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23 Cards in this Set
- Front
- Back
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What group of patients has the highest prevalence of delirium?
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Terminally ill patients 80%
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What are the consequences of delirium?
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Increased morbidity and mortality
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3 reasons elderly are at higher risk for delirium:
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-Decreased cholinergic activity
-Vascular changes -Pharmacokinetic changes |
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What is one of the greatest risk factors for delirium?
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Dementia
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4 other risk fx's for delirium:
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-burn patients
-multiple meds -low serum albumin -drug dependency |
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What are 4 cognitive impairments seen in delirium?
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-Attention deficits
-Memory impairment (long and short-term) -Disorientation to time/place -Executive dysfunction |
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2 types of language disturbances seen in delirium:
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Word finding problems
dysgraphia |
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2 types of perceptual disturbances often seen in delirium:
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-Hallucinations
-Misinterpretations/perceptions |
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What types of hallucinations predominate in delirium?
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Visual >>> auditory
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What does an EEG generally show in delirium?
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Generalized slowing
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What would low-voltage with fast activity point to?
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Alcohol or sedative-hypnotic withdrawal
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What type of head injury is associated with delirium?
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subdural hematoma
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What are the 3 major classes of medications used for treating delirium?
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-Antipsychotics
-Cholinesterase inhibitors -Benzodiazepines |
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What is the best "typical" antipsychotic to use? Why?
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Haloperidol - virtually no anticholinergic effects, fast acting
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How much haloperidol should you give to elderly for mild, mod, and severe agitation?
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mild 0.5 mg
mod 1 mg severe 2mg |
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What are 3 major side effects of haloperidol?
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-EPS reactions
-Hypotension -QTc prolongation |
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How can you prevent EPS reactions when giving haloperidol?
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Give it by IV, and with lorazepam
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What atypical antipsychotics can be used for delirium?
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-Aripiprazole - seroquel
-Quetiapine - abilify -Risperidone - risperdal -Olanzepine - zyprexa |
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When are benzodiazepines used for delirium treatment?
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Only in alcohol or sed-hypnotic withdrawal
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Why is benadryl a common contributor to delirium in elderly?
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Anticholinergic
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What is the difference between capacity and competence?
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Capacity can be determined by any clinician
Competence is determined in court |
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3 indications for determining capacity:
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-Refusing treatment
-Consenting for procedure -Seeking to sign out AMA |
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What are the 4 main ingredients of capacity?
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-Able to communicate a choice
-Demonstrate understanding -Appreciate circumstances -Manipulate info rationally |
