Delirium and Nausea. Delirium - definition. Delirium Incidence. Predisposing Risk Factors for Delirium. Impact. Delirium Types 10/14/2016
|
|
- Rosamund Williams
- 5 years ago
- Views:
Transcription
1 Delirium - definition Delirium and Nausea Etiologically non-specific global cerebral dysfunction associated with changes in LOC, attention, thinking, perception, memory, psychomotor behavior, emotion and the sleep/wake cycle Delirium Types Delirium Incidence Hypoactive confusion, somnolence, alertness Hyperactive agitation, hallucinations, aggression Mixed (>60%) features of both 20% - 44% on admission to a palliative care unit (common reason for admission) 28% - 45% of patients developed delirium while on the palliative care unit 68% - 90% prior to death 50% of episodes reversible Terminal delirium in 88% Lawlor et al. Arch Intern Med 2000; 160:786 Impact Predisposing Risk Factors for Delirium 73/99 patients (74%) remembered delirious episode Of these, 81% recalled experience as distressing Family stress > patients recalled stress Functional and psycho-social factors: Advanced age Sensory deficit (poor vision/hearing) Functional disability Chronic physical illness Substance abuse Disease state factors: Pre-existing dementia Depression Neurological impairment Dehydration Multiple medication use Hui et al. JPSM 99;2:
2 Mnemonics Drugs, including any new medications, increased dosages, drug interactions, over-the-counter drugs, alcohol, etc Electrolyte disturbances, especially dehydration, and thyroid problems DELIRIUM I WATCH DEATH Lack of drugs, such as when long-term sedatives (including alcohol and sleeping pills) are stopped, or when pain drugs are not being given adequately Infection, commonly urinary or respiratory tract infection Reduced sensory input, which happens when vision or hearing are poor Intracranial (referring to processes within the skull) such as a brain infection, hemorrhage, stroke, or tumor (rare) Urinary problems or intestinal problems, such as inability to urinate or constipation Myocardial (heart) and lungs, e.g. heart attack, problems with heart rhythm (arrhythmia), worsening of heart failure or chronic obstructive lung disease. There are many various acronyms for DELIRIUM these are just two INFECTIONS, (UTI, Pneumonia, Meningitis) WITHDRAWAL, (Benzo/Alcohol) ACUTE METABOLIC DISORDER, (Lytes/Liver/Kidney) TRAUMA, (Head injury/ Post op) CNS, (Stroke/Haemorrhage) HYPOXIA, (Anemia/CCF/Pulmonary Embolism) Symptomatology: Delirium v. Dementia Acute onset DELIRIUM More rapid changes in severity, cycling of symptoms DEMENTIA Usually slower progression Symptom severity more steady DEFICIENCIES, (B12/Folic Acid/Thiamine) ENDOCRINOPATHIES, (Thyroid/Parathyroid/Hypoglycemia/Adrenal) ACUTE VASCULAR PROBLEMS, (Shock/Vasculitis/Hypertensive Encephalopathy) TOXINS, (Substance Abuse/Anticholinergics/narcotics/Alcohol) HEAVY METALS, (Arsenic/ Lead / Mercury) Altered level of consciousness Reversible Hallucinations may occur Fully conscious Irreversible Hallucinations are generally rare A Step-Wise Approach to Drug Treatment of Delirium Management Of Delirium Establish diagnosis of delirium Establish goals of therapy Is it distressing for patient or family?? Prioritize according to patient s overall symptom management needs Identify risk factors for delirium Are they practically reversible? What is patient s tolerance for likely diagnostic and treatment options? Are there competing risks/benefits for other symptom management needs and the risk of delirium? 1. Environmental Quite, private setting: single room if possible Low lighting, calendar, clock, familiar objects Minimal room changes with unnecessary distractions 2. Fix the Fixable if possible and appropriate 3. Help family navigate complex choices and non-choices, dictated by how the patient would guide care if that were possible 4. Effective sedation with frank discussion of anticipated course If delirium irreversible, goal of care is sedation Sedation does not hasten the dying process Will facilitate meaningful visiting Encourage communication, even though patient not interactive 2
3 Drug Treatment for Delirium: Medication Classes 1 st Generation ( Typical ) Antipsychotics Haloperidol (Haldol ), Loxapine, Chlorpromazine, Methotrimeprazine (Nozinan ) 2 nd Generation ( Atypical ) Antipsychotics Olanzapine (Zyprexa ), Risperidone (Risperdal ), Quetiapine (Seroquel ) Benzodiazepines Lorazepam (Ativan ), Clonazepam, Midazolam Treatment - Pharmacological Mild restlessness haloperidol Delirium and Agitation in Terminal Illness Haloperidol, methotrimeprazine Sometimes chlorpromazine in more severe cases of delirium with aggression if haloperidol or methotrimeprazine not effective End Of Life Delirium/Restlessness Symptoms may appear or existing symptoms may worsen as patient deteriorates Benzodiazepenes are most likely to be used, if avoiding sedation is no longer an issue Lorazepam sc/sl q4h regularly Midazolam iv/sc by continuous infusion Nausea & Vomiting Nausea & Vomiting - definition Incidence Of Nausea & Vomiting In Terminal Cancer Patients Nausea - an unpleasant feeling of the need to vomit Vomiting - the expulsion of gastric contents through the mouth, caused by forceful and sustained contraction of the abdominal muscles and diaphragm Nausea: % Vomiting: 30 % 3
