Delirium and Agitation

Delirium Imitators

100

This is a common medical condition often confused with delirium in the elderly. A major difference between this condition and delirium is that delirium presents acutely (hours to days), whereas this condition generally comes on gradually.

What is dementia?

200

This is the mental disorder that is most often misdiagnosed in the elderly when the correct diagnosis is actually delirium.

What is depression?

300

This phenonemon is often confused with delirium, but is different because, while delirium has an underlying medical cause, this condition can occur in an otherwise healthy person who has impaired circadian regulation or is simply affected by changes in environment.

What is sundowning?

400

This should be considered in an elderly patient with bilateral facial twitching, irregular pupillary constriction and dilation, lip-smacking/chewing/swallowing movements, and/or acute aphasia or neglect.

What is seizure disorder? (Nonconvulsive status epilepticus)

500

This form of aphasia affects the temporo-parietal area of the brain, and may mimic delirium because of how it affects speech. The difference between this disorder and delirium is that in delirium, mental dysfunction and confusion are global, whereas in this condition the problem is restricted to language.

What is Wernicke's aphasia?

Causes of Delirium

100

This is a common cause of delirium, often treated with antibiotics if this is consistent with the patient's goals of care.

What is infection?

200

This condition may contribute to delirium in a patient who has extreme difficulty swallowing, and can lead to the accumulation of opioid metabolites. The decision to treat this underlying cause is often complex and must be made on a case-by-case basis.

What is dehydration?

300

This is the percentage of patients in inpatient hospice settings who suffer from delirium, expressed as a 10-point range (i.e. 20-30%, 80-90%, etc.)

What is 40-50%?

400

This cause of delirium accounts for 30% of all cases of delirium, making it the greatest single cause of delirium. The RN's role in identifying this cause is particularly important because of a task that s/he routinely performs.

What is drug toxicity?

500

This is the neurotransmitter thought to play a very large role in delirium. When levels of this neurotransmitter are too low, confusion and agitation can set in. Medications used to treat depression, incontinence, and allergies are famous for reducing the levels of this neurotransmitter and bringing on delirium, especially in the elderly.

What is acetylcholine?

Antipsychotic Medications

100

This typical antipsychotic medication reaches peak concentration 15 minutes after injection into a muscle. It's also the most widely-used treatment for intractable hiccups.

What is thorazine? (chlorpromazine)

200

This is a common disease in which haloperidol should not be given for agitation or psychosis because it can worsen the underlying symptoms of the disease. Instead, quetiapine (Seroquel) or clozapine (Clozaril) should be considered for agitated patients with this disease.

What is Parkinson's disease?

300

This is the name given to a group of symptoms that are often side-effects of antipsychotics. Symptoms include akathisia, akinesia, and acute dystonic reaction. These symptoms are treated with anticholinergic medications.

What are extrapyramidal symptoms?

400

This is the time that it takes oral Haldol to reach its peak concentration.

What is 2 to 6 hours?

500

This myocardial disorder can be genetic, or it can be caused by drug therapy, hypokalemia, or hypomagnesemia. A patient receiving high doses of Haldol (>30 mg/day p.o.) is at increased risk of developing this conduction abnormality.

What is long QT syndrome?

Benzodiazepines

100

This is the phenomenon characterized by diminishing response after prolonged exposure to a drug. In the case of benzodiazepines, this diminished response generally occurs for the sedative and euphoric effects after several days, but not for the anxiolytic effects.

What is tolerance?

200

This can occur after rapid cessation of benzodiazepines and is characterized by tremors, anxiety, perceptual disturbances, dysphoria, psychosis, and seizures. For this reason, benzodiazepines that have been used for an extended period of time should be tapered.

What is withdrawal?

300

This benzodiazepine has an extremely short half-life of 1.5 to 3 hours, and is often used for management of acute agitation in the inpatient setting. One of the advantages of the short half-life is that the dose can be titrated relatively easily.

What is midazolam or Versed?

400

This phenomenon is rarely fatal if only benzodiazepines are involved. The classic presentation is of CNS depression with normal vital signs and respiratory depression is very unusual. If this phenomenon does occur, the treatment recommended is generally supportive, and usually an antidote should NOT be given.

What is benzodiazepine overdose?

500

This phenomenon is characterized by increasing agitation, restlessness, and hostility in response to increasing doses of benzodiazepines used to treat increasing agitation, restlessness and hostility.

What is a paradoxical reaction?

Non-pharmacologic Management of Agitation

100

This therapy has been shown in three placebo-controlled trials to reduce the incidence of agitated behavior in patients with dementia, and employs the use of agents like lemon balm and lavender oil.

What is aromatherapy?

200

This is live music played at the bedside that responds to the physiological needs of the patient moment by moment. The goal is to relieve suffering, including restlessness and agitation, at the end of life, rather than to provide entertainment.

What is music thanatology?

300

This is the percentage of patients with Alzheimer's disease who develop agitated behaviors as the disease progresses.

What is 70%?

400

It is extremely important to use this sense when providing care to agitated patients with dementia. An example of appropriate use of this sense is hand-under-hand guidance.

What is touch?

500

This expert in dementia care has developed a program of approaches and tasks for caregivers of dementia patients that emphasizes a friendly and nonthreatening demeanor and clear choices. Everyone who takes care of patients with dementia can learn from her.

Who is Teepa Snow?