NURS 5333 Family 1 Geriatrics delirium and GI
Study Guide + Questions with Accurate Solutions
delirium
mental disorder marked by confusion; uncontrolled excitement; involves memory,
whereas delirium involves attention. Dementia is irreversible, but delirium is most often
reversible
I see a man holding a lantern waving me in?? Grandma, you have...
Delirium. perceptual disturbances, hallucinations, they can have agitation, or they can
be very drowsy and they can have fluctuations in their level of alertness between
agitation and drowsiness.
What are risk factors for delirium?
Occurs in 30% of hospitalized elderly patients. The unfamiliar environment as well as the
lack of sleep, unfamiliar faces, restraints, anything that restricts their movement can
also precipitate or exacerbate agitation. So restraints, Foley catheters, the telemetry
wires, all of these can contribute to the state of delirium. Patients with impaired vision
or impaired hearing are at higher risk of developing delirium.
Differentials for delirium are:
electrolyte disturbances, so baseline labs would be useful
underlying infection
So you need to rule those out and it can be things as simple as a UTI, which is
overwhelming to a geriatric patient, or pneumonia, or even an intra-abdominal process.
Meds?? ( Benadryl that patients may take for sleep, anticholinergics are notorious for
causing delirium in the geriatric population)
,be hypoxia or hypoglycemia or actually a stroke
baseline lab with a complete blood count to rule out anemia or infection, a metabolic
panel to rule out electrolyte disturbances, the TSH with reflex T3 and T4 to rule out
hypo or hyperthyroidism, urinalysis looking for urinary infection, urine drug screen to
look for drugs as the cause of the delirium symptoms, B12 and folate, and even an
arterial blood gas if you're questioning hypoxia if their SPO2 is low. A CT scan of the
brain is required to rule out any pathology or a cerebral hemorrhage.
R/O dementia and the labs to get are?
anti-psychotic drugs for delirium
medications can be used but they should be used cautiously due to the extrapyramidal
side effects. Also be aware that antipsychotics are associated with increased mortality in
elders. Haldol can be given at 0.25 to 0.5 mg either in an oral form or intramuscular, and
this can be given every four hours.
-quetiapine or Seroquel at bedtime
-should avoid any benzodiazepines because they are sedating or they may actually cause
paradoxical agitation
Frequent reorientation is essential in patients with delirium, and this is the benefit of
having family or support people at their bedside to help
If they do have visual problems or hearing problems, you can correct that with
ensuring that they can wear their glasses or putting in their hearing aids and creating a
familiar environment.
Make sure HOME IS SAFE!
, Sometimes in the hospital, when they're discharged and go home to a familiar place, the
delirium resolves
Gastroenteritis is acute diarrhea and/or vomiting lasting less than 14 days
Mild illness is usually vomiting and is likely due to a viral etiology.
fecal-oral route
bacterial illness gastroenteritis
Severe illness, the patient is going to have fevers, severe dehydration and severe
abdominal pain and bloody stools are more likely due to
Rotavirus is the most common pathogen but it can occur in adults also
Less than 1 yoa you have tummy ache it's probably?
Risk factors are exposure to infected persons...
Bacterial infections are less common but they are more severe
parasitic infections that you typically see in the United States are giardia lamblia
Risk factors for severe disease include in infants less than six months old, children in
daycare, daycare is where you see a high incidence of giardia and shigella, poor nutrition
status is another risk factor, frailty, travel, antibiotic use within the last three months,
recent hospitalization, immunocompromised patients, patients with comorbidities,
pregnancy and chronic proton pump inhibitor use.
&puppies from a the dog rescue....
History of Patient Illness (HPI)
you want to ask about potential exposures and travel history. You want to understand
the onset, frequency and consistency of the diarrhea or the onset, frequency and
consistency of emesis
Study Guide + Questions with Accurate Solutions
delirium
mental disorder marked by confusion; uncontrolled excitement; involves memory,
whereas delirium involves attention. Dementia is irreversible, but delirium is most often
reversible
I see a man holding a lantern waving me in?? Grandma, you have...
Delirium. perceptual disturbances, hallucinations, they can have agitation, or they can
be very drowsy and they can have fluctuations in their level of alertness between
agitation and drowsiness.
What are risk factors for delirium?
Occurs in 30% of hospitalized elderly patients. The unfamiliar environment as well as the
lack of sleep, unfamiliar faces, restraints, anything that restricts their movement can
also precipitate or exacerbate agitation. So restraints, Foley catheters, the telemetry
wires, all of these can contribute to the state of delirium. Patients with impaired vision
or impaired hearing are at higher risk of developing delirium.
Differentials for delirium are:
electrolyte disturbances, so baseline labs would be useful
underlying infection
So you need to rule those out and it can be things as simple as a UTI, which is
overwhelming to a geriatric patient, or pneumonia, or even an intra-abdominal process.
Meds?? ( Benadryl that patients may take for sleep, anticholinergics are notorious for
causing delirium in the geriatric population)
,be hypoxia or hypoglycemia or actually a stroke
baseline lab with a complete blood count to rule out anemia or infection, a metabolic
panel to rule out electrolyte disturbances, the TSH with reflex T3 and T4 to rule out
hypo or hyperthyroidism, urinalysis looking for urinary infection, urine drug screen to
look for drugs as the cause of the delirium symptoms, B12 and folate, and even an
arterial blood gas if you're questioning hypoxia if their SPO2 is low. A CT scan of the
brain is required to rule out any pathology or a cerebral hemorrhage.
R/O dementia and the labs to get are?
anti-psychotic drugs for delirium
medications can be used but they should be used cautiously due to the extrapyramidal
side effects. Also be aware that antipsychotics are associated with increased mortality in
elders. Haldol can be given at 0.25 to 0.5 mg either in an oral form or intramuscular, and
this can be given every four hours.
-quetiapine or Seroquel at bedtime
-should avoid any benzodiazepines because they are sedating or they may actually cause
paradoxical agitation
Frequent reorientation is essential in patients with delirium, and this is the benefit of
having family or support people at their bedside to help
If they do have visual problems or hearing problems, you can correct that with
ensuring that they can wear their glasses or putting in their hearing aids and creating a
familiar environment.
Make sure HOME IS SAFE!
, Sometimes in the hospital, when they're discharged and go home to a familiar place, the
delirium resolves
Gastroenteritis is acute diarrhea and/or vomiting lasting less than 14 days
Mild illness is usually vomiting and is likely due to a viral etiology.
fecal-oral route
bacterial illness gastroenteritis
Severe illness, the patient is going to have fevers, severe dehydration and severe
abdominal pain and bloody stools are more likely due to
Rotavirus is the most common pathogen but it can occur in adults also
Less than 1 yoa you have tummy ache it's probably?
Risk factors are exposure to infected persons...
Bacterial infections are less common but they are more severe
parasitic infections that you typically see in the United States are giardia lamblia
Risk factors for severe disease include in infants less than six months old, children in
daycare, daycare is where you see a high incidence of giardia and shigella, poor nutrition
status is another risk factor, frailty, travel, antibiotic use within the last three months,
recent hospitalization, immunocompromised patients, patients with comorbidities,
pregnancy and chronic proton pump inhibitor use.
&puppies from a the dog rescue....
History of Patient Illness (HPI)
you want to ask about potential exposures and travel history. You want to understand
the onset, frequency and consistency of the diarrhea or the onset, frequency and
consistency of emesis
