Lecture 12 Delirium Flashcards Preview

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Flashcards in Lecture 12 Delirium Deck (35)
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1

The Confusion Assessment Method for the ICU (CAM-ICU)

1. Evidence-based assessment tool for clinical *delirium*; should be used for all older adults admitted to an ICU.
2. Yes/no question format in the areas of: Acute onset or fluctuating course; inattention; *disorganized thinking*; and altered level of consciousness.
3. Can be used with nonspeaking, mechanically ventilated patients; can be adapted for use with patients with visual and hearing disturbances.

2

Older adults may have an *atypical presentation* of illness, encompassing _

1. Vague presentation.
2. Altered presentation.
3. No presentation.

3

Early indicators of underlying disease in the older adult population

1. *Change in mental status.*
2. Falls.
3. Dehydration.
4. Decrease in appetite (this is also a normal age-related change).
5. Pain.
6. Loss of function.
7. Dizziness.
8. Incontinence.

4

The most effective way to monitor for changes in health status is _

Observing changes from a previously established activity *baseline*.

5

A primary cause of change in mental status, particularly confusion, in older adults is _

Drug toxicity.

6

Until proven otherwise, new falls should *always* be seen as _

A symptom of illness.

7

The *decreased muscle mass* of older adults predisposes them to _

Dehydration.

8

Older adults experiencing heart failure and early-onset pneumonia often present with _

A decreased appetite or early satiety.

9

In a patient with dementia, resisting a caregiver's attempts at repositioning most likely indicates _

Pain.

10

The best pain scale to use with older adults experiencing *chronic pain* is _

The Wong-Baker FACES Pain Scale.

11

The most effective way to monitor function is to establish a baseline by _

Observing the patient as he performs his usual ADLs.

12

Nursing assessment of a patient experiencing *dizziness* should always include _

1. Orthostatic blood pressures.
2. Most recent EKG.
3. Neurologic - gait and balance.

13

Atypical presentation of a *urinary tract infection* classically presents in older adults with _

1. Cognitive changes - *confusion*.
2. Loss of appetite.
3. New-onset urinary incontinence.

14

_ and _ are two typical signs of *infection* that may be *absent* in older adults with an atypical presentation.

Fever/chills and leukocytosis (elevated WBC count).

15

Older adults with *pneumonia* may present with _

1. Increased respiratory rate.
2. Decreased appetite.
3. Decreased functional ability.

16

_ is often overlooked in individuals with chronic dependent edema and vascular disease.

Cellulitis.

17

RLQ pain with anorexia and elevated WBCs is likely to reflect _, which is often overlooked in older adults.

Appendicitis.

18

The most common sign of acute MI in the older adult is _

Sudden onset of dyspnea.

19

_ is a sign of worsening heart failure in the older adult.

Decreased appetite.

20

Older adults with type 2 diabetes often present with _

Dehydration and confusion.

21

_ is the early symptom of hypoglycemia.

Confusion.

22

Mnemonic for common causes of delirium

D= Drugs
E= Elimination (urinary retention, constipation)
L= Liver and other organ failure
I= Infection
R= Respiratory - hypoxia
I= Injury - trauma, pain, stress
U= Unfamiliar environment
M= Metabolic imbalance (B12, folate)

23

*Inattention* is a classic clinical manifestation of _

Delirium.

24

Delirium is characterized by _

1. Acute onset and fluctuating course.
2. Inattention - *core sign of delirium*.
3. Disorganized thinking.
4. Rambling, incoherent speech.
5. Altered level of consciousness.
6. Perceptual disturbances - hallucinations (visual).
7. Disturbed sleep-wake cycles (increased agitation at night).
8. Psychomotor agitation or retardation.

25

Subtypes of delirium

1. Hyperactive (20% of cases) - best prognosis.
2. Hypoactive (80% of cases).
3. Mixed (included in hypoactive) - worst prognosis.

26

Among *all* hospitalized older adults who undergo surgery, _ will experience delirium.

56%

27

Surgery for _ is most frequently associated with the onset of delirium in older adults.

Femoral neck fractures.

28

The leading predisposing factor for the development of delirium in older adults is _

Unmanaged pain.

29

An activating neurotransmitter that is believed to contribute to the development of delirium is _

Dopamine.

30

Inadequate amounts of _ can lead to drug toxicity and thus precipitate delirium.

Albumin.