PMHNP-Delirium and Dementia (ANCC
3Ed, Chapter 11) exams passed
Delirium Tidbits - ✔✔An acute onset syndrome, not a disease.
Hallmark symptom: disturbance of CONSCIOUSNESS accompanied by changes in COGNITION.
Delirium likely caused by direct physiologic process, substance use/abuse, or general medical condition)
Common findings:
-Develops over hours to days
-Fluctuates during the day
- Reversal of sleep-wake cycle (awake at night, asleep in day)
- Impaired recent and intermediate memory
- Psychomotor agitation (purposeless, randome actions)
Common, and often overlooked. Mistaken for dementia in older persons, and for worsening psychotic
symptoms in those with SMI. Symptoms can persist for months if not recognized; most resolve in 3-6
months if treated.
Delirium subtypes - ✔✔Hyperactive: agitated, restless, hyperalert
Hypoactive: lethargic, slowed, apathetic
Mixed: cycles between hyperactive and hypoactive
Delirium incidence, demographic, prognosis - ✔✔0.4% general population
1-2% those >65
14-56% of hospitalized pts
,poor prognosis: 50% mortality rate by 1 year
Early recognition, intervention, treatment is goal: when pts clinical presentation changes rapidly from
baseline, always keep delirium in differential.
Confusion Assessment Instrument (CAM) - ✔✔The Confusion Assessment Method (CAM) includes two
parts.
Part one is an assessment instrument that screens for overall cognitive impairment.
Part two includes only those four features that were
found to have the greatest ability to distinguish delirium or reversible confusion from other types of
cognitive
impairment.
http://consultgerirn.org
Delirium- Non Specific Neuro Abnormalities - ✔✔Urinary Incontinence
Mycoclonus
Nystagnus
Asterixis - flapping motion of the wrists
Increased muscle tone and reflex
Tremors
Incoordination
Delirium- Perceptual Disturbance - ✔✔Illusions most common
Hallucinations - usually visual & accompanied by illusions
Delusions are common
, Delirium - MSE findings - ✔✔GENERAL appearance: inattentive, disheveled, unconcerned
SPEECH: impaired, disorganized, rambling, incoherent, slurred
AFFECT: rapid, unpredictable shifts in affective state without known precipitant (lethargic to agitated)
MOOD: difficult to elicit
THOUGHT PROCESS: disorganized, distractible, perceptual disturbances
THOUGHT CONTENT: disorganized, distorted, delusional
ORIENTATION: disorientation to time & place (USUALLY FIRST SX TO APPEAR)
Impaired memory, concentration, abstraction, and jdgment
Delirium: diagnostic studies - ✔✔Chemistry
CBC
TFT
Syphilis
HIV
UA
CXR
serum or urine drug screen
EEG would show generalized slowing, unless ETOH withdrawal related (then would show generalized
increased activity)
Delirium Non-pharm treatment - ✔✔Monitor for safety, nutrition, hydration
Avoid sensory-deprivation or overstimulation
Frequent reality orientation (and familiar people, pictures, clock or calendar etc)
3Ed, Chapter 11) exams passed
Delirium Tidbits - ✔✔An acute onset syndrome, not a disease.
Hallmark symptom: disturbance of CONSCIOUSNESS accompanied by changes in COGNITION.
Delirium likely caused by direct physiologic process, substance use/abuse, or general medical condition)
Common findings:
-Develops over hours to days
-Fluctuates during the day
- Reversal of sleep-wake cycle (awake at night, asleep in day)
- Impaired recent and intermediate memory
- Psychomotor agitation (purposeless, randome actions)
Common, and often overlooked. Mistaken for dementia in older persons, and for worsening psychotic
symptoms in those with SMI. Symptoms can persist for months if not recognized; most resolve in 3-6
months if treated.
Delirium subtypes - ✔✔Hyperactive: agitated, restless, hyperalert
Hypoactive: lethargic, slowed, apathetic
Mixed: cycles between hyperactive and hypoactive
Delirium incidence, demographic, prognosis - ✔✔0.4% general population
1-2% those >65
14-56% of hospitalized pts
,poor prognosis: 50% mortality rate by 1 year
Early recognition, intervention, treatment is goal: when pts clinical presentation changes rapidly from
baseline, always keep delirium in differential.
Confusion Assessment Instrument (CAM) - ✔✔The Confusion Assessment Method (CAM) includes two
parts.
Part one is an assessment instrument that screens for overall cognitive impairment.
Part two includes only those four features that were
found to have the greatest ability to distinguish delirium or reversible confusion from other types of
cognitive
impairment.
http://consultgerirn.org
Delirium- Non Specific Neuro Abnormalities - ✔✔Urinary Incontinence
Mycoclonus
Nystagnus
Asterixis - flapping motion of the wrists
Increased muscle tone and reflex
Tremors
Incoordination
Delirium- Perceptual Disturbance - ✔✔Illusions most common
Hallucinations - usually visual & accompanied by illusions
Delusions are common
, Delirium - MSE findings - ✔✔GENERAL appearance: inattentive, disheveled, unconcerned
SPEECH: impaired, disorganized, rambling, incoherent, slurred
AFFECT: rapid, unpredictable shifts in affective state without known precipitant (lethargic to agitated)
MOOD: difficult to elicit
THOUGHT PROCESS: disorganized, distractible, perceptual disturbances
THOUGHT CONTENT: disorganized, distorted, delusional
ORIENTATION: disorientation to time & place (USUALLY FIRST SX TO APPEAR)
Impaired memory, concentration, abstraction, and jdgment
Delirium: diagnostic studies - ✔✔Chemistry
CBC
TFT
Syphilis
HIV
UA
CXR
serum or urine drug screen
EEG would show generalized slowing, unless ETOH withdrawal related (then would show generalized
increased activity)
Delirium Non-pharm treatment - ✔✔Monitor for safety, nutrition, hydration
Avoid sensory-deprivation or overstimulation
Frequent reality orientation (and familiar people, pictures, clock or calendar etc)
