies
as needed: lithium levels, CT, MRI, O2 stat/AGB, LP, EEG, XR |
|
|
Term
| what will an EEG show in delirium |
|
Definition
|
|
Term
|
Definition
| Na, K, glucose, BUN/CR, liver enzymes, bilirubin |
|
|
Term
| what are the non-medication tx for delirium |
|
Definition
coordinate with other physicians
monitor safety
monitor other medical conditions
environmental intervention: orientate using lighting, clocks, family, etc
sleep: agv ICU <2h sleep. sedative, opiates, and ventilator pt are not sleeping, their over sedated
remove all cath, line, tube, vent, opiate, sedative asap to reduce hospital stay and prognosis |
|
|
Term
| when diagnosing delirium how do you determine the prefence of order in your ddx, what conditions should come first |
|
Definition
diagnose and tx conditions that are reversible first
hypoglycemia, hypoxia, hyperthermia, hypertension, alcohol/substance withdrawl, anti-cholinergic delirium |
|
|
Term
| what is DOC for psychosis and agitation, how should it be administered, what are the percautions |
|
Definition
haldol and atival (lorazepam) / H2A protocol
IV haldol has better absorption, dosent depend on pt cooperation, and min effect on BP, HR, RR
stop if QTc > 500
stop if QTc > 25% baseline
ativan should be less than half haldol dose |
|
|
Term
| what are alternate medications for delirium |
|
Definition
risperidone
quetiapine + ativan PO
acetylcholinesterase inhibitors: rivastigmine (prevents dilirium), donepezil
a2 agonists: dexmedetomidine
psychostimulatants; hypoactive types |
|
|
Term
| what is the prognosis of delirium |
|
Definition
15% mortality but increases with time
40% recovery (only 4% at discharge)
25% permanent cogantive impairment |
|
|
Term
| what is another name for delirium |
|
Definition
| toxic metabolic encephalopathy |
|
|
Term
| what are the parts to a dementia evaluation |
|
Definition
history: patient, family, chart, nurses
Labs: CBC, CMP, TSH, B12, CT
folstein mini mental status exam
minicognative exam |
|
|
Term
| what is the difference between thw two mental status exams |
|
Definition
folstein: long, maybe education bias, no executive function portion
mini cog: short, less education and culture bias, measures executive functions |
|
|
Term
| what are the 11 steps for a folstein mini mental status exam and their scores |
|
Definition
location 5
date/season 5
repeat 3 obhects 3
sereal 7s/spell wold 5
recall 3 objects 3
name two objects 2
repeat: no ifs ands or buts 1
3 step command 3
read "close your eyes" 1
write a sentence 1
draw intersecting pentagons 1 |
|
|
Term
| what do the score sof a folstein exam mean |
|
Definition
18-30/30 = mild
10-18/30 = moderate
<10 / 30 = severe |
|
|
Term
| what are the steps to the mini cognative exam |
|
Definition
register 3 objects
draw a clock at 11:10 (requires organization)
recall 3 objects |
|
|
Term
| how is a mini mental cognative exam scored |
|
Definition
0 objects recalled = impaired
1-2 objects recalled = look at clock to decide
3 obhects recalled = not impaired |
|
|
Term
| what are the three steps of tx for dementia |
|
Definition
decide level of care: outpt, partial hospital, inpatient, involuntary hold
involve family, friends, caretakers
determine stage |
|
|
Term
|
Definition
| memory problems and decline in social function |
|
|
Term
| what do you need to do in mild dementia |
|
Definition
form alliance with pt, educate family and pt, determine plan, prevent depression and suicide, driving, psychosis, falls
advise on power of attourney, financial planning |
|
|
Term
| treatment of mild dementia |
|
Definition
acetylcholinesterase inhibitior start slow: dnepezil, rivastigmine, galantamine
limit meds adding confusion: anticholinergics, BDZ, anti-psychotics
treat depression with ssri |
|
|
Term
| signs of moderate dementia |
|
Definition
progressive memory loss and impairment of executive and social function
safety issues: driving, cooking, self care, medications, wandering |
|
|
Term
| what you need to do in moderate dementia |
|
Definition
| adress sagety concerns, avoidance of depression, psychosis, agitation, caregiver stress |
|
|
Term
| tx of moderate dementia and side effects |
|
Definition
| memantine (NMDA receptor antagonis): may cause extraparymidal symptoms, tarditive dyskinesia, neuropletic malignant syndrome, metabolic syndrome |
|
|
Term
|
Definition
| incapicated, dependent on others for basic needs, often psychotic or agitated |
|
|
Term
| what you need to do in severe dementia |
|
Definition
duscuss nursing home and preperation for death (CPR/DNR, med withdrawl, feeding tubes)
drugs not effective |
|
|
Term
| what are in the ddx for dementia that must be eliminated (2) |
|
Definition
mild cognative impairment
pseudodementia: major depressive disorder |
|
|
Term
| what is the first, second, and third common form of dementia, what is the prevelence |
|
Definition
50-75% alzheimers
5-35% vascular
20-30% lewy body |
|
|
Term
| how is alzheimers dementia diagnosed |
|
Definition
|
|
Term
| what are the two types of alzheimers dementia |
|
Definition
| early or late onset (before or after 65 yo) |
|
|
Term
| what are 3 causes of alzheimers dementia |
|
Definition
global atrophy
amyloid plaques
neurofibrillary tangles |
|
|
Term
| what are three required signs of alzheimers dementia |
|
Definition
gradual continual decline
social or occupational impairment
memory impairment (inability to learn new information or recall) |
|
|
Term
| you need one of these three symptoms to diagnoze alzheimers dementia |
|
Definition
aphasia: language disturbance
agnosia: failure to recognize or identify obhects despite normal sensory functions
disturbance of executive function: planning, organizing, executing |
|
|
Term
| what determines the prognosis of alzheimers dementia |
|
Definition
| diagnose early, family and pt education, planning, and safety |
|
|
Term
| who gets vascular dementia |
|
Definition
more common in men
associated with HTN, cardiac, and renal disease |
|
|
Term
| signs of vascular dementia |
|
Definition
acute onset
CT/MRI shows CVA
focal/lateralizing signs |
|
|
Term
| what are focal/lateralizing signs |
|
Definition
| hemiparesis, hemiparalysis, hemianopia, hyperactive DTR, babinski |
|
|
Term
| who gets lewy body dementia |
|
Definition
|
|
Term
| signs of lewy body dementia |
|
Definition
parkinsonian: tremor, bradykinesia, rigidity, gair abnormalities
visual hallucinations: auditory and delusions
agitation, varied arousal, depression, frequent falls
poor toleration to anti-psychotics |
|
|
Term
| what is the cause of lewy body dementia |
|
Definition
| dementia due to late stage parkinsons disease |
|
|
Term
| what is another name for picks disease |
|
Definition
|
|
Term
|
Definition
|
|
Term
| symptoms of picks disease |
|
Definition
rapid progression
personality and behavior changes
apathy
impaired judgement
emotional blunting
MRI: prominent frontal-temporal atrophy |
|
|
Term
| causes of substance abuse dementia |
|
Definition
| years of alcoholis, relapses, delerium, falls, subdural hematoma, seizures (hypoxia), cirrhosis |
|
|
Term
| tx for alcohol induced dementia |
|
Definition
| stabilized with abstinence |
|
|
