AGITATION
18 sept. 2019 Causes. - Assessment. - Impact on patient family and MDT Team. - Medical
Understanding agitation
When a person with a mood disorder is agitated friends and family members—or even doctors—can't always tell what underlying condition has caused it. In other
Retrospective Study on Agitation Provoked by Memantine in Dementia
treatment onset; previous episodes of agitation caused by other drugs; type and frequency of comorbidities; distribution of concurrent medications; evidence
Emergence agitation in pediatric anesthesia: current features
purpose of this paper is to discuss the possible causes of postoperative agitation in children providing a foundation for better methods of identifying and
Managing Delirium and Agitation in the Older Emergency
16 juil. 2019 Agitation and delirium are common reasons for older adults to seek care in the emergency department (ED). Providing care for this.
Alzheimers Association
environmental influences and some medications can cause behavioral symptoms or make them worse. These symptoms include: • Sleep disturbances. • Agitation
Changed behaviours and dementia 8 - Agitated behaviours
This help sheet discusses some of the causes of agitated behaviours which can be a very concerning symptom of dementia and suggests ways to prevent and manage
Location of Acute Infarcts and Agitation and Aggression in Stroke
6 oct. 2016 behavior causes damage to individuals or property; atti- ... symptoms15 mixing agitation with anger and hostility
Agitation dans les démences
On doit chercher et traiter les causes réversibles de ces symptômes et décoder le message caché derrière le comportement manifesté. Il faut considérer tout
Guidelines for the management of Behavioural and Psychological
Behavioural and Psychiatric Symptoms of Dementia (BPSD) are a core part of the syndrome of dementia. These include agitation aggression
Acute Agitation - ACEP
ED the cause of agitation is often undifferentiated and can be a consequence of alcohol intoxication drug intoxication psychiatric illness or underlying medical illness Early efforts in the ED should include identifying and treating any reversible causes but in many cases of behavioral disturbance intervention is indicated to reduce the
Agitation and Restlessness: What Causes It? - WebMD
agitation in the medical setting Step 1: Assess situation and cause of agitation • Delirium (make sure underlying medical cause is being addressed) • Intoxication (central nervous system [CNS] stimulant vs depressant) • Primary psychiatric disorder (e g psychosis mania) • Undetermined cause
Managing Delirium and Agitation in the Older Emergency - ACEP
Infections neurologic disorders and metabolic orelectrolyte disorder are 3 of the most common causes ofacute alterations in mental status among older patients 9Adverse medication effects are another common cause Alist of medications that are high risk for causingconfusion altered mental status or delirium is shown in Table 1
Guidelines for the Management of Agitation & Delirium
In addition agitation can be caused by: Pain Urinary retention Anxiety Depression/psychiatric illness Existential distress Drugs in order of use Step 1 Lorazepam or Midazolam Step 2 Benzodiazepine + Levomepromazine Step 3 Midazolam + Levomepromazine + Phenobarbital 6 1 Lorazepam Lorazepam can be given SL PO PR SC IM or IV
Can a medical condition cause agitation?
Agitation is a sense of inner tension and restlessness. When it happens, you may get annoyed easily or feel like you need to move around. It’s a normal emotion. But it’s more likely to show up when you’re under a lot of stress. It can also happen if you use drugs or withdraw from alcohol. But sometimes, a medical condition can cause agitation.
What causes agitation without delirium?
Both have a number of possible underlying causes and these overlap. Agitation without delirium can occur as a result of anxiety or psychological/spiritual distress and commonly due to unrelieved constipation or urinary retention. This policy advocates a ‘THINK DELIRIUM’and STEPWISE approach.
Is agitation the same as aggression?
You may act angry or violent at the same time. But agitation isn’t the same as aggression. It’s also different than akathisia. That’s a movement disorder often caused by antipsychotic medication. It’s normal to get worried if you or a loved one is agitated a lot. But your doctor can help you find and treat the cause.
Can hypothyroidism cause agitation?
Treatment for your hypothyroidism should ease your agitation. Your doctor will give you medicine to bring your hormone levels back to normal. Hormone changes before your period can make you feel tense. But you may get really overwhelmed and agitated if you have premenstrual dysphoric disorder (PMDD).
AGITATION
SEPTEMBER 18TH 2019
JULIA NEWELL & KATHERINE HARVEY
S P E C I A L I S T PA L L I A T I V E C A R E C L I N I C A L N U R S E S P E C I A L I S T S
R O YA L H A L L A M S H I R E & W E S T O N PA R K H O S P I T A L , S H E F F I E L D 1 AIMS - Definition of terms -Causes -Assessment -Impact on patient, family and MDT Team -Medical, nursing and holistic care management -Sedation & agitation 2WHAT IS
AGITATION?
Definition of AGITATION in English
/agitation)AGITATION: A state of anxiety or nervous
excitementSynonyms: Discomposure, disquiet, distress,
concern, worry, trouble, alarm, upset. 3Discuss
DEFINITIONS
Restlessness:
- Finding or affording no rest, uneasy, agitated. Constantly in motion and fidgeting.- Restlessness and agitation occurs in 42% of patients in the last 48 hours of life (Twycross & Lichter, 1995).
Agitation:
- Shaking, moving, unsettled ² can be both mental and/or physical.Delirium:
- Disordered state of mind with incoherent speech - distressing hallucinations and paranoia may feature.
