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14 Cards in this Set
- Front
- Back
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How common is delirium in hospitalized elderly patients? How many of these cases develop after admission?
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15-55% of hospitalized elderly patients have delirium, with half of all cases developing after admission
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Describe the importance of collateral history in the diagnosis of delirium.
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Important to know what their baseline cognition is and how this episode is different
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What are the four criteria for diagnosing delirium?
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"1. Acute onset, fluctuating course
2. Inattention 3. Disorganized thinking 4. Change in level of consciousness" |
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What classes of medications are predisposing risk factors for developing delirium?
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"Benzodiazepines
Anticholinergic Opioids/narcotics EtOH" |
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What are some non-pharmacological precipitating factors for developing delirium?
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"- New acute medical problem (eg. infection)
- Exacerbation of chronic medical problem (eg. COPD) - Surgery (esp. neurosurg, cardiovasc, ortho) - Urinary retention and fecal impaction" |
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"Contrast delirium and dementia in regards to:
Onset Duration Attention LOC Course Thoughts Memory" |
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What routine investigations would you order with a presentation of delirium?
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"CBC
Lytes (metabolic disturbance?) Renal fx Urine (UTI?) CXR (pneumonia?) EKG (cardiac?) Drug levels if applicable" |
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What non-pharmacologic measures can be used in the prevention and management of delirium?
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"Supportive measures: hearing aids, glasses
Calming and frequent reorientation Sleep protocols (quiet time, relaxing music) Out of bed during the day Fluid and nutritional intake Avoid physical restraints" |
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What is the #1 cause of delirium? What about #2 and #3?
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"MEDS
MEDS MEDS" |
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What anticholinergics should be avoided to prevent delirium?
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"TCAs
Antihistamines Bladder stabilizers Gravol (esp. important on the wards!)" |
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What can be used to control agitation and psychotic symptoms in delirium?
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Anti-psychotics (haloperidol most commonly)
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T/F: patients with delirium are at increased risk for the development of dementia
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TRUE
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T/F: an episode of delirium increases the risk of death during hospitalization by 3x
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False. it actually increases 10x
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What are some reasons for why delirium is sometimes missed?
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"- Misperception that confusion is normal in the elderly
- Assumption that all confusion is dementia - No collateral hx - Cognition not always documented by all members of the healthcare team" |
