Nurs623 Exam 3 - Delirum/agitation

Front 1

What is delirium?

Back 1

Acute, fluctuating change in mental status with inattention and altered level of consciousness.

Front 2

What % of delirium is considered hyperactive, hypoactive or a mixture of both?

Back 2

Hyperactive (20%)
Hypoactive (30%)
Mixed (50%)

Front 3

According to the DSM-IV Diagnostic Criteria, what are the clinical features of delirium?

Back 3

Disturbance of consciousness -reduced clarity of awareness of the environment,
reduced ability to focus, sustain, or shift attention;
Change in cognition -
memory deficit, disorientation, language problem, perceptual disturbance,
unexplained by a chronic dementia; 
Acute onset (hours to days) with fluctuating course throughout the day;
Evidence of an illness, trauma, or drug effect.

Front 4

What is agitation?

Back 4

Violent motion,
strong or tumultuous emotions.

Front 5

Physical manifestations of agitation?

Back 5

Continual movement
Fidgeting - pulling at dressings, catheters, sheets, etc.

Front 6

Cognitive manifestations of agitation?

Back 6

Disorientation in one or several spheres
Inability to listen, communicate, or follow commands.

Front 7

True/false?
Agitation frequently
equals delirium.

Back 7

True

Front 8

Name three widely accepted tools used to assess delirium?

Back 8

Ramsay Scale
Sedation Agitation Scale
Richmond Agitation Sedation Scale (RASS)

Front 9

What is the Confusion Assessment Method for the ICU (CAM-ICU)used for?

Back 9

To assess level of delirium
Asess delirium in intubated patients.

Front 10

Reasons delirium remains unrecognized in 66-84% of patients.

Back 10

It is often attributed to dementia,depression,“expected”occurrence in critically ill elderly patient;
underdiagnosed when hyperactivity and/or hallucinations not present;
it is often not looked for (thought about as a diagnosis).

Front 11

How does pathological changes in the body contribute to delirium?

Back 11

Infection and injury resulting in the production of cytokines, cell infiltration, and tissue damage leading to activation of a more systemic response can cause altered patterns of neuronal response that contributes to delirium.

Front 12

What are the three primary neurotransmitters of the brain?

Back 12

Dopamine, γ-aminobutryic acid (GABA), acetylcholine.
Delirium may be related to imbalances in their synthesis, release, and inactivation.

Front 13

List the three categories of risk factors that predisposes a pt to delirium in the acute care setting?

Back 13

Host factors;
Acute illness itself;
Iatrogenic or environmental factors.
Three or more risk factors increases the likelihood of delirium up to 60%.

Front 14

List three risk factors considered host factors that can cause delirium?

Back 14

Age;
Baseline comorbidities;
Baseline cognitive impairment.

Front 15

List three iatrogenic or environmental risk factors for delirium?

Back 15

Metabolic disturbance, anticholinergic meds, sedative/analgesic meds.

Front 16

State two condtion(s)/disease state(s) that are considered risk facors for delirium in the acute care setting?

Back 16

Sepsis, hypoxemia.

Front 17

What is the global severity of illness score?

Back 17

A scoring system that looks at an acute care pt's state of illness to determine the likelihood of developing delirium.

Front 18

History of hypertension and smoking have been linked to subsequent development of delirium,specifically how?

Back 18

Leads to underperfusion of the brain & nicotine withdrawal.

Front 19

Medications are the leading iatrogenic risk factors. List classes of medications that can cause delirium?

Back 19

Benzodiazepines,
Anticholinergic,
Narcotics &
some psychoactive medications.

Front 20

List managemnent stategies for delirium.

Back 20

Control behavior,correct underlying insult & rehabilitate.

Front 21

How can we minimize iatrogenesis?

Back 21

Stop inappropriate medications;
Minimize urinary catheter use;
Minimize restraints (actual & perceived).

Front 22

What are "medical housekeeping" measures that can help to prevent delirium?

Back 22

CNS oxygen delivery (SpO2 > 95%);
hydration (BUN/creat ratio);
attention to electrolytes/glucose;
extra vigilance for medical complications.

Front 23

What are rehab measures that can help to prevent delirium?

Back 23

Bowel regimen;
Nutrition (extra supplements, TF);
Early mobilization;
Pain control.

Front 24

Haldol may be used for anti-psychotic therapy in the management of delirium. What is the most adverse effect that this med can cause?

Back 24

Increased QT -> TdP