Post-Stroke Delirium: Risk Factors

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Questions and Answers

What is the likely cause of Adaibaa's confusion and paranoia?

Aspirin treatment

Delirium, a common post-stroke complication (correct)

Mild hemiparesis and expressive aphasia

Thrombolysis and thrombectomy treatment

What is the predicted outcome for stroke patients with delirium?

Only affects patients with mild strokes

Higher mortality and longer hospitalizations (correct)

No effect on mortality and hospitalizations

Lower mortality and shorter hospitalizations

What is the significance of Adaibaa's refusal to have breakfast?

She is paranoid and suspects the nurses of tampering with her food (correct)

She is experiencing mild hemiparesis

She is hungry but wants to eat something else

She is having a stroke relapse

What is the current blood pressure management for Adaibaa?

Controlled over 24 hours (C) Signup and view all the answers

What is the NIHSS score of Adaibaa after treatment?

6 (A) Signup and view all the answers

What is the estimated prevalence of delirium in acute stroke patients?

Up to a third (30%) (A) Signup and view all the answers

What is a significant factor that increases the risk of a patient developing post-stroke delirium?

More severe stroke (D) Signup and view all the answers

What is a common feature of hyperactive delirium?

Restlessness (D) Signup and view all the answers

What is the primary goal of managing post-stroke delirium?

To identify and treat the underlying cause (B) Signup and view all the answers

What is the recommended environment for nursing a patient with post-stroke delirium?

A calm sensory environment (C) Signup and view all the answers

What is the purpose of the Delirium Daily screen with the 4AT screening tool?

To screen for potential post-stroke complications (C) Signup and view all the answers

What is the risk of hypoactive delirium being overlooked?

Higher than hyperactive delirium (C) Signup and view all the answers

What is the purpose of the Waterlow scale?

To screen for risk of pressure injuries (C) Signup and view all the answers

What is the primary goal of preventive measures for post-stroke complications?

To prevent malnutrition or pressure sores (C) Signup and view all the answers

What is the recommended tool for screening for post-stroke depression?

Patient Health Questionnaire-9 (PHQ-9) (C) Signup and view all the answers

What is the recommended frequency for delirium screening in stroke patients?

Daily (D) Signup and view all the answers

Study Notes

Post-Stroke Delirium

Adaibaa, a 67-year-old woman, developed delirium after a left middle cerebral artery stroke, which is a common post-stroke complication affecting up to a third of acute stroke patients.

Risk Factors for Delirium

Older age
More severe stroke
Worse pre-stroke function and cognitive impairment
History of depression
Use of medications with anticholinergic (ACH) activity
Comorbid disorders (e.g., diabetes, atrial fibrillation)
Concurrent infection
Visual disturbances arising from stroke (visio-spatial neglect, hemianopsia)

Types of Delirium

Hyperactive delirium: characterized by restlessness, agitation, wandering, hyper alertness, and hallucinations
Hypoactive delirium: characterized by lethargy, inattention, withdrawal, and drowsiness; three times more common than hyperactive delirium but may be missed by healthcare staff

Diagnosis of Delirium

Use of a validated screening tool such as the 4AT screening tool
Adaibaa scored 7 on the 4AT screening tool, indicating a high possibility of delirium

Management of Delirium

Identify and treat the underlying cause
Nurse in a calm sensory environment
Use sedation sparingly
Prevent complications such as malnutrition, pressure sores, and others

Post-Stroke Complications

Delirium
Deep vein thrombosis (DVT)/pulmonary embolism (PE)
Pneumonia
Infections
Aspiration
Bowel/bladder dysfunction
Myocardial infarction/heart failure
Pressure injuries
Depression
Pain

Screening and Management Protocols

Daily screening for delirium using a validated tool
Monitoring for potential post-stroke complications
Use of validated tools for screening and management of complications (e.g., Waterlow scale, Patient Health Questionnaire-9 (PHQ-9), Functional Pain Scale (FPS))

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Description

Delirium after stroke is a common complication affecting up to a third of acute stroke patients. Learn about the risk factors that contribute to this condition, including age, stroke severity, and more.