4 Assessing Nausea & Vomiting Onset: when did it first start; is this new Provocation: identify triggers may have multiple, e.g. odors, eating, pain, anxiety, anticipation, medication, etc Quality: persistent nausea; cramping/ spasmodic; content of emesis; nausea +/- vomiting OR vomiting +/- nausea Relief: relieving factors effective medications & nonpharmacological interventions; relief with vomiting or not Severity: 0-10 (getting worse or improving; what is acceptable) Timing: pattern; for how long and how often Understanding of the symptom and what is its impact Principles of Treating Nausea & Vomiting Treat underlying causes e.g., hypercalcemia, urosepsis, constipation, uremia, intracranial pressure, bowel obstruction, dehydration, medication adverse effects, reduced intestinal motility Treat disease specific issues, i.e. match medication to etiology: anticipate need (prior to meals, treatment, etc.) use adequate, regular doses +/- PRN aim at receptor involved combinations if necessary anticipate need for alternate routes Value; what is the patient s goal for this symptom Nausea Vomiting Central Nervous System Cerebral High CNS Increased Intracranial Pressure Integrative Vomiting Center (IVC) [Emesis Center] Chemorecptor Trigger Zone (CTZ) Psychological (fear, anxiety, pain) Anticipatory nausea / vomiting to sights, smells, etc. Treatments Benzodiazepines Cannabinoids Relaxation Therapy Vestibular GI Tract - Vagal The IVC is stimulated by all of the pathways which in turn initiates N & V Central Nervous System Gastro-Intestinal Tract/ Vagal Increased Intracranial Pressure (brain metastases, infectious meningitis, cerebral edema, bleeding) Headache +/- cranial nerve signs, (diurnal). Vomiting often without nausea. Treatments Gastric irritation (ASA, NSAIDs, steroids, antibiotics, blood, ETOH, stress, radiotherapy) Obstruction (partial or complete) Constipation Gastric stasis Mass effect (GI, GU, hepaticdistention, carcinomatosis) Anatomic / Structural Epigastric pain, fullness, acid reflux, early satiety, flatulence, hiccup, intermittent nausea relieved with vomiting. Altered bowel habit, pain may occur with oral intake. Vomitus may be large volume and fecal smelling. 4
5 Gastro-Intestinal Tract/ Vagal Gastro-Intestinal Tract/ Obstruction Treatment (non-obstruction) Dopamine Receptors Gastrokinetic Metoclopramide (Maxeran) Domperidone Phenothiazine Serotonin Receptors Ondansetron (Zofran) Metoclopramide (Nozinan) Octreotide Treatment (obstruction) Haloperidol Octreotide Avoid prokinetics and serotonin agonists NPO NG tube for suction Consideration of surgical interventions Chemorecptor Trigger Zone (CTZ)/ Chemical Chemorecptor Trigger Zone (CTZ)/ Chemical Drugs (opioids, digoxin, steroids, antibiotics, anticonvulsants, cytotoxics) Biochemical (hypercalcaemia, uremia, organ failure) Toxins (tumour factors, infection, drug metabolites, radiation) Symptoms of drug toxicity or underlying disease plus nausea as the prominent symptom. Nausea usually not relieved by vomiting. Treatments Dopamine Receptors Gastrokinetic Metoclopramide Domperidone Phenothiazine Methrotrimeprazine Haloperidol (Haldol) Prochlorperazine (Stemitil) Chlorperazine Neurokinin Receptors Aprecipitant Serotonin Receptors Ondansetron Metoclopramide Benzodiazepines Cannabinoids Relaxation Therapy Vestibular Motion sickness Cerebellar tumour Nausea +/- vomiting with movement. Treatment H1 Antagonist Dimenhydrinate (Gravol) Anticholinergic Scopolamine Atropine Integrative Vomiting Centre (IVC)/ Emesis Centre Treatment Histamine Receptors Dimenhydrinate Anticholinergic Scopolamine Atropine Serotonin Receptors Olanzapine Ondansetron Cannabinoid Receptors THC Neurokinin Receptors Aprecipitant The IVC is stimulated by any and all of the pathways which in turn initiates N & V 5
6 Principles of Treating Nausea & Vomiting - Non-pharmacological Modifications to diet (consult Dietitian if needed) food modification restricted intake small frequent meals sips of fluid (sports drinks, broth, popsicles, water) cool and bland food avoiding lying flat after eating avoid alcohol & tobacco avoid spicy, acidic, salty, hard, crunchy foods Principles of Treating Nausea & Vomiting - Non-pharmacological Modifications to environment e.g. control smells and noise, air fresheners/deodorizers Good oral hygiene, especially after vomiting Relaxation, visualization, distraction Psychosocial support and anxiety reduction: social worker, counsellor, spiritual health practitioner Acupressure for chemotherapy-induced acute nausea but not for delayed symptoms Urgent Blood (bright red or black); coffee ground emesis Severe cramping, acute abdominal pain Dizziness, weakness, confusion, excessive thirst, dark urine Projectile vomiting Fever No improvement with interventions 6
