A Confused Patient - Simulation Day

Question 1

delirium

Answer 1

Really common
- Up to 20% of patients in hospital will experience
- Likelihood influenced by risk factors
Alarming for patients and carers
- Mistaken for something more serious (e.g. dementia, stroke, psychosis, depression)
- Normally temporary

Three key features common to all:
- Rapid onset
- Fluctuating symptoms
- Severely impaired attention

Question 2

3 types of delirium

Answer 2

1. Hyperactive
2. Hypoactive
3. Mixed

Question 3

4AT – SIMPLE TEST FOR DELIRIUM

Answer 3

• Alertness: whether the person is drowsy or agitated
• Awareness: ask age or DoB, or where they are
• Attention: the ability to stay focused on a mental task
• Acute change: if symptoms seem to come and go
• Quick (2mins)
• Limited training needed

Question 4

risk factors for delirium

Answer 4

• Age – more common in older patients
• Disorientation: New place (e.g. hospital), Diminished sensory input (Faulty hearing aids, misplaced glasses)
• Anticholinergic drugs
• Opioid Drugs (E.g recent surgery or trauma)
• Infection
• Dehydration
• Dementia
• Delirium

Question 5

treatments for delirium

Answer 5

NICE guidelines
- Changing risk factors to change symptoms/turn them down
- Depends on the underlying cause (address underlying risk factor(s)