Assessing Delirium - #14
Take QuizIdentify and assess delirium.
| Risk Assessment at Admission | Precipitating Risk Factors | Medications |
|---|---|---|
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1.Decreased vision (<20/70) 2.Severe Illness 3.Decreased cognition (< 24 MMSE) 4.Dehydration (BUN/Cr >18) --1-2 = int. risk → OR 2.5 --3-4 = high risk → OR 9.2 |
1.Phys Restraints 2.Malnutrion 3.Greater or equal to 3 Med classes added 4.Bladder catheter 5.Int. risk = 1-2 → OR 7.1 6.High risk = 3-5 →OR 1.5 |
1.Anticholinergic Meds 2.Medications with sig. anticholinergic properties |
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NEXT STEP Is it Delirium versus Dementia? |
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|---|---|---|
| Feature | Delirium | Dementia |
| Onset | Acute | Insicious |
| Course | Fluctuating | Constant |
| Attention | Disordered | Generally Preserved |
|
Consciousness Hallucinations |
Disordered / Often Present |
Generally Preserved Generally Absent |
| Involv. - Involvement | Often Present | Generally Absent |
|
NEXT STEP Diagnosis → Cam: 1 + 2 + (3 or 4) |
|---|
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1.Acute onset & fluctuating course 2.Inattention 3.Disorganized thinking 4.Altered LOC |
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NEXT STEP Management |
|---|
|
1.Prevention 2.Treat underlying disorder 3.Manage symptoms |
Patient in hospital or institution.
Elderly patient that either presents to the hospital or develops symptoms of altered mental status.
Approximately 1/3 of patients 70 years and older admitted to a general medical service are delirious. 50% have symptoms upon admission and the other 50% develop them in-house. 67% of delirium cases are missed.[i]
Acute cardiac/pulmonary events, bed rest, sedative or alcohol withdrawal, fluid/lyte abnormalities, infections, intracranial events, medications, anemia, uncontrolled pain, urinary retention or fecal impaction, indwelling devices, and restraints.
- Assessing the hospitalized patient for delirium
- Awareness of risk factors and medications for delirium
- Managing delirium with a completed diagnosis
Review of Systems (ROS)
Geriatric Topics
ACGME Compentencies
Science Principles
[i] Inouye SK. The dilemma of delirium: Clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly patients. Am J Med 1994; 97(3): 278-88. http://www.ncbi.nlm.nih.gov/pubmed/?term=dilemma+of+delirum+clinical+and+research+controversies
Users are free to download and distribute Geriatric Fast Facts for informational, educational, and research purposes only. Citation: Yana Thaker, Steven Denson MD, Kathryn Denson MD, Bambi Wessel - Fast Fact #14: Assessing Delirium. February 2012.
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