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Lecture

Module 9 _ Delirium.doc

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Department
Nursing
Course
NURSING 2LA2
Professor
Peter Helli
Semester
Fall

Description
Module9DeliriumPathophysiologyDeliriumAcutedeclineinthecognitiveprocessesofthebrainnamelyattentionandcognitionoDeliriumisacommonlifethreateningandpotentiallypreventableclinicalsyndromeMostcommonlyassociatedwithhospitalizedpatientsaged65yearsandolderCognitivefunctionfluctuatesthroughoutthedayoPatientswithdeliriummayexhibitperiodsofinattentiondisorganizedthinkingchangesinlevelofconsciousnessdisorientationdelusionsperceptualdisturbancesaswellasimpairedmemoryspeechsleepandpsychomotoractivityWiderangeofsymptomsandpatientcharacteristics23ofcasesgounreportedoThiscanbeattributedtoboththesyndromesfluctuatingnatureandthewiderangeofsymptomsandpatientcharacteristicsassociatedwiththesyndromeoSomeclinicianscontinuetousethetermsconfusionalstateorencephalopathywhendiagnosingdeliriumfurthercomplicatingtheproperidentificationmanagementandtreatmentDeliriumfrequentlyaccompaniesacuteillnessesinhospitalizedelderlypatientsLinkedtopoorclinicaloutcomesMarkerforsevereillnessandmortalityoInNorthAmericadeliriumcomplicatesthehospitalstayof20ofpatients65yearso1yearmortalityrateof3540InitiatesacascadeofpathophysiologicalchangesthatleadtooLossofindependenceoIncreasedriskofmorbidityanddeathoIncreasedhealthcarecostsincreaseshospitalstaysrehabilitationtheneedforformalhomehealthcareorlongterminstitutionalcareYetonly40ofhealthcareworkersroutinelyscreenfordeliriuminatriskpatientsDiagnosticCriteriaforDeliriumClinicalFeaturesofDelirium1AcuteonsetOccursabruptlyusuallyoveraperiodofhoursordaysReliableinformationoftenneededtoascertainthetimecourseofonset2FluctuatingcourseSymptomstendtocomeandgooverincreaseanddecreaseinseverityovera24hourperiodCharacteristiclucidintervals3InattentionDifficultyfocusingsustainingandshiftingattentionDifficultymaintainingconversationorfollowingcommands4DisorganizedthinkingManifestedbydisorganizedorincoherentspeechRamblingorirrelevantconversationoranunclearorillogicalflowofideas5AlteredlevelofconsciousnessCloudingofconsciousnesswithreducedclarityofawarenessoftheenvironment6CognitivedeficitsTypicallyglobalormultipledeficitsincognitionincludingdisorientationmemorydeficitsandlanguageimpairment7PerceptualdisturbancesIllusionorhallucinationsinabout30ofpatients8PsychomotordisturbancesPsychomotorvariantsofdeliriumiHyperactivemarkedbyagitationandvigilanceiiHypoactivemarkedbylethargywithamarkedlydecreaselevelofmotoractivityiiiMixed9AlteredsleepwakecycleCharacteristicsleepcycledisturbancesTypicallydaytimedrowsinessnighttimeinsomniafragmentedsleepanxietydepressionirritabilityapathyangeroreuphoria10EmotionaldisturbancesCommonManifestedbyintermittentandlabilesymptomsoffearparanoiaanxietydepressionirritabilityapathyangeroreuphoriaDeliriumDementiaDepressionWithdeliriumtheonsetofalteredconsciousnesscognitivedisturbanceorhallucinationsistypicallyacuteandpresentsinthecontextofmedicalillnesssurgeryormedicationchangeoNotethatschizophreniatendstohaveagradualonsetandappearsinlateadolescentsearlyadulthoodItisalsoprecededbyaphaseofsocialisolationthatlastsweekstomonthsoDisorientationandfluctuationsinlevelofconsciousnessarerareinschizophreniabutareahallmarkofdeliriumWithdementiaoThepatientslevelofconsciousnessistypicallyintactoInattentioniseitherabsentormildwhencomparedtoothercognitivedeficitsoPatientswithdementiararelyexhibitfluctuationsintheircognitivefunctionWithdepressionoDepressionhasamoregradualonsetofpsychomotorslowingoCognitivedeficitstendtoreflectdisinterestasopposedtothedisorientationcommonlyseeninpatientswithdelirium
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