Podcast
Questions and Answers
What is the likely cause of Adaibaa's confusion and paranoia?
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?
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?
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?
What is the current blood pressure management for Adaibaa?
What is the NIHSS score of Adaibaa after treatment?
What is the NIHSS score of Adaibaa after treatment?
What is the estimated prevalence of delirium in acute stroke patients?
What is the estimated prevalence of delirium in acute stroke patients?
What is a significant factor that increases the risk of a patient developing post-stroke delirium?
What is a significant factor that increases the risk of a patient developing post-stroke delirium?
What is a common feature of hyperactive delirium?
What is a common feature of hyperactive delirium?
What is the primary goal of managing post-stroke delirium?
What is the primary goal of managing post-stroke delirium?
What is the recommended environment for nursing a patient with post-stroke delirium?
What is the recommended environment for nursing a patient with post-stroke delirium?
What is the purpose of the Delirium Daily screen with the 4AT screening tool?
What is the purpose of the Delirium Daily screen with the 4AT screening tool?
What is the risk of hypoactive delirium being overlooked?
What is the risk of hypoactive delirium being overlooked?
What is the purpose of the Waterlow scale?
What is the purpose of the Waterlow scale?
What is the primary goal of preventive measures for post-stroke complications?
What is the primary goal of preventive measures for post-stroke complications?
What is the recommended tool for screening for post-stroke depression?
What is the recommended tool for screening for post-stroke depression?
What is the recommended frequency for delirium screening in stroke patients?
What is the recommended frequency for delirium screening in stroke patients?
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.
