NURS 5333 Family 1 Test 3 Geriatrics delirium and GI part 1 Exam Comprehensive
1. delirium: mental disorder marked by confusion; uncontrolled excitement; involves memory, whereas delirium involves
attention. Dementia is irreversible, but delirium is most often reversible
2. 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.
3. 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 con- tribute to the state of
delirium. Patients with impaired vision or impaired hearing are at higher risk of developing delirium.
4. 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
5. baseline lab with a complete blood count to rule out anemia or infection, a metabolic panel to rule out
electrolyte disturbances, theTSH with reflexT3 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?
6. 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
7. Frequent reorientation is essential in patients with delirium, and this is the benefit of having family or support
people at their bedside to help
, NURS 5333 Family 1 Test 3 Geriatrics delirium and GI part 1 Exam Comprehensive
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
8. 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
9. 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
10. Rotavirus is the most common pathogen but it can occur in adults also: -
Less than 1 yoa you have tummy ache it's probably?
11. 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....
12. 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
urinating normally, are they thirsty and have they had any behavioral or activity changes due to the illness?
13. Exam findings on gastroenteritis....: Physical exam findings are usually tran- sient and self-limiting
BUT
Blood in the stool, weight loss or severe abdominal pain are all red flags and would require further investigation and possi
imaging
14. More exam findings on gastroenteritis: hyperactive bowel sounds, the patient is going to be complaining of
anorexia, maybe fever, tenesmus, which is a strong
, NURS 5333 Family 1 Test 3 Geriatrics delirium and GI part 1 Exam Comprehensive
urge to defecate due to anal sphincter spasm and fecal incontinence if they have clostridium difficile
15. What IS acute diarrhea???: patients are going to complain about acute diar- rhea and this is considered three or
more loose stools within 24 hours and lasting no longer than two weeks
16. steps to tak in a physical exam are palpation:: nausea and vomiting that proceeds to diarrhea and they may have
abdominal cramps. They may also exhibit guarding when you palpate the abdomen as well.
17. steps to tak in a physical exam are : Hydration status: level of dehydration that the patient has. Moderate to
severe dehydration is a red flag. These patients will exhibit poor skin turgor, dry mucus membranes, flattened or sunken
fontanels, tachycardia, tachypnea, hypotension, altered mental status, headache, oliguria, lethargy and pale skin color.
18. level of dehydration in infants and children.: It's divided into measurement of the anterior fontanel, the eyes, skin
appearance, skin turgor, pulse rate, urine output and physical signs. With mild symptoms, everything is going to appear
mostly normal. Severe symptoms, you're going to see the anterior fontanel markedly sunken, the eyes will be markedly
sunken, skin will be cool and mottled, tenting will be present, the pulse will be fast and weak, there will be little or no
urine output and the patient may be lethargic. Moderate symptoms: the anterior fontanel would be sunken but not as
markedly sunken as with severe. The eyes are also sunken. Skin will be cool but not mottled. The skin turgor will be
reduced but tenting is not yet present. Pulse will be fast but not weak at this point. Urine output is going to be markedly
reduced and the patient may be listless
19. Salmonella: this has an onset of 12 to 36 hours. The patient is going to have
nausea, vomiting, cramps, fever and bloody stools.This is caused from undercooked poultry, contaminated eggs, red meats a
contaminated pets such as turtles. So history is very important
20. Shigella dysentery: the onset is usually two to four days. These patients have abdominal pain or cramps, fever,
watery diarrhea, it may be bloody. They'll have tenesmus and there'll be white blood cells in the stool. This is transferred
fecal-oral route or it can be transferred via homosexual transmission. This is reportable and it is the major cause of
pediatric morbidity and mortality. This has to have a definitive diagnosis with a stool culture
21. E. coli O157:H7: Toxin-producing strain of E. coli First seen in 1982;
causes bloody diarrhea
Leading cause of diarrhea worldwide
onset is 10 hours to six days. The patient will have mild cramps, no fever, watery
1. delirium: mental disorder marked by confusion; uncontrolled excitement; involves memory, whereas delirium involves
attention. Dementia is irreversible, but delirium is most often reversible
2. 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.