Nausea and Vomiting in Palliative Care
Nausea and Vomiting in Palliative Care Definitions Nausea - an unpleasant feeling of the need to vomit Vomiting - the expulsion of gastric contents through the mouth, caused by forceful and sustained contraction
More informationDelirium. Assessment and Management
Delirium Assessment and Management Goals and Objectives Participants will: 1. be able to recognize and diagnose the syndrome of delirium. 2. understand the causes of delirium. 3. become knowledgeable about
More informationDelirium. Delirium. Delirium Etiology and Pathophysiology. Fall 2018
Three most common cognitive problems in adults 1. (acute confusion) 2. Dementia 3. Depression These problems often occur together Can you think of common stimuli for each? 1 1 State of temporary but acute
More informationLearning Objectives. Delirium. Delirium. Delirium. Terminal Restlessness 3/28/2016
Terminal Restlessness Dr. Christopher Churchill St. Cloud VA Health Care System EC&R Service Line Director & Medical Director Hospice & Palliative Care March 31, 2016 Learning Objectives Different Terminology
More informationGI Pharmacology -4 Irritable Bowel Syndrome and Antiemetics. Dr. Alia Shatanawi
GI Pharmacology -4 Irritable Bowel Syndrome and Antiemetics Dr. Alia Shatanawi 11-04-2018 Drugs used in Irritable Bowel Syndrome Idiopathic, chronic, relapsing disorder characterized by abdominal discomfort
More informationApproach to Nausea & Vomi2ng
Approach to Nausea & Vomi2ng Med 3 Seminar 2017 Dr. Robin Grant Division of Pallia2ve Medicine robin.grant@nshealth.ca Why nausea and vomi2ng? Pain 80-90+ % Fa2gue / asthenia 75-90% Cons2pa2on 70% Dyspnea
More informationSymptom Management Pocket Guides: DELIRIUM
Symptom Management Pocket Guides: DELIRIUM August 2010 DELIRIUM Page Considerations. 1 Assessment 2 Diagnosis. 3 Non-Pharmacological treatment 3 Pharmacological treatment. 5 Mild Delirium... 6 Moderate
More informationNausea and Vomiting. Principles and Practice in End of Life Care November 2018
Nausea and Vomiting Principles and Practice in End of Life Care November 2018 Overview Aims and Objectives Why is managing nausea and vomiting important? Definitions Causes Interventions pharmacological
More informationPart 2: Pain and Symptom Management Nausea and Vomiting
Part 2: Pain and Symptom Management Nausea and Vomiting Effective Date: February 22, 2017 Key Recommendations Select anti-nausea medication based on the etiology of the nausea and vomiting. Assessment
More information3/27/2013. Objectives. Psychopharmacology at the End of Life Nicole Thurston, MD
Psychopharmacology at the End of Life Nicole Thurston, MD Psychiatrist Mountain States Tumor Institute Objectives Describe 2 common psychiatric symptoms that can present at or near end of life. Review
More informationDelirium. Dr. Lesley Wiesenfeld. Deputy Psychiatrist in Chief, Mount Sinai Hospital. Dr. Carole Cohen
Delirium Dr. Lesley Wiesenfeld Deputy Psychiatrist in Chief, Mount Sinai Hospital Dr. Carole Cohen Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre Case Study Mrs B
More informationNausea & Vomiting. Dr Eve Lyn TAN Liverpool Hospital NSW, AUSTRALIA
Nausea & Vomiting Dr Eve Lyn TAN Liverpool Hospital NSW, AUSTRALIA Prevalence prevalence varies *, systemic review 2007 : overall prevalence : nausea 30%, vomiting 20% in last 1-2 weeks of life : nausea
More informationManagement of Delirium in Hospice Patients
Presentation Objectives Management of Delirium in Hospice Patients Lynn Williams, BSPharm Clinical Pharmacist Hospice Pharmacy Solutions Identify the clinical features of delirium Understand the underlying
More informationDIAH MUSTIKA HW SpS,KIC Intensive Care Unit of Emergency Department Naval Hospital dr RAMELAN, Surabaya
DIAH MUSTIKA HW SpS,KIC Intensive Care Unit of Emergency Department Naval Hospital dr RAMELAN, Surabaya Encephalopathy is a common complication of systemic illness or direct brain injury. Acute confusional
More informationDelirium. A Plan to Reduce Use of Restraints. David Wensel DO, FAAHPM Medical Director Midland Care
Delirium A Plan to Reduce Use of Restraints David Wensel DO, FAAHPM Medical Director Midland Care Objectives Define delirium Describe pathophysiology of delirium Understand most common etiologies Define
More informationDelirium in Cancer: Psychopharmacologic Management
