Class Notes (1,100,000)
CA (620,000)
Mohawk (200)
NURSING (500)
Lecture 9

NURSING 2LA2 Lecture Notes - Lecture 9: Melatonin, Vitamin B12 Deficiency, Protective Factor


Department
Nursing
Course Code
NURSING 2LA2
Professor
Ruth Hannon
Lecture
9

This preview shows pages 1-3. to view the full 20 pages of the document.
Module 4: Delirium
Learning Outcomes
Define delirium as a clinical syndrome
Discuss the importance of delirium as a predictor of increased mortality in the elderly
hospitalized population
Distinguish between delirium and other neuropsychiatric illnesses
Identify the subtypes of delirium and their associated characteristics
Describe the screening tools available to diagnose delirium
Identify the predisposing and precipitating factors that increase a patient’s risk for
delirium
Discuss the pathophysiology of delirium
Describe the intervention protocols used to prevent and manage delirium in the
hospitalized elderly population
Delirium
Acute decline in the cognitive processes of the brain
Most commonly associated with hospitalized patients aged 65 years and older
Cognitive function fluctuates throughout the day
Wide range of symptoms and patient characteristics
2/3 of cases go unreported
Delirium is a common, life-threatening and potentially preventable clinical syndrome induced by
a variety of physical causes. It is often defined as an acute decline in the cognitive processes of
the brain, namely attention and cognition. It is most strongly associated with hospitalized
patients who are 65 years of age or older. Patients with delirium may exhibit periods of
inattention, disorganized thinking, changes in level of consciousness, disorientation, delusions,
perceptual disturbances, as well as impaired memory, speech, sleep, and psychomotor activity.
These changes in cognitive function can fluctuate in severity throughout the day and as such,
delirium is often under-recognized and undertreated. It is estimated that two thirds of patients
with delirium go unreported. This can be attributed to both the syndromes fluctuating nature and
the wide range of symptoms and patient characteristics associated with the syndrome. Some
clinicians continue to use the term “confusional state” or encephalopathy when diagnosing
delirium, further complicating the proper identification, management, and treatment of this life-
threatening syndrome.
Delirium
Linked to poor clinical outcomes
Marker for severe illness and mortality
o1 year mortality rate of 35 – 40%
Initiates a cascade of pathophysiological changes that lead to:
oLoss of independence
oIncreased risk of morbidity and death

Only pages 1-3 are available for preview. Some parts have been intentionally blurred.

oIncreased health care costs
Yet, only 40% of health care workers routinely screen for delirium in at risk patients
As mentioned earlier, delirium frequently accompanies acute illness in hospitalized elderly
patients. Historically, delirium was accepted as a harmless process, however data collected from
the past 15 years has shown that this clinical syndrome is relaying to poor clinical outcomes and
should be regarded as a marker for severe illness and mortality. In North America, delirium
complicates the hospital stays of approximately 20% of patients 65 years of age and older. More
concerning is the evidence that the one year mortality rate associated with cases of delirium in
the elderly is 35-40%.
Current studies investigating delirium and its outcomes suggest that the development of delirium
in the hospitalized elderly initiates of events that culminate in a loss of a patients independence
and an increased risk of morbidity and mortality. There are also associated increases in health
care costs due to longer hospital stays, rehabilitation, and the need for formal home health care or
long term institutionalized care. Despite this evidence, it is estimated that only 40% of clinicians
routinely screen for delirium in hospitalized elderly patients.
Diagnostic Criteria for Delirium
A. Disturbance of consciousness (e.g., reduced clarity of awareness of the environment) with
reduced ability to focus, sustain or shift attention
B. A change in cognition (such as memory deficit, disorientation, language disturbance) or the
development of a perceptual disturbance that is not better accounted for by a preexisting,
established or evolving dementia
C. The disturbance develops over a short period of time (usually hours to days) and tends to
fluctuate during the course of the day
D. There is evidence from the history, physical examination or laboratory findings that the
disturbance is caused by the direct physiological consequences of a general medical condition
Currently, the DSM4 defines delirium by the presence of disturbed consciousness and a change
in cognition or the development of a perceptual disturbance that is not better accounted for by a
preexisting, established or evolving dementia. This disturbance in consciousness must develop
over a short period of time as you fluctuate during the course of the day. Moreover, there must be
evidence from clinical history, physical examination and/or laboratory findings that the
disturbance is caused by the direct physiological consequences of a general medical condition.

Only pages 1-3 are available for preview. Some parts have been intentionally blurred.

Clinical Features of Delirium
In addition to the core symptoms outlined by the DSM4, the clinical features shown below are
also hallmark characteristics of delirium.
1. Acute Onset
Occurs abruptly, usually over a period of hours or days
Reliable information often needed to ascertain the time course of onset
2. Fluctuating Course
Symptoms tend to come and go or increase and decrease in severity over a 24-hr period
Characteristic lucid intervals
3. Inattention
Difficulty focusing, sustaining, and shifting attention
Difficulty maintain conversation or following commands
4. Disorganized Thinking
Manifested by disorganized or incoherent speech
Rambling or irrelevant conversation or an unclear or illogical flow of ideas
5. Altered level of consciousness
Clouding of consciousness, with reduced clarity of awareness of the environment
6. Cognitive deficits
Typically global or multiple deficits in cognition, including disorientation, memory
deficits, and language impairment
7. Perceptual Disturbances
Illusions or hallucinations in about 30% of patients
8. Psychomotor Disturbances:
Psychomotor variants of delirium
oHyperactive: marked by agitation and vigilance
oHypoactive: marked by lethargy, with a markedly decrease level of motor activity
oMixed
9. Altered sleep-wake cycles
Characteristic sleep-cycle disturbances
Typically daytime drowsiness, nighttime insomnia, fragmented sleep, anxiety, depression,
irritability, apathy, anger, or euphoria
10. Emotional disturbances
Common
You're Reading a Preview

Unlock to view full version