3. 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 con- tribute to the state of
delirium. Patients with impaired vision or impaired hearing are at higher risk of developing delirium.
4. 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
5. baseline lab with a complete blood count to rule out anemia or infection, a metabolic panel to rule out
electrolyte disturbances, theTSH with reflexT3 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?
6. 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
7. Frequent reorientation is essential in patients with delirium, and this is the benefit of having family or support
people at their bedside to help
, NURS 5333 Family 1 Test 3 Geriatrics delirium and GI part 1 Exam Comprehensive
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
8. 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
9. 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
10. Rotavirus is the most common pathogen but it can occur in adults also: -
Less than 1 yoa you have tummy ache it's probably?
11. 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....
12. 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
urinating normally, are they thirsty and have they had any behavioral or activity changes due to the illness?
13. Exam findings on gastroenteritis....: Physical exam findings are usually tran- sient and self-limiting
BUT
Blood in the stool, weight loss or severe abdominal pain are all red flags and would require further investigation and possi
imaging
14. More exam findings on gastroenteritis: hyperactive bowel sounds, the patient is going to be complaining of
anorexia, maybe fever, tenesmus, which is a strong
, NURS 5333 Family 1 Test 3 Geriatrics delirium and GI part 1 Exam Comprehensive
urge to defecate due to anal sphincter spasm and fecal incontinence if they have clostridium difficile
15. What IS acute diarrhea???: patients are going to complain about acute diar- rhea and this is considered three or
more loose stools within 24 hours and lasting no longer than two weeks
16. steps to tak in a physical exam are palpation:: nausea and vomiting that proceeds to diarrhea and they may have
abdominal cramps. They may also exhibit guarding when you palpate the abdomen as well.
17. steps to tak in a physical exam are : Hydration status: level of dehydration that the patient has. Moderate to
severe dehydration is a red flag. These patients will exhibit poor skin turgor, dry mucus membranes, flattened or sunken
fontanels, tachycardia, tachypnea, hypotension, altered mental status, headache, oliguria, lethargy and pale skin color.
18. level of dehydration in infants and children.: It's divided into measurement of the anterior fontanel, the eyes, skin
appearance, skin turgor, pulse rate, urine output and physical signs. With mild symptoms, everything is going to appear
mostly normal. Severe symptoms, you're going to see the anterior fontanel markedly sunken, the eyes will be markedly
sunken, skin will be cool and mottled, tenting will be present, the pulse will be fast and weak, there will be little or no
urine output and the patient may be lethargic. Moderate symptoms: the anterior fontanel would be sunken but not as
markedly sunken as with severe. The eyes are also sunken. Skin will be cool but not mottled. The skin turgor will be
reduced but tenting is not yet present. Pulse will be fast but not weak at this point. Urine output is going to be markedly
reduced and the patient may be listless
19. Salmonella: this has an onset of 12 to 36 hours. The patient is going to have
nausea, vomiting, cramps, fever and bloody stools.This is caused from undercooked poultry, contaminated eggs, red meats a
contaminated pets such as turtles. So history is very important
20. Shigella dysentery: the onset is usually two to four days. These patients have abdominal pain or cramps, fever,
watery diarrhea, it may be bloody. They'll have tenesmus and there'll be white blood cells in the stool. This is transferred
fecal-oral route or it can be transferred via homosexual transmission. This is reportable and it is the major cause of
pediatric morbidity and mortality. This has to have a definitive diagnosis with a stool culture
21. E. coli O157:H7: Toxin-producing strain of E. coli First seen in 1982;
causes bloody diarrhea
Leading cause of diarrhea worldwide
onset is 10 hours to six days. The patient will have mild cramps, no fever, watery