Delirium in Cancer: Psychopharmacologic Management William Breitbart, MD Professor and Chief, Psychiatry Service Memorial Sloan-Kettering Cancer Center New York, New York Delirium in Patients with Cancer
More informationCare in the Last Days of Life
Care in the Last Days of Life Introduction This guideline is an aid to clinical decision making and good practice in person-centred care for patients who are deteriorating and at risk of dying. The patient
More informationBRAIN. Tumor byproducts. Autonomic nerves. Somatic nerves. Host immune cells. Cytokines
Patient s Problems Pain (80%) Fatigue (90%) Weight Loss (80%) Lack of Appetite (80%) Nausea, Vomiting (90%) Anxiety (25%) Shortness of Breath (50%) Confusion-Agitation (80%) Tumor Mass Tumor Function Somatic
More informationNausea and Vomiting During Cancer Treatment
Published on: 9 Feb 2013 Nausea and Vomiting During Cancer Treatment Nausea And Vomiting During Cancer Treatment Are Nausea And Vomiting Common During Cancer Treatment? Yes. Nausea and Vomiting are the
More informationPalliative Care Emergencies. Additional module if needed
Palliative Care Emergencies Additional module if needed Learning objectives Understand emergency /urgent / important Describe common emergencies in PC Explore principles of essential management Outline
More informationPalliative Care and Delirium. Ambereen K. Mehta, MD MPH Assistant Professor Division of General Medicine, Geriatrics, and Palliative Care
Palliative Care and Delirium Ambereen K. Mehta, MD MPH Assistant Professor Division of General Medicine, Geriatrics, and Palliative Care Disclosures I have no personal or professional financial relationships
More informationInpatient Palliative Medicine Update
Inpatient Palliative Medicine Update David Dupere MD, FRCPC Head, Division of Palliative Medicine Department of Medicine QEII Health Sciences Centre Halifax, Nova Scotia Disclosures Book chapter in Compendium
More informationDELIRIUM. Approach and Management
DELIRIUM Approach and Management By Dr. K.S. Jacob, Professor of Psychiatry and Dr. Anju Kuruvilla, Professor of Psychiatry, Christian Medical College, Vellore. Based on a chapter in the book Psychiatric
More informationVomiting Approach to diagnosis
Vomiting Approach to diagnosis By Dr. Sahar El-Gharabawy Associate professor of internal medicine Hepato-gastroenterology Unit )SMH ) Mansoura University Definitions: Nausea: Feeling "sick to the stomach",
More informationDelirium in Palliative care. Presentation to Volunteers 2016 David Falk
Delirium in Palliative care Presentation to Volunteers 2016 David Falk Delirium What is delirium? Case Study - Delirium 60+ year old PQ presents to hospice very somnolent. She was admitted with her adult
More informationDelirium and Dementia
Delirium and Dementia Elder Friendly Care in Acute Care Seniors Health Strategic Clinical Network Acute Care Stress Blender Poor Poor sleep At-Risk Older Adult TREAT CAUSE immediately & aggressively. Increased
More informationSymptom Management. Thomas McKain, MD, ABFM, ABHPM Medical Director
Symptom Management Nausea & Vomiting Thomas McKain, MD, ABFM, ABHPM Medical Director Mr. Jones has nausea and vomiting. May I initiate Compazine from the Comfort Pak? Objectives 1. Delineate the Differential
More informationChapter 29 - Nausea and Vomiting
Chapter 29 - Nausea and Vomiting Episode Overview: 1) Describe the mechanism of development of a Hypochloremic Metabolic Alkalosis in vomiting 2) List commonly used anti-emetics including their dose and
More informationPRESCRIBING PRACTICE IN DELIRIUM. John Warburton Critical Care Pharmacist
PRESCRIBING PRACTICE IN DELIRIUM John Warburton Critical Care Pharmacist Learning outcomes Modifiable medication risk factors for delirium An appreciation of contributing factors modifiable with medicines
More informationControlling nausea and vomiting: anti-emetic therapy advice
Controlling nausea and vomiting: anti-emetic therapy advice Chemotherapy A guide for patients and carers Contents Treatments that may cause nausea and vomiting... 2 Physical reasons that may cause nausea
More informationApproach to symptom control near the end-of-life
Approach to symptom control near the end-of-life 18 Sept 2011 Dr Alethea Yee Senior Consultant, Department of Palliative Medicine National Cancer Centre,Singapore What is end of life? No precise definition
More informationMedications used for symptom control in palliative care
Learning Objectives used for symptom control in palliative care Luis Viana, R. Ph., M.Ed., CGP 1. For common symptoms experienced by the person managed with palliative care: Recognize the symptom to be
More informationWaterloo Wellington (WW) Symptom Management Guideline for the End of Life (EOL) Medication Order Set for Long Term Care (LTC)
Waterloo Wellington (WW) Symptom Management Guideline for the End of Life (EOL) Medication Order Set for Long Term Care (LTC) May 2018 THE WATERLOO WELLINGTON SYMPTOM MANAGEMENT GUIDELINE FOR THE END OF
