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23 Cards in this Set
- Front
- Back
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delirium is a...
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acute confusional state
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Delirium can be diagnosed with up to… sensititivity and specificity using…
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95% using Confusion Assessment Method
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Confusion Assessment Method requires the presence of…
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A and B and either C or D. A: acute fluctuating MS. B: Inattention. C: altered LOC. D: disorganized thinking
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Incidence of delirium in hospitalized elderly patients…
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>20%
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Mortality of delirium in hospitalized elderly patients…
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>20%, similar to MI or sepsis
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Cost of delirium in medicare expenitures (annually)…
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6.9 billion
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Prevention and treatment of delirium requires… why…
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Requires that all factors (predisposing and precipitating) be addressed because it is multifactorial
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Most common causes of delirium..
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Meds, infxn, metabolic problems
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What percentage of cases of delirium can be prevented…
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40%
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Situations of delirium requiring specific treatment…
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EtOH withdrawal, primary psych disorder, primary intracranial process and drug OD
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When should D/C planning with delirium patient begin and when should it be a topic of discussion with patient…
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Should begin immediately and be daily topic.
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Predisposing factors for delirium (large list)…
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Incr age (>65yo), h/o dementia or delirium, depression, immobility, falls, poor functional capacity, Sensory impairment (visual and hearing), malnutrition/dehydration, treatment with psychoactive drugs, tx with many drugs, alcohol abuse, severe coexisting med condition
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Precipitating factors for delirium…
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Meds, infxn, metabolic problems, primary neuro disease, surgery/anesthesia, uncomfortable or different environment, sleep deprivation, urinary retention or constipation
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Management of meds in acute delirium…
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Detailed review with d/c or decrease in possible offenders as well as tox screen and or drug levels
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Possible offender drugs in delirium…
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Anticholinergics, benzos, opiates, antihistamines, entiemetics, sleep meds, steroids, anticonvulsatns, clonidine, antiparkinsons, antipsychotics, muscle relaxants, lithium, polypharm, withdrawal
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Workup for infxious cause of delirium..
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CBC with diff, UA, CXR… further w/u: blood cultures, LP, Cdiff
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Workup for metabo causes of delirium… metabolic causes of delirium…
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w/u: CMP. Causes: hypovolemia (#1) or underperfusion, electrolyte and acid-base disturbances, hypoxia or hypercapnia, hypoglycemia, anemia, uremia, hepatic encephalopathy, thiamine or B12 def, thyroid/adrenal imbalance, HTN encephalopathy, acute cardiac problem
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W/u for primary neuro cause of delirium…
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Neuroimaging if new, inability to perform neuro exam or obtain hx, severly depressed LOC, h/o trauma, fever w/o other source of infxn, no identifiable cause EEG if seizure or nonconvulsive stat epipilepticus suspected
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w/u for uncomfortable or different environment cause of delirium…
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Tx pain aggressively, avoid restraints (Foley, IV, O2, continuous pulse ox), encourage hearing aids, eyeglasses, family, encourage mobility (ambulatioin, PT/OT), reorient patient regulary
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w/u for sleep deprivation cause of delirium…
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Encourage light and stimulating environment during day but dark and quite at night. Consider trazodone or quetiapine
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Pharmacological tx of delirium and who for…
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Only for patients with significant behavioral or emotional problems. Haloperidol 0.5mg-2mg PO/IV bid with extra doses prn, start low in elderly. QT prolongation concern. Atypical antipsychs equally effective, Lorazepam 0.5-1mg PO/IV q 4hrs prn as last resort, implicated as cause of delirium, start with .5mg in elderly. Other tx: sitter (family best) or if absoluelty necessary then restraints
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delirium prevalence... mortality... expense...
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>20% incidence in hospitalized, >20% mortality- similar to MI or sepsis, 6.9billion in medicare
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percentage of cases of delirium that can be prevented...
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40%
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