MDS Alert
Clip "N" Save ~ Resident Showing Signs Of Delirium? Check Out These Meds And MDS Items
Here's what the RAP suggests you review. Anytime a resident develops new or worsening confusion and behavioral changes, take a close look at his medications and the following MDS items. 6. OVER-THE-COUNTER DRUGS, especially those with anticholinergic properties
Drugs That Cause Delirium:
1. PSYCHOTROPIC
- Antipsychotics
- Antianxiety/hypnotics
- Antidepressants
2. CARDIAC
- Digitalis glycosides (Digoxin)
- Antiarrhythmics, such as quinidine, procainamide (Pronestyl), and disopyramide (Norpace)
- Calcium channel blockers, such as verapamil (Isoptin), nifedipine (Procardia), and diltiazem (Cardizem)
- Antihypertensives, such as methyldopa (Aldomet), and propranolol (Inderal)
3. GASTROINTESTINAL
- H2 antagonists, such as cimetidine (Tagamet) and ranitidine (Zantac)
4. ANALGESICS such as Darvon, narcotics (e.g., morphine, dilaudid)
5. ANTI-INFLAMMATORY
- Corticosteroids, such as prednisone
- Nonsteroidal anti-inflammatory agents, such as ibuprofen (Motrin)
- Cold remedies (antihistamines, pseudoephedrine)
- Sedatives (antihistamines, e.g., Benadryl)
- Stay-awakes (caffeine)
- Antinauseants
- Alcohol
Factors That May Be Associated With Signs And Symptoms Of Delirium:
Diagnoses and Conditions:
Diabetes [I1a], Hyperthyroidism [I1b], Hypothyroidism [I1c], Cardiac Dysrhythmias [I1e], CHF [I1f], CVA [I1t], TIA [I1bb], Asthma [I1hh], Emphysema/COPD [I1ii], Anemia [I1oo], Cancer [I1pp], Dehydration [J1c] or Fever [J1h], Myocardial Infarction [I3], any Viral or Bacterial Infection [I2], Surgical Abdomen [I3], Head Trauma [I3], Hypothermia [I3], Hypoglycemia [I3].
Medications:
Number of Meds [O1]
New Meds [O2]
Antipsychotics [O4a], Antianxiety [O4b], Hypnotics [O4d]
Analgesics (Pain Meds), Cardiac Meds, GI Meds, Anti-inflammatory, Anticholinergics [from med charts].
Psychosocial:
Sad or Anxious Mood [E1, E2, E3]
Isolation [F2e; from record]
Recent Loss [F2f]
Depression [I1ee]
Restraints [P4c,d,e]
Recent Relocation [AB1; A4a].
Sensory Impairment:
Hearing [C1], Vision [D1].
Consider this clarifying information in establishing a diagnosis:
Sleep disturbance [E1k]
Alzheimer's [I1q]
Other Dementia [I1u]
Time of symptom onset within hours to days [from record or observation];
Environment Conducive To Reducing Symptoms:
Quiet, well-lit, calm, familiar objects [from observation]; Task segmentation [G7].
Source: RAI manual, Chapter 6.
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