Causes/Results
List at least 5 causes and contributors of delirium.
Drugs
Electrolytes
Low O2 insults (to the hearts, lungs...)
Infection
Retention of urine or stool (impaction)
Ictal (seizures)
Underhydration (intravascular volume depletion)
Metabolic
Impact on brain (head trauma)
Sleep deprivation
Pain
Attachments (IVs, telemetry, rectal tubes)
Immobility
Neurological sensory deprivation (eyes, ears)
Foley catheter
Undernutrition
Lights, loud noises
In the study about the effect of oral Risperidone and Haloperidol on symptoms of delirium in palliative care patients, which group lived longer (treatment or placebo group)?
Placebo group
--> proves that antipyschotic drugs are not ALWAYS helpful in reducing delirium symptoms
True/False: There are currently no FDA-approved drugs for delirium.
True
What is considered the worst proposed phenotype of delirium?
Delirium superimposed on Delirium
List at least 3 consequences associated with delirium.
-Hospital complications
-Loss of function
-Increased nursing home placement
-Increased hospital stay
-Long term cognitive impairment (LTCI)
-Increased mortality
-PTSD
What was the unique setup of the Delirium Room Dr. Flaherty discussed to help combat delirium?
-4 Bed unit within the ACE unit
-Restraint Free
-24 Hour Nursing
What is the TADA approach?
Tolerate
Anticipate
Don't Agitate
Delirium severity and duration both matter, with longer and more severe episodes increasing the risk of this outcome at 90 days.
death or nursing home placement
What is a possible reason why delirium affects a patient's swallowing?
The brain gets hypoactive and can't tell the rest of the body instructions; swallowing requires 30 different nerves, which tend to falter when the brain cannot process the swallowing mechanism.
A famous MRI case study showed measurable “loss of brain” after this condition in the ICU, with IQ dropping from 140 to 110 within six months.
sepsis with delirium
This class of drugs, often used in hospitals, has not shown effectiveness in preventing or treating delirium and may even increase mortality in palliative care patients.
Antipsychotics
List at least one similarity and one difference between delirium and dementia.
Dementia: memory loss that affects daily life, challenges in planning or solving problems, difficulty completing familiar tasks, decline in judgement/decision making
Delirium: recent change in person's baseline level of mental function, new abnormalities in attention and awareness, change in level of consciousness or alertness, new incoherent thinking, new medical illness
Both: agitation, restlessness, hallucinations, delusions, pulling on lines/IVs, trying to get out of bed, sundowning, sleep problems
This basic physiological need, when lacking, can lead to delirium and is often identified with a BUN/Cr ratio of 17:1.
underhydration (volume depletion)
In studies of critically ill patients, longer delirium duration was directly linked to worse performance on this type of cognitive test one year later.
executive function/global cognition testing
According to take-home messages, clinicians should distinguish between these two aspects of delirium when deciding on management strategies.
core symptoms (alertness, attention) and behavioral symptoms?
This medical device, used for urine collection, is a common precipitant of delirium.
Foley catheter
Phenotypes of delirium include septic, hypoxic, and metabolic types. These are all examples of what category of delirium classification
etiology-based phenotypes
In ICU studies, this subtype accounted for nearly 90% of delirium cases, yet is often overlooked due to its “quiet” presentation.
hypoactive delirium
When medications are used, clinicians are advised to avoid “as needed” orders, also called this type of prescription.
PRN orders
This commonly used IV benzodiazepine was linked to higher mortality among older hospitalized patients.
IV lorazepam (Ativan)