©THEBRIGHT EXAM STUDY SOLUTIONS 8/22/2024 12:54 PM
Delirium and Dementia Exam Questions
With Correct Answers.
Identify the main difference between delirium and dementia. - answer✔✔Delirium- develops
quickly, change in consciousness, direct physiological consequence of a medical condition,
change in cognition not accounted for
Dementia- slow progression, consciousness may not be affected, progressive cognitive decline
Risk Factors for Delirium (6) - answer✔✔Hospitalization
Advanced age (> 70)
Pre-existing psychological conditions
Advanced life-threatening illness
Comorbidities
Poor nutrition
Neurotransmittors affected in delirium - answer✔✔Acetylcholine (especially), NE, 5HT,
somatostatin
Clinical Presentation of a patient with delirium - answer✔✔Altered reality (Hallucinations,
delusions)
Agitation or Restlessness
Movement may or may not be purposeful
Self-harm
Hyperactive, hypoactive, or mixed
What are assessment scales used for delirium? - answer✔✔CAM-ICU
NEEHCHAM
Delirium Observation Screening Scale (DOSS)
, ©THEBRIGHT EXAM STUDY SOLUTIONS 8/22/2024 12:54 PM
What are the pros of CAM-ICU? - answer✔✔-Great for ventilated patients (don't need to speak)
who are conscious
-Quickly done at bedside
Cons of CAM-ICU? - answer✔✔-No indication of severity
-Does take some minor training
-Cannot be done retrospectively
Features of CAM-ICU (4) - answer✔✔Feature 1: Acute onset or fluctuating course
Feature 2: Inattention (+) or (-) ['Squeeze my hand when you hear me say the letter A--> S A V
E A H A A R T']
Feature 3: Altered level of consciousness (+) if RASS anything other than zero
Feature 4: Disorganized thinking [May ask a series of questions, eg does a stone float on water;
OR hold this many fingers up. Now with the other hand]
What findings on the CAM-ICU indicates a patient is positive for delirium? - answer✔✔Feature
1 and 2 are present plus 3 or 4
Pros for NEECHAM confusion scale? - answer✔✔-Better than CAM-ICU for determining
severity (good for showing if there is improvement)
-Has been validated inside and outside of the ICU
Cons for NEECHAM confusion scale? - answer✔✔-May have higher false positive rate
compared to CAM-ICU
-May be a bit more complex
Levels of assessment in the NEECHAM - answer✔✔Information processing, behavior,
physiological control
This is a 13-item scale that is fairly easy to evaluate. It was was developed to allow nurses to
detect delirium at the bedside during routine care. Patients must be able to speak. -
answer✔✔Delirium Observation Screening Scale (DOSS)
A score of 3 or higher is positive for delirium.
What are some metabolic derangements that contribute to delirium? -
answer✔✔Hyperammonemia, hepatic encephalopathy, uremia (imbalance of NTs due to aa
accumulation), hyponatremia, dehydration, hypoglycemia (decreased energy delivery or usage
Delirium and Dementia Exam Questions
With Correct Answers.
Identify the main difference between delirium and dementia. - answer✔✔Delirium- develops
quickly, change in consciousness, direct physiological consequence of a medical condition,
change in cognition not accounted for
Dementia- slow progression, consciousness may not be affected, progressive cognitive decline
Risk Factors for Delirium (6) - answer✔✔Hospitalization
Advanced age (> 70)
Pre-existing psychological conditions
Advanced life-threatening illness
Comorbidities
Poor nutrition
Neurotransmittors affected in delirium - answer✔✔Acetylcholine (especially), NE, 5HT,
somatostatin
Clinical Presentation of a patient with delirium - answer✔✔Altered reality (Hallucinations,
delusions)
Agitation or Restlessness
Movement may or may not be purposeful
Self-harm
Hyperactive, hypoactive, or mixed
What are assessment scales used for delirium? - answer✔✔CAM-ICU
NEEHCHAM
Delirium Observation Screening Scale (DOSS)
, ©THEBRIGHT EXAM STUDY SOLUTIONS 8/22/2024 12:54 PM
What are the pros of CAM-ICU? - answer✔✔-Great for ventilated patients (don't need to speak)
who are conscious
-Quickly done at bedside
Cons of CAM-ICU? - answer✔✔-No indication of severity
-Does take some minor training
-Cannot be done retrospectively
Features of CAM-ICU (4) - answer✔✔Feature 1: Acute onset or fluctuating course
Feature 2: Inattention (+) or (-) ['Squeeze my hand when you hear me say the letter A--> S A V
E A H A A R T']
Feature 3: Altered level of consciousness (+) if RASS anything other than zero
Feature 4: Disorganized thinking [May ask a series of questions, eg does a stone float on water;
OR hold this many fingers up. Now with the other hand]
What findings on the CAM-ICU indicates a patient is positive for delirium? - answer✔✔Feature
1 and 2 are present plus 3 or 4
Pros for NEECHAM confusion scale? - answer✔✔-Better than CAM-ICU for determining
severity (good for showing if there is improvement)
-Has been validated inside and outside of the ICU
Cons for NEECHAM confusion scale? - answer✔✔-May have higher false positive rate
compared to CAM-ICU
-May be a bit more complex
Levels of assessment in the NEECHAM - answer✔✔Information processing, behavior,
physiological control
This is a 13-item scale that is fairly easy to evaluate. It was was developed to allow nurses to
detect delirium at the bedside during routine care. Patients must be able to speak. -
answer✔✔Delirium Observation Screening Scale (DOSS)
A score of 3 or higher is positive for delirium.
What are some metabolic derangements that contribute to delirium? -
answer✔✔Hyperammonemia, hepatic encephalopathy, uremia (imbalance of NTs due to aa
accumulation), hyponatremia, dehydration, hypoglycemia (decreased energy delivery or usage
