Flashcards in Delirium/Dementia Deck (28)
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1
What is considered an "Abnormal" score on a Mini Mental Status Exam (MMSE)
<24
2
What MMSE indicates increased odds of dementia? What level of education is this?
<21
Abnormal for 8th grade education
3
What MMSE range is considered NO cognitive impairment?
24-30
4
What is the risk of death in hospitals associated with delirium?
10 fold risk
5
List the 3-5 fold increased risks associated with delirium (other than death)
1. Nosocomial complications
2. Prolonged stay
3. Post-acute NH placement
6
How long following discharge are patients at an increased risk for poor functional recovery and increased risk of death following their delirium?
2 years
7
What % of delirium is recognized by nurses? by physicians?
Nurses=50%
MD's=20%
8
Clinically, what do we use to diagnose delirium?
Confusion Assessment Method (CAM)= 95% sensitivity and specificity
9
What is the MC type of delirium
HYPOactive delirium=50%
10
What is the other type of delirium? %?
HYPERactive delirium=25%
11
What type of delirium has a poorer prognosis ? Why?
HYPOactive delirium:
1. Less recognized
2. Not appropriate tx
12
List the two Neuropathophysiology causes for delirium
1. Cholinergic deficiency
2. Inflammation
13
Delirium Etiology in cholinergic deficiency? Treatment?
Anticholinergic Drug OD
Tx: Physostigmine
14
What increases with inflammation associated delirium?
1. C-Reactie Protein
2. IL-1B
3. TNF
15
What patients does inflammation delirium especially affect?
1. Postop pt's
2. CA pt's
3. Sepsis pt's
16
List some predisposing factors to delirium
1. Male
2. Hx of Etoh abuse
3. Sensory impairment: decreased vision/hearing
4. Advanced age
5. Functional impairment in ADL's
6. Dementia
7. Medical Comorbidity
17
List some precipitating factors
1. Acute cardiac/pulmonary event
2. Fecal impaction
3. Urinary retention
4. Infections: Urinary and Respiratory
5. Drug Withdrawal
18
List the top 3 surgeries that increase the incidence of post delirium. By how much?
1. Cardiac surgery
2. AAA repair
3. Hip repair
Increased by 50%
19
How many pre-op risk factors significantly increase incidence of dementia? by how much?
3+ RF's
50%
20
What postop day is peak onset for delirium?
2nd
21
What opiod is especially associated with post-op delirium?
Meperidine
22
What is the BEST treatment in delirium?
Prevention
23
What diagnostic studies are RARELY helpful in the assessment of delirium?
1. Cerebral imaging: Except in head trauma or new focal neuro findings
2. EEG and CSF: Except in seizure activity and meningeal signs
24
What is the most successful management of delirium?
Multifactorial approach
25
What is the appropriate behavioral management of delirium?
"Social Restraint"= Sitter
26
Who should receive Lorazepam?
1. Sedative and Alcohol withdrawal
2. Hx of Neurleptic malignant signdrome
27
What do you need to assess/monitor for IF you give a patient Haloperidol?
1. Akathesia
2. Extrapyramdial effects
3. QT prolongation
4. Torsades
5. Withdrawal dyskinesias
28
