8 - Delirium

Question 1

3 key features of delirium?

Answer 1

disturbed consciousness

change in cognition

acute onset and fluctuant

Question 2

3 other common features?

Answer 2

Disturbance of sleep wake cycle

Disturbed psychomotor behaviour

Emotional disturbance

Question 3

give 5 examples of things which precipitates delirium?

Answer 3

infection

dehydration

hypoxia

drugs

brain injury

Question 4

how common is delirium?

Answer 4

most common complication of hospitalisation

Question 5

how do we diagnose delirium?

Answer 5

4AT

Question 6

who should have 4AT test done?

Answer 6

anyone > 65 yrs who is admitted to hospital

Question 7

what should be done when we find delirium?

Answer 7

treat the cause

fully history and examination

explain the diagnosis

non-/ pharmacological measures

Question 8

4 steps taken in non pharmacological treatment of delirium?

Answer 8

re-orientate and reassure agitated patients

correct sensory impairment

normalise continuity of care

discharge people asap

Question 9

what needs to be considered when using drug management for delirium?

Answer 9

most drugs exacerbate situation - start slow and with low doses

Question 10

which drug should be used to treat delirium and when should it be used?

Answer 10

12.5mg quetiapine orally - only use if they are a danger to themselves or others - only consultant can make this decision

Question 11

name 4 possible preventative measures for delirium?

Answer 11

promoting sleep hygiene

pain control

maintaining optimal hydration

early mobilisation

Question 12

2 things to consider in terms of capacity for patients with delirium?

Answer 12

Is the person capable of making decisions about their care?

Do they have a legally appointed proxy decision maker?

Question 13

relationship between delirium and falls?

Answer 13

4.5x more likely to fall if you have delirium

Question 14

how do we NOT diagnose UTIs in older people?

Answer 14

dipstick tests