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Flashcards in Altered Mental Status Deck (36):
1

AMS is appropriate for a diagnosis when?

admission...NOT discharge

2

what is a common reason for presenting to the ER?

AMS

3

what is derangement of arousal?

either hypervigilant or obtunded or in between

4

what is PVS?

persistent vegetative state-may be either coma type or stupor type (no upper level cognition)

5

what is evidence of psychosis?

they are crazy-usually have hx of psychotic event
acute process
may be gradual decompensation or stress trigger (most common)

6

what type of process is dementia?

progressive
may worsen with delirium

7

what is characteristic of depression?

intact cognition, but may be slow or disengaged
-can remember three words, but are sad

8

what is the definition of psychosis?

loss of contact with reality (delusions, hallucinations, disorganized thinking)

9

which type of hallucination is more common?

auditory

10

depression is a comorbidity with what?

MI, CVA, PD, CA

11

what is an important question for depressed patients?

have you considered committing suicide?
do you have a plan in place?

12

symptoms of depression vary how?

either agitated or lethargic
eat everything or nothing
hopeless

13

how does patient usually find out that they are demented?

they get lost a lot, otherwise they won't know they are declining

14

what are primary problems of dementia?

short term memory
understanding or following complex instructions
poor driving (take the keys away!!!!), hygiene or grooming

15

what factor improves long term mental health?

education

16

what is the acronym for treatable causes of confusion?

D-dehydration, depression
E-endocrine, electrolyte, environment
M-medications, metabolic
E-eye and ear problems
N-nutritional deficiencies, normal pressure hydrocephalus, neurosyphilis
T-toxicity
I-infection, impaction (cerumen, fecal), ischemia, insomnia
A-anemia, alcohol, anoxia, anesthetic (off-gasing)

17

what is the definition of delirium?

acute, confused state that occurs to a response to an identifiable trigger
REVERSIBLE
specific organic factor

18

what is dysphoria?

disquiet, restlessness, malaise, depression

19

in pts who are in delirium, what do you have to rely on?

physical exam
they won't be able to tell you what hurts, so rule out everything!!!!

20

what are signs of bacteremia?

tachycardia
dilated pupils
diaphoresis

21

what as the #1 cause of delirium?

infection of the chest or urinary tract

22

what was the 2nd leading cause of delirium?

stroke, drugs, MI, fracture

23

what does pulmonary embolis masquerade as?

pneumonia

24

why is delirium tricky to treat?

1/4 pts have multiple factors that cause the problem

25

pts who fall require what type of testing?

bleeding assessment

26

what should be considered with metabolic encephalopathy?

alcohol
hepatic
water
electrolyte
uremic

27

how does a hypertensive crisis present?

severe headache
N/V
visual disturbances
convulsions

28

what is critical about taking hx with delirium/dementia?

give them choices, but don't lead them into the answer
take a full hx including THOROUGH medication review

29

what is the No#1 reason for sleeping in the recliner?

can't breathe when they lie down bc of heart failure

30

what is the only way to get a good sputum culture?

bronchoscopy with sedation

31

who is most at risk for silent MI?

females

32

what is a major drawback of MRI?

takes a long time, pt has to be immobile for a long time

33

what kind of EEG should you order for neurologic questions?

evoked potentials-attempts to promote seizure activity

34

what nutritional deficits are likely to cause altered mentation?

folate and folic acid (can cause nerve damage)
"hang a banana bag"

35

ER protocol if you don't know whats going on

1. amp of narcan
2. amp of D50
3. banana bag

36

why do you have to be patient with delirium?

it can take days to figure out what is going on
treat what you know is happening first and monitor

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