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6 Cards in this Set
- Front
- Back
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Causes of Delirium
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DELIRIUM
drugs eyes, ears low O2 state (MI, Stroke) infection retention of stool/urine ictal under-hydration/nutrition metabolism subdural hematoma |
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Main symptoms of Delirium/Acute unconsciousness
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CAC, dTPP, A, M, pHD, PM, fS
Consciousness - vary from alert-coma disorientated in TPP (Time, Place, Person) poor Attention span impaired Memory disturbed pDH (perception- delusion, hallucination) incr/decr'd PM - psychomotor activity fluctuating symptoms |
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Pathophysiology of Delirium
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i) diffuse, reversible impairment of cerebral metabolic oxidation and neurotransmission
ii) Cholinergic neurotransmission --impaired in old age & Alzheimer's disease --highly sensitive to toxic&metabolic insults known to ppt delirium --anti-Ch-ergic medication --serum anti-Ch-ergic levels (by radiorec assay) iii) serotonin, catecholamine, GABA |
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High index of suspicion for delirium is needed when there is...
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recent change in an elderly pat's LOC and cognition
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Management of delirium
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i) identify & treat underlying causes:
-usually multiple -need accurate hx: esp drug change & thorough exam -temp, signs of dehydration, possible injuries -Basic Lab: CRP, RFT, LFT, glucose, CXR, urine dipstix&culture, ECG -Other: CT brain if... focal neurological signs, confusion post-head injury, fall, raised ICP -treat underlying causes, stop all non-essential drugs ii) supportive measure: --prevent harm --minimize distress by... -fluid&nutrition -vitamin supplem -avoid physical restraint -spectacles & hearing aid -quiet&well-lit environm -reassurance, re-orientation (calm&friendly staff) --constant supervision till stable -involve family iii) pharmacological therapy -note indications -neuroleptic agents superior than BDZ 1st choice: haloperidol --start low, go slow --few anti-Ch-ergic, sedative&hypotensive effect Other: Lorazepam --for withdrawal state --pat with extra-pyramidal disease |
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Prevention of delirium in high risk pat's
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i) repeated reassurance & orientation of the pat
ii) non-pharmacological sleep promotion iii) early mobilization iv) provide of visual & hearing aids v) avoid dehydration |