More informationDelirium, Dementia, and Amnestic Disorders. Dr.Al-Azzam 1
Delirium, Dementia, and Amnestic Disorders Dr.Al-Azzam 1 Introduction Disorders in which a clinically significant deficit in cognition or memory exists The number of people with these disorders is growing
More informationRenal Palliative Care Last Days of Life
Renal Palliative Care Last Days of Life Introduction This guideline is an aid to clinical decision-making and good practice for patients with stage 4-5 chronic kidney disease (egfr
More informationA SLP s Guide to Medication Therapy and Management. Sarah Luby, PharmD, BCPS KSHA 2017
A SLP s Guide to Medication Therapy and Management Sarah Luby, PharmD, BCPS KSHA 2017 Objectives Identify the appropriate route of administration for medications and proper formulations for use Understand
More informationSummary of Delirium Clinical Practice Guideline Recommendations Post Operative
Summary of Delirium Clinical Practice Guideline Recommendations Post Operative Intensive Care Unit Clinical Practice Guideline for Postoperative Clinical Practice Guidelines for the Delirium in Older Adults;
More informationEnd of Life with Dementia Sue Quist RN, CHPN
End of Life with Dementia Sue Quist RN, CHPN Objectives: Describe the Medicare hospice benefit and services. Discuss the Medicare admission criteria for hospice patients with dementia due to Alzheimer
More informationChapter 01 Introduction
Chapter 01 Introduction Defining the Elderly There is no universally accepted age cut-off defining elderly. This reflects the fact that chronological age itself is less important than biological events
More informationChapter Goal. Learning Objectives 9/12/2012. Chapter 36. Geriatrics. Use assessment findings to formulate management plan for geriatric patients
Chapter 36 Geriatrics Chapter Goal Use assessment findings to formulate management plan for geriatric patients Learning Objectives Describe dependent & independent living environments Identify local resources
More informationNausea. Assessment & Management. R J Crossno, MD, CMD, FAAFP, FAAHPM. Disclosures
Nausea Assessment & Management R J Crossno, MD, CMD, FAAFP, FAAHPM Disclosures Dr. Crossno discloses his employment as Area Medical Director for VistaCare VistaCare has provided commercial support for
More informationHospice and Palliative Medicine
Hospice and Palliative Medicine Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the
More informationBehavior Management in Children with Cancer
Behavior Management in Children with Cancer Anna (Nina) Muriel, MD, MPH Chief, Division of Pediatric Psychosocial Oncology Department of Psychosocial Oncology and Palliative Care Behavior matters Behavior
More informationDelirium in the Elderly
Delirium in the Elderly ELITE 2017 Liza Genao, MD Division of Geriatrics Why should we care about delirium? It is: common associated with high mortality associated with increased morbidity Very much under-recognized
More informationDelirium. A Geriatric Syndrome. Jonathan McCaleb, MD, CMD, HMDC UNSOM, Assistant Professor of Medicine Geriatrics / Hospice & Palliative Medicine
Delirium A Geriatric Syndrome Jonathan McCaleb, MD, CMD, HMDC UNSOM, Assistant Professor of Medicine Geriatrics / Hospice & Palliative Medicine Introduction Common Serious Unrecognized: a medical emergency
More informationg Prevention, Diagnosis, and Management in Palliative Care
8/3/2012 Improving p g Prevention, Diagnosis, g and Management in Palliative Care MN Rural Palliative Care Networking Group Quarterly Education Session June 27,2012 Sandra W. Gordon-Kolb, MD, MMM, CPE
More information譫妄症 (Delirium) Objectives. Epidemiology. Delirium. DSM-5 Diagnostic Criteria. Prognosis 台大醫院老年醫學部陳人豪 2016/8/28
譫妄症 (Delirium) 台大醫院老年醫學部陳人豪 2016/8/28 Objectives Delirium Epidemiology Etiology Diagnosis Evaluation and Management Postoperative delirium Delirium (and acute problematic behavior) in the longterm care
More informationVOMITING. Tan Lay Zye
VOMITING Tan Lay Zye Vomiting is a common symptom. It is a complex reflex behavioural response involving forceful expulsion of the stomach contents through oral cavity. Contents Emetic reflex Causes of
More informationBEHAVIORAL PROBLEMS IN DEMENTIA
BEHAVIORAL PROBLEMS IN DEMENTIA CLINICAL FEATURES Particularly as dementia progresses, psychiatric symptoms may develop that resemble discrete mental disorders such as depression or mania The course and
More informationInterprofessional Webinar Series
Interprofessional Webinar Series Assessment and Management of Delirium Pauline Lesage, MD, LLM Physician Educator MJHS Institute for Innovation in Palliative Care Disclosure Slide Pauline Lesage, MD, LLM,
More informationIntroduction & Expectations Learning Objectives Etiology & Pathophysiology of Nausea & Vomiting Pharmacology of Dimenhydrinate...