- Delirium develops in 80-90% of dying patients at some stage in the last week of life (Twycross et al, 2009).
4WHAT IS TERMINAL
AGITATION?
-Agitation is a term that describes anxious, restless and occasionally aggressive behaviour. -Terminal agitation means agitation that occurs in the last few days of life. -KRX PM\ MOVR OHMU PHUPLQMO MJLPMPLRQ NHLQJ GHVŃULNHG MV" Terminal restlessness, terminal anguish, confusion at the end of life or terminal delirium. - These terms all have different meanings but do overlap. 5Discuss
WHAT CAUSES
TERMINAL AGITATION?
Terminal agitation happens to people
who are already compromised by advanced illness.A diagnosis of terminal agitation can
only be made if reversible conditions are excluded or are failing to respond to treatment. 6POSSIBLE
CAUSES
OFAGITATION?
Medication
Alcohol intoxication or
withdrawal PainConstipation
Urinary
Retention
Nicotine withdrawal
Nausea
Brain tumour
Sepsis
Organ failure
Deranged bloods
Hypoxia
Infection
Spiritual
distressEmotional
distress FearAnxiety
Dyspnoea
Terminal agitation
7Neurological
deficit DiscussInsomnia
HOW DO I KNOW IF
SOMEONE HAS TERMINAL
AGITATION?
-Distressed behaviour -Confusion -Calling out; could be shouting or screaming -Hallucinations -Trying to get out of bed or wandering -Sleeping during the day but active at night -Unable to concentrate or relax - Jerking or twitching -Fidgeting -Despite interventions on-going deterioration * Remember always consider reversible factors and individual assessment of patient; these symptoms also present in palliative patients who may not be in the terminal agitation phase. 8Discuss
ASSESSMENT
-Holistic assessment (Physical, Psychological, Spiritual, Social) -What does the patient want? -Does the patient know what they want? -If unable to discuss who is the right person to involve to understand this? -Start with obvious things ² but what is obvious? -Treat obvious causes and reassess regularly.-Discuss case with the MDT and involve other professionals where appropriate i.e. Chaplain, pharmacist, therapists etc.
-Ensure patient is in a safe environment ² may not always be their preferred place of care but how do you assess within this environment?
-Support family and friends ² remain calm, patient and empathise. 9WHAT DO YOU THINK CAN HELP A
PATIENT WITH AGITATION?
POMP \RX MUH OMYLQJ GLVPUHVVHG PORXJOPV·B ([SUHVVLRQ RI POHLU PORXJOPV and feelings may help you manage their agitation. - Try simple methods first, repositioning, playing music, talk in gentle and reassuring manner. -Try to provide a calm and safe environment that suits the persons needs. -Take a thorough history; have they started new medications? Been unable to take medications? If agitation limits taking medications what options are there? -Try making sure a clock is visible to help orientate the patient in time. -Have familiar objects nearby; photos and ornaments can be reassuring. -Provide reassurance to family & friends explaining what's happening; encourage them to use the same techniques with their loved ones to reduce agitation and distress. May help carers cope, especially in caring for terminal agitation. 10Discuss
MEDICATION F+2HF(6"
How do you decide between a benzodiazepine and anti-psychotic to help in agitation? 110(GHF$7H21 F+2HF(6"
12Indication Drug Comments
Acute confusional
statesTitrates doses
accordinglyHaloperidol 1.5mg
(po/sc at night +/- every four to six hours when required).Olanzapine 2.5mg PO
stat and at bedtimeRisperidone 500mcg
PO twice daily
Max 10mg / 24hours ²
take care with side effects.Terminal Restlessness
End of Life Care
Haloperidol 1.5-5mg PO
or sc +/- Midazolam 2.5-10mg SC stat.
Levomepromazine
6.25mg ² 25mg PO or
SC may be used if
period of sedation requiredMore sedating than
haloperidolWHAT IF SOMEONE NEEDS SEDATION?
-6RPHPLPHV ROHQ M SMPLHQPV MJLPMPLRQ ŃMQ·P NH UHOLHYHG N\ simple measures, medication is required to sedate them.
-Sedation means using medication to lower a persons consciousness so that they are calm or even asleep.
-There are many ethical issues to consider when making a decision about sedation. It may mean the patient is no longer able to eat, drink or communicate. The patients medical team, the patient themselves, and their close family or friends should be involved in open discussions around this.
-Common worry about sedation is that is makes death come more quickly.Sedation does not hasten death but it can bring relief from distressing symptoms and allow a more peaceful death.
-It is vital to discuss this with your patient, their carer, family and friends and address their concerns and worries.
13KEY POINTS
-Terminal agitation is anxious, restless or distressed behaviour that can occur at the end of life. -Keep calm and avoid confrontation. -Even when prognosis is days rather than weeks, underlying causes should be considered, and treated appropriately. -There are many potential causes of agitation and many of them can be reversed, involve MDT, patient and family to reach these decisions. -Try non-drug methods to relieve agitation first. -If your patient requires sedation, try to address any concerns that they or their family and friends might have. Clarify perceptions and validate those that are accurate. -Consider appropriate dosage of medication used ² anticipate and plan availability before reaches crisis point. 14Thank-you for listening
Any Questions?
15REFERENCES AND RESOURCES
zone/symptom-control/agitation Sheffield Palliative Care Formulary 5th Edition, NHS Sheffield. 16quotesdbs_dbs35.pdfusesText_40[PDF] fiche les solides gs
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