AGITATION Agitation refers to a state of hyperarousal, increased tension, and irritability that can lead to confusion, hyperactivity, and

overt hostility. Agitation can result from a toxic (poison s), metabolic, or infectious cause; brain injury; or a psychiatric disorder. It can also result from pain, fever, anxiety, drug use and withdrawal, hypersensitivity reactions, and various disorders. It can arise gradually or suddenly and last for minutes or months. Whether it's mild or severe, agitation worsens with increased fever, pain, stress, or external stimuli. Agitation alone merely signals a change in the patient's condition. However, it's a useful indicator of a developing disorder. Obtaining a good history is critical to determining the underlying cause of agitation. History and physical examination Determine the severity of the patient's agitation by examining the number and quality of agitation-induced behaviors, such as emotional lability, confusion, memory loss, hyperactivity, and hostility. Obtain a history from the patient or a family member, including diet, known allergies, and use of herbal medicine. Ask if the patient is being treated for any illnesses. Has he had any recent infections, trauma, stress, or changes in sleep patterns? Ask the patient about prescribed or over-the-counter drug use, including supplements and herbal medicines. Check for signs of drug abuse, such as needle tracks and dilated pupils. Ask about alcohol intake. Obtain the patient's baseline vital signs and neurologic status for future comparison. Medical causes Alcohol withdrawal syndrome. Mild to severe agitation occurs in alcohol withdrawal syndrome, along with hyperactivity, tremors, and anxiety. With delirium, the potentially life-threatening stage of alcohol withdrawal, severe agitation accompanies hallucinations, insomnia, diaphoresis, and a depressed mood. The patient's pulse rate and temperature rise as withdrawal progresses; status epilepticus, cardiac exhaustion, and shock can occur. Anxiety. Anxiety produces varying degrees of agitation. The patient may be unaware of his anxiety or may complain of it without knowing its cause. Other findings include nausea, vomiting, diarrhea, cool and clammy skin, frontal headache, back pain, insomnia, depression, and tremors. Dementia. Mild to severe agitation can result from many common syndromes, such as Alzheimer's and Huntington's diseases. The patient may display a decrease in memory, attention span, problem-solving ability, and alertness. Hypoactivity, wandering behavior, hallucinations, aphasia, and insomnia may also occur. Drug withdrawal syndrome. Mild to severe agitation occurs in drug withdrawal syndrome. Related findings vary with the drug, but include anxiety, abdominal cramps, diaphoresis, and anorexia. With opioid or barbiturate withdrawal, a decreased level of consciousness (LOC), seizures, and elevated blood pressure, heart rate, and respiratory rate can also occur. Hepatic encephalopathy. Agitation occurs only with fulminating encephalopathy. Other findings include drowsiness, stupor, fetor hepaticus, asterixis, and hyperreflexia.

 Hypersensitivity reaction. Moderate to severe agitation appears, possibly as the first sign of a reaction. Depending on the severity of the reaction, agitation may be accompanied by urticaria, pruritus, and facial and dependent edema. With anaphylactic shock, a potentially life-threatening reaction, agitation occurs rapidly along with apprehension, urticaria or diffuse erythema, warm and moist skin, paresthesia, pruritus, edema, dyspnea, wheezing, stridor, hypotension, and tachycardia. Abdominal cramps, vomiting, and diarrhea can also occur. Hypoxemia. Beginning as restlessness, agitation rapidly worsens. The patient may be confused and have impaired judgment and motor coordination. He may also have headaches, tachycardia, tachypnea, dyspnea, and cyanosis. Increased intracranial pressure (ICP). Agitation usually precedes other early signs and symptoms, such as headache, nausea, and vomiting. Increased ICP produces respiratory changes, such as Cheyne-Stokes, cluster, ataxic, or apneustic breathing; sluggish, nonreactive, or unequal pupils; widening pulse pressure; tachycardia; a decreased LOC; seizures; and motor changes such as decerebrate or decorticate posture. Post-head trauma syndrome. Shortly after, or even years after injury, mild to severe agitation develops, characterized by disorientation, loss of concentration, angry outbursts, and emotional lability. Other findings include fatigue, wandering behavior, and poor judgment. Vitamin B6 deficiency. Agitation can range from mild to severe. Other effects include seizures, peripheral paresthesia, and dermatitis. Oculogyric crisis may also occur. Other causes Drugs. Mild to moderate agitation, which is commonly dose related, develops as an adverse reaction to central nervous system stimulantsespecially appetite suppressants, such as amphetamines and amphetamine-like drugs; sympathomimetics, such as ephedrine; caffeine; and theophylline. Radiographic contrast media. Reaction to the contrast medium injected during various diagnostic tests produces moderate to severe agitation along with other signs of hypersensitivity. Special considerations Because agitation can be an early sign of many different disorders, continue to monitor the patient's vital signs and neurologic status while the cause is being determined. Eliminate stressors, which can increase agitation. Provide adequate lighting, maintain a calm environment, and allow the patient ample time to sleep. Ensure a balanced diet, and provide vitamin supplements and hydration. Remain calm, nonjudgmental, and nonargumentative. Use restraints sparingly because they tend to increase agitation. If appropriate, prepare the patient for diagnostic tests, such as a computed tomography scan, skull X-rays, magnetic resonance imaging, and blood studies. Patient counseling Reassure the patient, and orient him to the procedures and routines of the unit. Provide emotional support and a quiet environment. Explain stress-reduction measures.

PEDIATRIC POINTERS A common sign in children, agitation accompanies the expected childhood diseases as well as more severe disorders that can lead to brain damage: hyperbilirubinemia, phenylketonuria, vitamin A deficiency, hepatitis, frontal lobe syndrome, increased ICP, and lead poisoning. In neonates, agitation can stem from alcohol or drug withdrawal if the mother abused these substances. When evaluating an agitated child, remember to use words that he can understand and to look for nonverbal clues. For instance, if you suspect that pain is causing agitation, ask him to tell you where it hurts, but make sure to watch for other indicators, such as wincing, crying, or moving away. GERIATRIC POINTERS Any deviation from an older person's usual activities or rituals may provoke anxiety or agitation. Any environmental change, such as a transfer to a nursing home or a visit from a stranger in the patient's home, may trigger a need for treatment. Activity 1. En el texto, consiga 30 cognados, haga una lista con ellos y diga si son verdaderos o falsos. (0,25pts c/u; total: 7,5pts) 2. En las siguientes oraciones indica las funciones gramaticales presentes en cada una de ellas. Sigue el ejemplo. (8pts) Example: Agitation refers to a state of hyperarousal, increased tension.
Sustantivo verbo adjetivo adjetivo sustantivo

a) Agitation alone merely signals a change in the patient's condition. b) The patient may be unaware of his anxiety or may complain of it without knowing its cause. c) Agitation occurs only with fulminating encephalopathy. d) Any deviation from an older person's usual activities or rituals may provoke anxiety or agitation. 3. Responda las siguientes preguntas (4,5pts) a) What is the text about? b) What is agitation referred to? c) What can the medical causes for agitation be? d) Which are the pediatric pointers for agitation? e) According to the text, describe how the physical examination can be