Primary Care Paramedic Dimenhydrinate (Gravol) Certification Learner Package www.lhsc.on.ca/bhp 1 Table of Contents Introduction & Expectations... 4 Learning Objectives... 4 Etiology & Pathophysiology
More informationMedicines Management and the Unwell Parkinson s Patient
Medicines Management and the Unwell Parkinson s Patient Belinda Kessel Geriatrician and Movement Disorder Specialist Princess Royal University Hospital Orpington, Kent The Society for Acute Medicine, 7
More informationAgitation Excessive physical or mental restlessness. Increased activity that is generally not purposeful and associated with anxiety.
October 2012 4 Agitation Excessive physical or mental restlessness. Increased activity that is generally not purposeful and associated with anxiety. Depending on appropriateness, evaluate for reversible
More informationManaging Adverse Events in the Cancer Patient. Learning Objectives. Chemotherapy-Induced Nausea/Vomiting
Managing Adverse Events in the Cancer Patient Lisa A Thompson, PharmD, BCOP Assistant Professor University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Learning Objectives Describe
More informationPalliative care for patients with brain cancer
Palliative care for patients with brain cancer Lyn Cave Clinical Nurse Specialist Palliative Care Hospital2Home (H2H) Dr Jayne Wood Clinical Lead Palliative Care The Royal Marsden and Royal Brompton Palliative
More informationJacinta Lucke Resident Emergency Medicine PHD Gerontology & Geriatrics
Jacinta Lucke Resident Emergency Medicine PHD Gerontology & Geriatrics TAKE HOME MESSAGE When managing confusion in older patients: Routinely screen for impaired cognition Patients with impaired cognition
More informationFirst a caution. Processes we might NOT try to treat with medications. Processes we might try to treat. Main drug categories.
Pharmacological Interventions for dizziness Timothy C. Hain, MD Northwestern University Medical School Chicago, Illinois, USA First a caution Torok N. Old and new in Meniere's disease. Laryngoscope 87:1870-1877,
More informationSomatostatin analogues. Other drugs
Octreotide Somatostatin analogues Lack the adverse effects of antimuscarinic agents Somatostatin decreases the release of gastrin, insulin, glucagon, gastric acid and pancreatic enzymes Also inhibits neurotransmission
More information9/20/2017. Effectively Managing Nausea and Vomiting. Disclosure. Objectives
Effectively Managing Nausea and Myra Belgeri, Pharm.D, BCGP, BCPS, FASCP Clinical Pharmacist, Optum Hospice Pharmacy Services October 2017 1 Disclosure I have no relevant financial relationships with manufacturers
More informationManaging Respiratory Symptoms - Breathlessness, Cough and Secretions. Dr Laura Healy. Palliative Medicine Registrar, Beaumont Hospital.
Managing Respiratory Symptoms - Breathlessness, Cough and Secretions. Dr Laura Healy. Palliative Medicine Registrar, Beaumont Hospital. Things to consider: 1. Very common symptoms. 2. Can occur in any
More informationTest your Knowledge: Recognizing Delirium
The Ottawa Hospital Name: Unit: Profession: RN RPN PT OT SW Other Note: Each question has only one correct answer. 1. If a patient is identified as being at high risk for developing delirium, his/her mental
More informationPalliative Medicine in Critical Care Not Just Hospice. Robin. Truth or Myth 6/11/2015. Francine Arneson, MD Palliative Medicine
Palliative Medicine in Critical Care Not Just Hospice Francine Arneson, MD Palliative Medicine Robin 45 year old female married, husband in Afghanistan. 4 children ages 17-24. Mother has been providing
More informationFull details and resource documents available:
Clinical & Regulatory News by Pharmerica Urinary Tract Infection (UTI) Second Most Common Cause of Hospital Readmission within 30 days UTIs are prevalent and account for up to 22% of infections in LTC,
More informationDelirium. Preconference SHPCA Clinical Day Saskatoon, SK May 13, 2014
Preconference SHPCA Clinical Day 2014 Saskatoon, SK May 13, 2014 Carmen L. Johnson MD, CCFP, ABFP, AAHPM, AAPM, ABAM, ABRPM (Pain Medicine) Medical Director Palliative Care Services, Regina Qu Appelle
More informationDelirium Assessment. February 24, Susan Schumacher, MS, APRN-BC
Delirium Assessment February 24, 2016 Susan Schumacher, MS, APRN-BC Objectives Define delirium Differentiate delirium from dementia Identify predisposing and precipitating factors leading to delirium.
