10-24 L1 Delirium

Question 1

What are the requirements for delirium?

(Confusion assessment method CAM)

Answer 1

You need 1&2 abd either 3 or 4

1. Acute & fluctuating course
2. Inattention
3. Disorganized thinking
4. Altered L.O.C.

Question 2

Delirium

Answer 2

An acute change/rapidly fluctuating _not _ consistent with dementia

Question 3

Depression

Answer 3

• frquently confused with hypoactive delirirum
• what effort is the pt giving during assessment

actue mania can be confused with hyperactive delirium

Question 4

What are the three types of delirium?

Answer 4

• Hyperactive delirium
  
  • acutely agitated pt running through the halls pulling out IV and screaming
  • 25% of delirious pts.
• Hypoactive delirium
  
  • More common, the quiet delirium
  • more difficult to detect b/c nursing and famliy is less likely to notice
  • still associated with badness
• Mixed type delirium

Question 5

what are precipitating risk factors for delirium?

‘I watch death’

Answer 5

anything can cause delirium

• Infection: especially urine and respiratroy tract
• Withdrawal: benzodiazepines (especially those w/long hlaf lives (temazepams, diazepams) , alcohol, lack of sensory imput (poor vision, hearin)
• Acute metabolic: dehydration, sodium + thyroid+ calcium + heptaic abnormalities,(medicaiton side effects, especially sedating or anti-cholinergics
• Trauma: subdural hematoma, uncontrolled pain from fall (maybe unwhitenessed) skin ulceration, inadequate post-operative pain control after surgery, acute anemia, use of indwelling devices, and restraints (foiley catheter, IVs)
• CNS pathology: intracranial hemorrhage, stroke, tumor
• Hypoxia: acute myocardial infarction, pulmonary emboloism, CHF or COPD, exacerbation
• Deficiencies: B12 folate
• Endocrinopathies: thryoid abnormalities, diabetes w/glucose
• Acute vascular: stroke
• Toxins:
• Heavy Metals (lead, mercury)

Question 6

What are the four steps in management of delirium?

Answer 6

1. Identify and treat reversible conributors
2. maintain behavioral control (safe)
3. anticipate and prevent or manage complications
4. restore function in delirious pts.