Flashcards in Lecture 12 Delirium Deck (35)
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.
Older adults may have an *atypical presentation* of illness, encompassing _
1. Vague presentation.
2. Altered presentation.
3. No presentation.
Early indicators of underlying disease in the older adult population
1. *Change in mental status.*
4. Decrease in appetite (this is also a normal age-related change).
6. Loss of function.
The most effective way to monitor for changes in health status is _
Observing changes from a previously established activity *baseline*.
A primary cause of change in mental status, particularly confusion, in older adults is _
Until proven otherwise, new falls should *always* be seen as _
A symptom of illness.
The *decreased muscle mass* of older adults predisposes them to _
Older adults experiencing heart failure and early-onset pneumonia often present with _
A decreased appetite or early satiety.
In a patient with dementia, resisting a caregiver's attempts at repositioning most likely indicates _
The best pain scale to use with older adults experiencing *chronic pain* is _
The Wong-Baker FACES Pain Scale.
The most effective way to monitor function is to establish a baseline by _
Observing the patient as he performs his usual ADLs.
Nursing assessment of a patient experiencing *dizziness* should always include _
1. Orthostatic blood pressures.
2. Most recent EKG.
3. Neurologic - gait and balance.
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.
_ 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).
Older adults with *pneumonia* may present with _
1. Increased respiratory rate.
2. Decreased appetite.
3. Decreased functional ability.
_ is often overlooked in individuals with chronic dependent edema and vascular disease.
RLQ pain with anorexia and elevated WBCs is likely to reflect _, which is often overlooked in older adults.
The most common sign of acute MI in the older adult is _
Sudden onset of dyspnea.
_ is a sign of worsening heart failure in the older adult.
Older adults with type 2 diabetes often present with _
Dehydration and confusion.
_ is the early symptom of hypoglycemia.
Mnemonic for common causes of delirium
E= Elimination (urinary retention, constipation)
L= Liver and other organ failure
R= Respiratory - hypoxia
I= Injury - trauma, pain, stress
U= Unfamiliar environment
M= Metabolic imbalance (B12, folate)
*Inattention* is a classic clinical manifestation of _
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.
Subtypes of delirium
1. Hyperactive (20% of cases) - best prognosis.
2. Hypoactive (80% of cases).
3. Mixed (included in hypoactive) - worst prognosis.
Among *all* hospitalized older adults who undergo surgery, _ will experience delirium.
Surgery for _ is most frequently associated with the onset of delirium in older adults.
Femoral neck fractures.
The leading predisposing factor for the development of delirium in older adults is _
An activating neurotransmitter that is believed to contribute to the development of delirium is _