Delirium PPT

What is delirium?

Delirium is a state of disturbed consciousness and altered cognition with a rapid onset over hours or a few days

Does delirium happen rapidly or slowly?

RAPID ONSET

When is delirium a common complication?

Delirium is a common complication in hospitalized elderly population

Delirium: Examples

• Dulled awareness of the environment and reduces ability to focus, sustain, and shift attention

• Memory and judgment are impaired

• Disorientation may occur

• Speech is rapid, rambling, incoherent

• Intense emotional swings

• Hallucinations

• Delusions

• Vivid dreams

• Restlessness

Patho: Delirium

• Disorder of cognitive function, consciousness, or perception

• Sudden or gradual onset

• Acute confusional state

• A result of many medical conditions

Delirium: What is there a disruption of?

There is a disruption of widely distributed brain networks (not in a discrete area of the brain)

Delirium: Metabolic disturbances

Metabolic disturbances that cause delirium interfere with neuronal metabolism or synaptic transmission.

Delirium: Involved neurotransmitters

Neurotransmitters involved include:

• Decreased acetylcholine

• Excess dopamine

Delirium: What may interfere with neurotransmission?

Drug and toxins may interfere with neurotransmission function at the synapse

What conditions cause delirium?

• Conditions that cause delirium

  • Drug intoxication

  • Alcohol or drug withdrawal

  • Metabolic disorders (hypoglycemia, thyroid storm)

  • Brain trauma, surgery, tumors

  • Meningoencephalitis

  • Post-anesthesia

  • Febrile

  • Electrolyte imbalance, dehydration

  • Heart, kidney, liver failure

  • Sepsis

TREAT UNDERLYING CAUSE

Delirium: Clinical Manifestations

• Acute disturbance in attention & awareness (ANS overactivity)

• Develops over 2-3 days

Delirium: When is delirium common?

• Common in ICU, after surgery, during CNS depressant withdrawal, elderly

• Risk factors:

  • Meds (narcotics, benzos, anticholinergics)

  • Infection or sepsis

  • Surgery

  • F&E imbalances

  • Hypoxia metabolic disorders (liver, kidney, hypoglycemia, thyroid dx)

Delirium: S&S

• Restlessness

• Irritability

• Difficulty concentrating

• Insomnia

• Tremulousness

• Poor appetite

• Seizures

• Nightmares

• Hallucinations

• Altered perceptions

• Distressed

• Incoherent conversations

• Tremors/restless movements

• Flushed

• Dilated pupils

• Tachycardia, febrile, diaphoresis

Delirium: Treatment

• Establish cause

• Treatment is directed at correcting the primary disorder