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12 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Delirium |
Onset: Hours to days, usually sudden, often in the evening Duration : Hours to less than one month Progression: abrupt, fluctuating Thinking : Disorganised, slow, incoherent Memory: Impaired, sudden Sleep: Nocturnal confusion Awareness: reduce Alertness: flacutates Attention: impaired |
onset duration progression thinking memory and sleep awareness and attention |
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Dementia |
Onset: Months to years , chronic and insidious Duration : months to years Progression: slow but generally steady Thinking : pacuity of though, poor judgement Memory: impaired Sleep: Often disturbed Awareness: Clear Alertness: generally normal Attention: generally normal |
onset
duration progression thinking memory and sleep awareness and attention |
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What are the cause of delirium? |
infections of all kinds, most commonly, bladder (UTI), chest or skininfections; medications, or a combination of medications, including thosepurchased over the counter; heavy alcohol consumption ; withdrawal from drugs and/or alcohol constipation; lack of sleep; dehydration;stress other condition eg Urinary retention (not able to pass urine). |
Infections medication alcohol and drug lifestyle |
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Sudden and new development of: |
Confusion – the patient may seem jumbled and not their usual self. Disorganised thinking or behaviour Emotional upset especially anxiety, bewilderment and/ orsuspiciousness. Restlessness or agitation. Poor short term memory Loss of bowel/ bladder control. |
what are the symptoms of UTI |
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How do we treat delirium? |
Find and give treatment for the underlying condition.Doctors will try to find the cause/s of the condition. Often sometests will be needed. Once the cause/s are identified, specifictreatment can be started. |
TREAT the underlying cause |
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What medicine do we give for urinary incontinence? |
Oxybutynin - withhold until delirium is resolved - direct relaxant effect on S.M - decrease symptoms of urgency and urge in incontinence -used in caution in elderly monitor : constipation |
oxybutynin
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When is antipsychotic used? |
Antipsychotics are only appropriate for patients with BPSD if aggression, agitation or psychotic symptoms are causing severe distress or an immediate risk of harm to the patient or others Antipsychotics do not appear to improve overall functioning, care needs or quality of life in patients with dementia It should be given on a trial basis, and response and adverse effects regularly reviewed - up to four weeks and up to three months |
BPDS trial |
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how do find out the behavioural and psychological symptoms of dementia (BPSD)? |
1.Are the symptoms explained by another psychiatric condition such as depression or delirium? 2.Is the patient taking any medicines that may be causing or contributing to the symptoms? 3.Is the patient in otherwise good physical health? Is there a possibility of undetected pain, infection, constipation or discomfort? 4.Are there any factors in the patient’s living environment, i.e. their home/care facility, or unmet personal needs which may be exacerbating behaviours? |
1. psychiatric symptoms 2. any medication 3 good physical health 4. living environement |
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What can cause dementia? |
Pain Infection (especially urinary tract infection) Dehydration or hyponatraemia Constipation Urinary retention AnxietyFatigue Hearing/visual impairment Poor dental health |
alot of things... |
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What medicines can ppt or worsen BPSD? |
Anticholinergics, e.g. amitriptyline, oxybutynin Anticonvulsants, e.g. carbamazepine, phenytoinLithium Systemic corticosteroids, especially high doses H2 antagonists, e.g. ranitidine Some antibiotics, e.g. ciprofloxacin, norfloxacin, metronidazole, clarithromycin Analgesics, particularly opioids Anti-Parkinson’s medicines ACE inhibitors Digoxin |
alot of durgs... |
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What are the treatment option for anti psychotics? |
Risperidone is the most extensively studied antipsychotic for use in BPSD, and is the only atypical antipsychotic approved for this use in New Zealand. Quetiapine appears to be increasingly used in older people, as it is safer than other antipsychotics (including risperidone) low doses (< 100 mg/day) is generally well tolerated in older people. Low-dose haloperidol has a restricted place in the short-term management of the acute symptoms of delirium |
3 meds |
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What are the adverse effect of anti psychotics |
CNS dperession w/ benzodiazepine, opioid, antihistamine, anit parkison, antidepressant Anticholinergic effect - with oxybuynin, antidepressant and opioid analgesics Dizziness and postural hypotension - falls with antihypertensive, diuretic, SSRI metabolic changes - BSL Hba1c , every 3 months, and year infection - in particulary urinary tract and penumonia |
CNS depression anticholinergic effect monitoring infections |
