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NURSING 2LA2 (105)


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Peter Helli

DeliriumCommon life threatening potentially preventable clinical syndromecaused by variety of physical causesDefined as acute decline in the cognitive processes of the brainnamely attention and cognitionStrongly associated with hospitalized patients who are 65 year of age or olderCognitive function fluctuates throughout the dayPeriods of inattention disorganized thinking changes in level of consciousness disorientation delusion perceptual disturbances as well as impaired memory speech sleep and psychomotor23 of cases go untreatedPhysicians use terms such as confusional state or encephalopathyLinked to poor clinical outcomesMarker for severe illness and mortality 1 year mortality rate 3540Initiates a cascade of pathophysiological changes that lead to oLoss of independenceoIncrease risk of morbidity and deathoIncrease health care costs Yet only 40 of clinicans screen for delirium as patient as riskDSM 4Diagnostic Criteria for Delirium1Disturbances of consciousness with reduced ability to focus sustain and shift attention2A change in cognition memory deficit disorientation language or development of perceptual disturbances that is not better accounted for by preexisting established or evolving dementia3Disturbance develops over short period of time hours to days and tends to fluctuate throughout the day4There is evidence from the history physical examination lab finding that the disturbance is caused by direct physiological consequences of general medical conditionClinical Features1Acute onset occurs abruptly usually over a period of hours to days2Fluctuation course symptoms tend to come and go or increase in severity over a 24 hour period lucid interval3Inattention Difficult focusing sustain and shifting attention4Disorganized thinking manifested by disorganizedincoherence speech Rambling or irrelevant conversation or unclearillogical flow of ideas5Altered level of consciousness cloudiness with reduced clarity and awareness of environment6Cognitive deficits global or multiple deficits in cognition disorientation memory deficits and language impairment7Perceptual disturbances illusion or hallucinations in about 308Psychomotor disturbances hyper active marked by agitation and vigilance hypoactive marked by lethargy and decrease motor activity
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