More informationDelirium in the Elderly
Delirium in the Elderly ELITE 2015 Mamata Yanamadala M.B.B.S, MS Division of Geriatrics Why should we care about delirium? It is: common associated with high mortality associated with increased morbidity
More informationDelirium in Palliative Care. Case Studies 2015
Delirium in Palliative Care Case Studies 2015 Case 1 - Alex 35 yo M with metastatic melanoma Decreased LOC, unilateral hearing loss and bilateral vision loss, back pain, lower extremity weakness,? confusion/hallucinations
More informationCare for patients with Neurological disorders
King Saud University College of Nursing Medical Surgical Department Application of Adult Health Nursing Skills ( NUR 317 ) Care for patients with Neurological disorders Outline; EEG Overview. Nursing Interventions;
More informationDelirium in the ICU: Prevention and Treatment. Delirium Defined Officially. Delirium: Really Defined. S. Andrew Josephson, MD
Delirium in the ICU: Prevention and Treatment S. Andrew Josephson, MD Director, Neurohospitalist Service Medical Director, Inpatient Neurology June 2, 2011 Delirium Defined Officially (DSM-IV-TR) criteria
More informationPalliative care in long-term conditions Scottish Palliative Care Pharmacists Association
Palliative care in long-term conditions 2011 2012 Scottish Palliative Care Pharmacists Association Aims & Objectives To explore symptoms, general management principles and appropriate palliative treatment
More informationSyringe driver in Palliative Care
Syringe driver in Palliative Care Introduction: Syringe drivers are portable, battery operated devices widely used in palliative care to deliver medication as a continuous subcutaneous infusion over 24
More informationPalliative Emergencies. Ken Stakiw
Palliative Emergencies Ken Stakiw Disclosure None to disclose for this lecture Have received honoraria from a number of agencies and companies previously Intend to discuss some off label use of medications
More informationAgitation. Susan Emmens Palliative Care Clinical Nurse Specialist
Agitation Susan Emmens Palliative Care Clinical Nurse Specialist Definitions Restlessness finding or affording no rest, uneasy, agitated. Constantly in motion fidgeting Agitation shaking, moving, mental
More informationDelirium. Approach. Symptom Update Masterclass:
Symptom Update Masterclass: Delirium Jason Boland Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine Wolfson Centre for Palliative Care Research Hull York Medical School University
More informationSymptom Management Guidelines for End of Life Care
Symptom Management Guidelines for End of Life Care The following pages are guidelines for the management of common symptoms in the last few days of life. General principles: 1. Consider how symptoms can
More informationNausea and Vomiting During Pregnancy. Reassuring, with rare exception, that your pregnancy is healthy
1 Nausea and Vomiting During Pregnancy Keith Merritt, MD Overview Common problem affecting 50-90% of pregnancies between 5 and 18 weeks o Peaks, in most, around 9 weeks o Resolves, in most, by 16 to 18
More informationGood hydration checklist
Good hydration checklist Staying hydrated is very important because our bodies need the right balance of water and electrolytes to help them function properly. Drink the right amount and types of fluid
More informationAddressing Difficult Behaviors in Dementia
Addressing Difficult Behaviors in Dementia GEORGE SCHOEPHOERSTER, MD GERIATRICIAN GENEVIVE/CENTRACARE CLINIC Objectives By the end of the session, you will be able to: 1) Explain the role of pain management
More informationflorida child neurology
Headaches florida child neurology You re sitting at your desk, working on a difficult task, when it suddenly feels as if a belt or vice is being tightened around the top of your head. Or you have periodic
More informationTim Hiebert - MD MSc FRCPC General Internist/Palliative Care Winnipeg Regional Health Authority
Tim Hiebert - MD MSc FRCPC General Internist/Palliative Care Winnipeg Regional Health Authority Conflicts of Interest: None 1. Identify key features that suggest the End-of-Life 2. Review of Common End-of-life
More informationDyspnea: The top things you need to you know! Dr. Megan Sellick & Dr. Lawrence Lee Edmonton Zone Palliative Care Program
: The top things you need to you know! Dr. Megan Sellick & Dr. Lawrence Lee Edmonton Zone Palliative Care Program Faculty / Presenter Disclosure Faculty: Dr. Lawrence Lee Relationships with commercial
More informationPsychopharmacology in the Emergency Room. Michael D. Jibson, M.D., Ph.D. Associate Professor of Psychiatry University of Michigan
Psychopharmacology in the Emergency Room Michael D. Jibson, M.D., Ph.D. Associate Professor of Psychiatry University of Michigan Pretest 1. Appropriate target symptoms for emergency room medication treatment
More informationPAIN AND SYMPTOM MANAGEMENT GUIDANCE IN THE LAST DAYS OF LIFE
PAIN AND SYMPTOM MANAGEMENT GUIDANCE IN THE LAST DAYS OF LIFE Reference: DCM029 Version: 1.1 This version issued: 07/06/18 Result of last review: Minor changes Date approved by owner (if applicable): N/A
More informationCognitive disorders. Dr S. Mashaphu Department of Psychiatry
Cognitive disorders Dr S. Mashaphu Department of Psychiatry Delirium Syndrome characterised by: Disturbance of consciousness Impaired attention Change in cognition Develops over hours-days Fluctuates during
More informationSymptom Control in the Community Setting. Dr Andrew Tysoe-Calnon
Symptom Control in the Community Setting Dr Andrew Tysoe-Calnon Lead Consultant t Common symptoms Pain Agitation Shortness of breath Nausea and vomiting Intestinal obstruction Confusion Pain Occurs in
More informationDECONTAMINATION AGENTS and ANTIEMETICS *** This material won t be covered in lecture, but you are responsible for it***
Decontamination and Antiemetics Med 5724 Page 1 of 8 DECONTAMINATION AGENTS and ANTIEMETICS *** This material won t be covered in lecture, but you are responsible for it*** REFERENCES: Katzung (9th ed.)
