Exam (elaborations)

PMHNP-Delirium and Dementia (ANCC 3Ed, Chapter 11) exams passed

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PMHNP

Institution
AQA

Delirium Tidbits - An acute onset syndrome, not a disease. Hallmark symptom: disturbance of CONSCIOUSNESS accompanied by changes in COGNITION. Delirium likely caused by direct physiologic process, substance use/abuse, or general medical condition) Common findings: -Develops over hours to days ...

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pmhnp delirium and dementia ancc 3ed chapter 11

Study Level A/AS Level
Examinator AQA
Subject PMHNP
Unit PMHNP

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PMHNP-Delirium and Dementia (ANCC
3Ed, Chapter 11) exams passed
Delirium Tidbits - ✔✔An acute onset syndrome, not a disease.

Hallmark symptom: disturbance of CONSCIOUSNESS accompanied by changes in COGNITION.

Delirium likely caused by direct physiologic process, substance use/abuse, or general medical condition)

Common findings:

-Develops over hours to days

-Fluctuates during the day

- Reversal of sleep-wake cycle (awake at night, asleep in day)

- Impaired recent and intermediate memory

- Psychomotor agitation (purposeless, randome actions)

Common, and often overlooked. Mistaken for dementia in older persons, and for worsening psychotic
symptoms in those with SMI. Symptoms can persist for months if not recognized; most resolve in 3-6
months if treated.

Delirium subtypes - ✔✔Hyperactive: agitated, restless, hyperalert

Hypoactive: lethargic, slowed, apathetic

Mixed: cycles between hyperactive and hypoactive

Delirium incidence, demographic, prognosis - ✔✔0.4% general population

1-2% those >65

14-56% of hospitalized pts

,poor prognosis: 50% mortality rate by 1 year

Early recognition, intervention, treatment is goal: when pts clinical presentation changes rapidly from
baseline, always keep delirium in differential.

Confusion Assessment Instrument (CAM) - ✔✔The Confusion Assessment Method (CAM) includes two
parts.

Part one is an assessment instrument that screens for overall cognitive impairment.

Part two includes only those four features that were

found to have the greatest ability to distinguish delirium or reversible confusion from other types of
cognitive

impairment.

http://consultgerirn.org

Delirium- Non Specific Neuro Abnormalities - ✔✔Urinary Incontinence

Mycoclonus

Nystagnus

Asterixis - flapping motion of the wrists

Increased muscle tone and reflex

Tremors

Incoordination

Delirium- Perceptual Disturbance - ✔✔Illusions most common

Hallucinations - usually visual & accompanied by illusions

Delusions are common

, Delirium - MSE findings - ✔✔GENERAL appearance: inattentive, disheveled, unconcerned

SPEECH: impaired, disorganized, rambling, incoherent, slurred

AFFECT: rapid, unpredictable shifts in affective state without known precipitant (lethargic to agitated)

MOOD: difficult to elicit

THOUGHT PROCESS: disorganized, distractible, perceptual disturbances

THOUGHT CONTENT: disorganized, distorted, delusional

ORIENTATION: disorientation to time & place (USUALLY FIRST SX TO APPEAR)

Impaired memory, concentration, abstraction, and jdgment

Delirium: diagnostic studies - ✔✔Chemistry

CBC

TFT

Syphilis

HIV

UA

CXR

serum or urine drug screen

EEG would show generalized slowing, unless ETOH withdrawal related (then would show generalized
increased activity)

Delirium Non-pharm treatment - ✔✔Monitor for safety, nutrition, hydration

Avoid sensory-deprivation or overstimulation

Frequent reality orientation (and familiar people, pictures, clock or calendar etc)

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