AMS is appropriate for a diagnosis when?
what is a common reason for presenting to the ER?
what is derangement of arousal?
either hypervigilant or obtunded or in between
what is PVS?
persistent vegetative state-may be either coma type or stupor type (no upper level cognition)
what is evidence of psychosis?
they are crazy-usually have hx of psychotic event
may be gradual decompensation or stress trigger (most common)
what type of process is dementia?
may worsen with delirium
what is characteristic of depression?
intact cognition, but may be slow or disengaged
-can remember three words, but are sad
what is the definition of psychosis?
loss of contact with reality (delusions, hallucinations, disorganized thinking)
which type of hallucination is more common?
depression is a comorbidity with what?
MI, CVA, PD, CA
what is an important question for depressed patients?
have you considered committing suicide?
do you have a plan in place?
symptoms of depression vary how?
either agitated or lethargic
eat everything or nothing
how does patient usually find out that they are demented?
they get lost a lot, otherwise they won’t know they are declining
what are primary problems of dementia?
short term memory understanding or following complex instructions poor driving (take the keys away!!!!), hygiene or grooming
what factor improves long term mental health?
what is the acronym for treatable causes of confusion?
E-endocrine, electrolyte, environment
E-eye and ear problems
N-nutritional deficiencies, normal pressure hydrocephalus, neurosyphilis
I-infection, impaction (cerumen, fecal), ischemia, insomnia
A-anemia, alcohol, anoxia, anesthetic (off-gasing)
what is the definition of delirium?
acute, confused state that occurs to a response to an identifiable trigger
specific organic factor
what is dysphoria?
disquiet, restlessness, malaise, depression
in pts who are in delirium, what do you have to rely on?
they won’t be able to tell you what hurts, so rule out everything!!!!
what are signs of bacteremia?
what as the #1 cause of delirium?
infection of the chest or urinary tract
what was the 2nd leading cause of delirium?
stroke, drugs, MI, fracture
what does pulmonary embolis masquerade as?
why is delirium tricky to treat?
1/4 pts have multiple factors that cause the problem
pts who fall require what type of testing?
what should be considered with metabolic encephalopathy?
alcohol hepatic water electrolyte uremic
how does a hypertensive crisis present?
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
what is the No#1 reason for sleeping in the recliner?
can’t breathe when they lie down bc of heart failure
what is the only way to get a good sputum culture?
bronchoscopy with sedation
who is most at risk for silent MI?
what is a major drawback of MRI?
takes a long time, pt has to be immobile for a long time
what kind of EEG should you order for neurologic questions?
evoked potentials-attempts to promote seizure activity
what nutritional deficits are likely to cause altered mentation?
folate and folic acid (can cause nerve damage)
“hang a banana bag”
ER protocol if you don’t know whats going on
- amp of narcan
- amp of D50
- banana bag
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