Delirium: Predisposing and Vulnerability Factors

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Questions and Answers

Which factor most clearly differentiates a predisposing factor from a precipitating factor in the context of delirium?

Predisposing factors are usually environmental, whereas precipitating factors are primarily related to an individual's medical condition.
Predisposing factors directly trigger the onset of delirium, while precipitating factors increase susceptibility over time.
Predisposing factors are reversible conditions, such as dehydration, while precipitating factors are irreversible, such as dementia.
Predisposing factors establish baseline vulnerability, while precipitating factors are the immediate triggers that cause delirium in a vulnerable individual. (correct)

An elderly patient with a history of mild cognitive impairment is admitted to the hospital for a hip fracture following a fall. Post-surgery, the patient develops delirium. Which combination of factors would be considered both a predisposing and a precipitating factor in this scenario?

Male gender (predisposing) and orthopedic surgery (precipitating).
Older age (predisposing) and bladder catheter use (precipitating).
History of falls (predisposing) and pain (precipitating). (correct)
Cognitive impairment (predisposing) and sedative-hypnotics (precipitating).

According to the DSM-V criteria for delirium, which of the following is the most critical and necessary diagnostic criterion for delirium?

The presence of visual or auditory hallucinations, causing a distorted perception of reality.
A disturbance in memory, such as difficulty recalling recent events or names.
Significant language difficulties, such as trouble finding words or understanding speech.
A reduced ability to direct, focus, sustain, and shift attention, coupled with reduced orientation to the environment. (correct)

How does the presence of metabolic derangements (e.g., electrolyte imbalances) serve as both a predisposing and precipitating factor for delirium?

<p>Chronic metabolic imbalances increase vulnerability to delirium (predisposing), while acute, severe imbalances directly trigger delirium (precipitating). (C)</p> Signup and view all the answers

A patient in the ICU is being treated with multiple medications, including narcotics for pain and anticholinergic drugs to manage secretions. They are also physically restrained due to agitation. Based on the presented information, which combination of factors presents the highest risk for precipitating delirium in this patient?

<p>The use of anticholinergic drugs combined with physical restraint. (C)</p> Signup and view all the answers

Flashcards

Predisposing Factors

Factors increasing susceptibility to delirium, such as older age or dementia.

Precipitating Factors

Factors that directly trigger delirium, such as certain drugs or infections.

Delirium: Attention/Awareness

Reduced ability to focus and maintain attention along with decreased awareness of surroundings.

Delirium: Onset

Delirium develops rapidly, typically over hours to days, not gradually over months.

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Delirium: Cognitive Disturbance

Additional cognitive issues alongside attention/awareness deficits like memory loss or disorientation.

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Study Notes

Predisposing or Vulnerability Factors

Older age is a demographic predisposing factor of delirium.
Being male increases vulnerability.
Dementia and cognitive impairment are cognitive status risk factors.
A history of delirium and depression are predisposing factors.
Functional dependence and immobility are functional status risk factors.
A poor activity level and history of falls are predisposing factors.
Vision and hearing impairment are sensory impairments that increase the risk of delirium.
Dehydration and malnutrition contribute to the risk.
The use of multiple psychoactive drugs or a high number of drugs is a risk factor.
Alcohol abuse can predispose individuals to delirium.
High severity of illness and high levels of comorbidity are medical risk factors.
Chronic renal or hepatic disease and previous stroke increases risk
Neurologic diseases and metabolic derangements are predisposing factors.
Fracture or trauma, terminal illness, and HIV infection are also risk factors.

Precipitating Factors

Sedative hypnotics, narcotics, and anticholinergic drugs are drug-related factors.
Polypharmacy and alcohol or drug withdrawal are precipitating factors.
Stroke (particularly nondominant hemispheric) can precipitate delirium.
Intracranial bleed and meningitis/encephalitis are primary neurological diseases
Intensive care unit admission is an environmental factor
Physical restraint use and bladder catheter use are environmental factors
A high number of procedures, pain, emotional stress, and prolonged sleep deprivation can precipitate delirium.
Infections and iatrogenic complications are intercurrent illnesses.
Severe acute illness and Hypoxia are intercurrent illnesses.
Shock, fever/hypothermia, and anemia can precipitate delirium.
Dehydration, poor nutritional status, and low serum albumin are intercurrent illnesses.
Metabolic derangements (e.g., electrolytes, glucose, acid-base)
Orthopedic and cardiac surgery are surgical factors that can precipitate delirium.
Duration of cardiopulmonary bypass and non-cardiac surgery also increase risk.

DSM V Diagnostic Criteria of Delirium

A disturbance in attention, that is, reduced ability to direct, focus, sustain, and shift attention, and awareness as reduced orientation to the environment.
Develops over a short time, usually hours to a few days.
There is an additional disturbance in cognition, for example, memory deficit, disorientation, language, visuospatial ability, and perception.

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Description

Explore the various predisposing and vulnerability factors associated with delirium. These include demographic factors like older age and being male, cognitive impairments such as dementia, and functional dependencies. Other factors include sensory impairments, dehydration, medication use, substance abuse, and underlying medical conditions.