More informationDelirium. Geriatric Giants Lecture Series Divisions of Geriatric Medicine and Care of the Elderly University of Alberta
Delirium Geriatric Giants Lecture Series Divisions of Geriatric Medicine and Care of the Elderly University of Alberta Overview A. Delirium - the nature of the beast B. Significance of delirium C. An approach
More informationDelirium. Dr. John Puxty
Delirium Dr. John Puxty Learning Objectives By the end of the workshop participants will be able to: Appreciate the main diagnostic criteria for delirium. Describe common risk factors, causes and main
More informationDELIRIUM. Sabitha Rajan, MD, MSc, FHM Scott &White Healthcare Texas A&M Health Science Center School of Medicine
DELIRIUM Sabitha Rajan, MD, MSc, FHM Scott &White Healthcare Texas A&M Health Science Center School of Medicine Disclosure Milliman Care Guidelines - Editor Objectives Define delirium Epidemiology Diagnose
More informationPalliative Medicine Overview. Francine Arneson, MD Palliative Medicine
Palliative Medicine Overview Francine Arneson, MD Palliative Medicine Palliative Medicine: Definition Palliative care: An approach that improves the quality of life of patients and their families facing
More informationPrevention of Antineoplastic Medication induced Nausea and Vomiting in Pediatric Cancer Patients
Prevention of Antineoplastic Medication induced Nausea and Vomiting in Pediatric Cancer Patients Done by :Meznah Zaid Al-Mutairi Pharm.D Candidate PNU University College of Pharmacy Introduction Nausea
More informationDelirium in Hospital Care
Delirium in Hospital Care Dr John Puxty 1 Learning Objectives By the end of the workshop participants will be able to: Appreciate the main diagnostic criteria for delirium. Describe common risk factors,
More informationFighting the Fog A Collaborative Approach to Decreasing ICU Delirium
Fighting the Fog A Collaborative Approach to Decreasing ICU Delirium Kimberly Scherr NP Jennifer Barker RN Misericordia Hospital ICU Edmonton, AB CACCN Dynamics Sept 21, 2014 Delirium Delirium is an acute
More informationChapter 161 Antipsychotics
Chapter 161 Antipsychotics Episode Overview Extrapyramidal syndromes are a common complication of antipsychotic medications. First line treatment is benztropine or diphenhydramine. Lorazepam is used in
More informationPsychopharmacology in the Emergency Room. Michael D. Jibson, M.D., Ph.D. Professor of Psychiatry University of Michigan
Psychopharmacology in the Emergency Room Michael D. Jibson, M.D., Ph.D. Professor of Psychiatry University of Michigan Pretest 1. Which of the following conditions is LEAST likely to benefit from emergency
More informationCharles Bernick, MD, MPH Cleveland Clinic Lou Ruvo Center for Brain Health June 2, 2018
Charles Bernick, MD, MPH Cleveland Clinic Lou Ruvo Center for Brain Health June 2, 2018 Delirium common Prolongs hospitalization Worsens dementia ( if you survive) Increased risk of institutionalization
More informationDelirium in the Elderly
Delirium in the Elderly Jeffrey M. Burock, MD Division Director/ Psychiatry / Miriam Hospital Clinical Assistant Professor Warren Alpert School Of Medicine Learning Objectives Identify the symptoms of
More informationManaging Delirium: The best way to achieve clarity (of mind) Tim Walsh. Professor of Critical Care, Edinburgh University
Managing Delirium: The best way to achieve clarity (of mind) Tim Walsh Professor of Critical Care, Edinburgh University Lecture Plan: a route to clarity What is delirium? Why is delirium important? Step
More informationSUMMARY OF PRODUCT CHARACTERISTICS FOR BENZODIAZEPINES AS ANXIOLYTICS OR HYPNOTICS
SUMMARY OF PRODUCT CHARACTERISTICS FOR BENZODIAZEPINES AS ANXIOLYTICS OR HYPNOTICS Guideline Title Summary of Product Characteristics for Benzodiazepines as Anxiolytics or Hypnotics Legislative basis Directive
More information