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Adult Final > Delirium > Flashcards

Delirium Flashcards

1
Q

Gist of the DSM-5 criteria for delirium

A

Acute and fluctuating syndrome of impaired attention and awareness

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2
Q

Most useful bedside assessment tool for delirium and how often should be used

A

Confusion Assessment Method (CAM)Screen at least daily if at risk

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3
Q

Elements of CAM

A
  1. acute change in mental status and fluctuating course2. Inattention ( one of following: digit span, days, months, continuous performance task, serial 7s, “world” backward)3. Disorganized thinking (rambling, unclear, flitting btwn subjects)4. Altered LOC (anything other than alert – vigilant, lethargic, stuporous, comatose)1, 2, and either 3 or 4
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4
Q

Predisposing factors for delirium

A

Advanced age, dementia, prior delirium, dependency in ADLs, medical comorbidities, history etoh use, male, diminished vision/hearing

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5
Q

Precipitating causes for delirium

A

Drugs

Electrolyte distrubances

Lack of drugs

Infection

Reduced sensory input or mobility

Intracranial

Urinary, fecal

Myocardial, pulmonary

Surgery
Causes are usually multifactorial, and sometimes a small insult can push a person over the edge

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6
Q

Medications that can contribute to delirium

A

anythin - even tylenol, antibiotics! Common offendors:Alcohol, anticholinergics (oxybutynin, benztropine), anticonvulsants (primidone, phenobarbital, phenytoin), antiDs (amitriptyline, imipramine, doxepin), antihistamines (diphenhydramine), anti-inflammatory agents (prednisone), antiparkinsonian agents (levodopa-carbidopa, dopamine agonists, amantadine), antipsychotics, barbiturates, benzodiazepines (triazolam, alprazolam, diazepam, flurazepam, chlordiazepoxide), H2 agonists (cimetidine, ranitidine), opioid analgesics (especially meperidine)

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7
Q

Lab tests you may order for delirium based on H & P

A
  • CBC, TFT, serum drug levels, CXR, CMP, UA, arterial blood gases, ECG, serum calcium, blood cultures, ammonia, blood alcohol levels
  • *cerebral imagingrarely helpful unless head trauma or new focal neuro findings.
  • EEG and CSF rarely helpful unless seizure activity or signs meningitis
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8
Q

Prevention/mgmt. strategies for delirium

A
  • ID and reverse contributors
  • Maintain behavioral control (appropriate interactions, family visits)
  • Anticipate and prevent or manage complications (urinary incontinence, falls, ulcers, sleep, feeding Dos, …)
  • Restore function in delirious patients
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9
Q

Pharm mgmt for agitated delirium

A
  • If behavior is dangerous to patient or others and other interventions do not work
  • *Do not newly Rx cholinesterase inhibitors to prevent/tx delirium
  • *Do not use antipsychotics as prophylaxis
  • Agent of choice is typically haloperidol
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10
Q

Possible warning signs of dementia

A

Unkempt appearance, poor historian, difficulty following instructions, repeating the same question, lost in familiar places

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11
Q

Examples of screening instruments for evaluation of cognition

A

Mini-cog, SLUMS, MoCA, Folstein MMSE

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12
Q

Characteristics of normal aging

A
  • Mild decline in memory
  • More effort/time needed to recall new info
  • New learning slowed but well compensated by lists, calendars, etc
  • No impairment in social and occupational functioning
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13
Q

Characteristics of mild cognitive impairment

A
  • Subjective complaint of cognitive decline in at least one domain: memory, executive function, language, or visuospatial perception
  • Cognitive decline is noticeable and measurable
  • No impairment in social and occupational functioning
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14
Q

Characteristics of Alzheimer’s dementia (DSM IV diagnostic criteria)

A
  • Memory impairment &
  • Aphasia OR apraxia or agnosia OR disturbed executive functioning &
    Causes significant impairment in social and occupational functioning and represents a significant decline from previous level of functioning
  • Other medical and psychiatric conditions, including delirium, have been excluded
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15
Q

Alzheimer’s vs vascular vs Lewy body vs frontotemporalOnset

A

Gradual: alz, LBD, FTD (Sudden or stepwise: vascular

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16
Q

Alzheimer’s vs vascular vs Lewy body vs frontotemporalCognitive domains and symptoms

A
  • Alz: memory, language, visuospatial
  • VD: depends on location
  • LBD: memory, visuospatial, hallucination, fluctuating sx
  • FTD: executive dysfunction, personality changes, disinhibition, language, +/- memory
17
Q

Alzheimer’s vs vascular vs Lewy body vs frontotemporalMotor sx

A
  • Alz: rare early, apraxia later
  • VD: correlates w/ischemia
  • LBD: parkinsonism
  • FTD: none
18
Q

Alzheimer’s vs vascular vs Lewy body vs frontotemporal

A
  • progression
  • Gradual but alzheimer’s takes longest
  • VD may be stepwise
19
Q

Alzheimer’s vs vascular vs Lewy body vs frontotemporalImaging

A
  • AD & LBD: possible global atrophy
  • VD: cortical or subcortical changes on MRI
  • FTD: atrophy in frontal and temporal lobes
20
Q

(possible) risk factors for alzheimer’s

A

Advancing age, hx head trauma, late onset MDD, fewer years formal education, RFs for CVD

21
Q

Primary treatment goals for pts w/dementia

A
  • Enhance QoL and maximinze functional performance
  • improve/stabilize cognition, mood, behavior
    recognize that there are no good treatments - that’s why screening is not recommended for (or against) by USPSTF
22
Q

MGMT strategies for dementiaInfo for pt/caregiver

A
  • diagnosis, prognosis, behavioral symptoms
  • home safety
  • adult day cares, respite stays
  • support groups/classes for caregivers
  • advance directives, surrogate decision maker
23
Q

Alzheimer’s vs vascular vs Lewy body vs frontotemporal

A
  • Cholinesterase inhibitors
  • AD: modest benefits
  • VD: not recommended.
  • Discuss initiation of stroke propylaxis meds
  • LBD: may help manage attention and behavioral disturbances
  • FTD: no role! May worsen agitation
  • need to have realistic expectationsEvaluate after 6moTaper off!
24
Q

Referrals for dementia

A
  • Driving assessment
  • Full neuropsychological testing, esp if atypical or when presentation confounded by high level of education or subtle changes
25
Q

ADLs

A

bathing, eating, dressing, transferring, toiletinglosing these = losing function

26
Q

IADL

A
  • Managing finances, handling transportation, shopping , preparing meals, telephone, managing meds, housework
  • First to go: pay bills – notice a loved one has not been paying bills
27
Q

Sleep problems/hallucinations then parkinson’s movement symptoms. What do you suspect?

A

Lewy BodyIf mvmt first - likely parkinson’s

Adult Final (6 decks)

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