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1

DELIRIUM

- A complex reversible, neuropsychiatric syndrome characterised by fluctuating change in mental status with inattention and altered levels of consciousness
- Common
- 25% elective surgery and 50% trauma surgery

2

8 COMMON CAUSES OF DELIRIUM

- Dementia
- Electrolytes
- Lungs
- Infection
- Rx (Treatment)
- Injury stress
- Unfamiliar environment
- Metabolic

3

DELIRIUM MANAGEMENT: Treat the underlying cause

- The cause of delirium, usually medical should be promptly treated
- Common causes→ infections, adverse drug reactions (especially analgesics, anticholinergics, parkinson's medications, sleeping and anxiolytic drugs) dehydration and metabolic abnormalities

4

DELIRIUM MANAGEMENT: Supportive Treatment to Reduce Expressive Behaviours

- The management should start with non-pharmacological multi component interventions
- Reduce sensory distress by having glasses on having aids in
- Having a familiar person with them if possible
- ALERT: All patients with delirium require falls risk alerts, assessment and management

5

MAIN TYPES OF DELIRIUM (3)

- Hyperactive
- Hypoactive (Easily missed by staff)
- Mixed

6

3 MAIN TYPES OF DELIRIUM: HYPERACTIVE

The resident feelts alert and active, and may have any of the following symptoms:
- Confusion and forgetting people, place and time
- Easily angered, restless or excited
- False beliefs about themselves and the area around the them e.g. delusions
- Hearing, smelling, seeing, tasting, touching things that are not there e.g. hallucinations
- Losing focus or attention on what they are doing

7

3 MAIN TYPES OF DELIRIUM:: HYPOACTIVE (EASILY MISSED BY STAFF)

- Feel very tired or sleepy
- Not caring about what happens around them, and not wanting to eat
- Not knowing where they are, where you are or the date or time
- Slow to think, move or respond to people

8

3 MAIN TYPES OF DELIRIUM:: MIXED

May have signs and symptoms of the other 2 types of delirium

9

DEMENTIA

- Usually a progressive and irreversible syndrome of the brain with persistent memory loss combined with→
- Dysfunction within 1 or more functions of the brain impacting on ADLs (can include organisation, planning, problem solving, speech, insight and behaviour)
- 101 different kinds of brain illnesses which all come under the 1 umbrella- dementia
- Dementia is NOT a normal part of ageing but is more common after the age of 65 years

10

LOW BODY DEMENTIA

- Fluctuation in mental state
- Vivid visual hallucinations
- Parkinsonism- gait changes
- Difficulties judging distances and communicating

11

VASCULAR DEMENTIA

- Single strategic stroke
- Multiple small strokes
- Thickening of walls of arterioles
- Haemorrhage

12

FRONTOTEMPORAL DEMENTIA

- Atrophy only of the frontal and temporal areas (until advanced disease)
- Often asymmetrical

2 different proteins present
- Tau
- Progranulin

13

ALZHEIMER’S DISEASE

- Deterioration in social skills and language
- Memory problems
- Word finding difficulties
- Taking longer with routine tasks

14

DEMENTIA AND DELIRIUM

- Dementia is a risk factor for developing delirium
Reduced neurotransmitters
- Between 22-89% of patients with dementia will develop a delirium
- The use of restraint is more likely to have an adverse outcome especially in hyperactive delirium
- The patient is more likely to have a negative outcome if the patient has behavioural expression or BPSD prior to delirium

15

WHAT DO DELIRIUM, DEMENTIA AND DEPRESSION HAVE IN COMMON?

- The physiological cause is not known but in neurotransmitter concentrations change
- Memory, mood and attention may be impaired, agitation, impaired judgement and lack of insight at times
- Changes in environment, stress or a traumatic event reduce coping ability
- Changes to arousal levels and sleep/wake cycles