16 Questions
What is the likely cause of Adaibaa's confusion and paranoia?
Delirium, a common post-stroke complication
What is the predicted outcome for stroke patients with delirium?
Higher mortality and longer hospitalizations
What is the significance of Adaibaa's refusal to have breakfast?
She is paranoid and suspects the nurses of tampering with her food
What is the current blood pressure management for Adaibaa?
Controlled over 24 hours
What is the NIHSS score of Adaibaa after treatment?
6
What is the estimated prevalence of delirium in acute stroke patients?
Up to a third (30%)
What is a significant factor that increases the risk of a patient developing post-stroke delirium?
More severe stroke
What is a common feature of hyperactive delirium?
Restlessness
What is the primary goal of managing post-stroke delirium?
To identify and treat the underlying cause
What is the recommended environment for nursing a patient with post-stroke delirium?
A calm sensory environment
What is the purpose of the Delirium Daily screen with the 4AT screening tool?
To screen for potential post-stroke complications
What is the risk of hypoactive delirium being overlooked?
Higher than hyperactive delirium
What is the purpose of the Waterlow scale?
To screen for risk of pressure injuries
What is the primary goal of preventive measures for post-stroke complications?
To prevent malnutrition or pressure sores
What is the recommended tool for screening for post-stroke depression?
Patient Health Questionnaire-9 (PHQ-9)
What is the recommended frequency for delirium screening in stroke patients?
Daily
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))
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.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
