Assessing Delirium - #14Take Quiz
Identify and assess delirium.
|Risk Assessment at Admission||Precipitating Risk Factors||Medications|
1.Decreased vision (<20/70)
3.Decreased cognition (< 24 MMSE)
4.Dehydration (BUN/Cr >18)
--1-2 = int. risk → OR 2.5
--3-4 = high risk → OR 9.2
3.Greater or equal to 3 Med classes added
5.Int. risk = 1-2 → OR 7.1
6.High risk = 3-5 →OR 1.5
2.Medications with sig. anticholinergic properties
Is it Delirium versus Dementia?
|Disordered / Often Present||
|Involv. - Involvement||Often Present||Generally Absent|
Diagnosis → Cam: 1 + 2 + (3 or 4)
1.Acute onset & fluctuating course
2.Treat underlying disorder
Patient in hospital or institution.
Elderly patient that either presents to the hospital or develops symptoms of altered mental status.
Approximately 1/3 of patients 70 years and older admitted to a general medical service are delirious. 50% have symptoms upon admission and the other 50% develop them in-house. 67% of delirium cases are missed.[i]
Acute cardiac/pulmonary events, bed rest, sedative or alcohol withdrawal, fluid/lyte abnormalities, infections, intracranial events, medications, anemia, uncontrolled pain, urinary retention or fecal impaction, indwelling devices, and restraints.
- Assessing the hospitalized patient for delirium
- Awareness of risk factors and medications for delirium
- Managing delirium with a completed diagnosis
Review of Systems (ROS)
[i] Inouye SK. The dilemma of delirium: Clinical and research controversies regarding diagnosis and evaluation of delirium in hospitalized elderly patients. Am J Med 1994; 97(3): 278-88. http://www.ncbi.nlm.nih.gov/pubmed/?term=dilemma+of+delirum+clinical+and+research+controversies
Users are free to download and distribute Geriatric Fast Facts for informational, educational, and research purposes only. Citation: Yana Thaker, Steven Denson MD, Kathryn Denson MD, Bambi Wessel - Fast Fact #14: Assessing Delirium. February 2012.
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