Acute and Chronic confusion

Question 1

What is acute confusion known as?

Answer 1

Delirium

Question 2

What are predisposing factors for delirium?

Answer 2

• Age > 65
• Background dementia
• Significant injury e.g hip fracture
• Frailty or multimorbidity
• Polypharmacy

Question 3

What are the different causes of delirium?

CHIMPS PHONED

Answer 3

C onstipation
H ypoxia
I nfection
M etabolic disturbances
P ain
S leeplessness

P rescriptions
H ypothermia/pyrexia
O rgan dysfunction
N utrition
E nvironmental change
D rugs

Question 4

What are the two different types of delirium?

Answer 4

• Hyperactive

* Hypoactive

Question 5

How does hyperactive delirium present?

Answer 5

Agitation
Delusions
Hallucinations
Wandering
Aggression

Question 6

How does hypoactive delirium present?

Answer 6

Lethargy
Slowness with everyday tasks
Excessive sleeping
Inattention

Question 7

What is delirium?

Answer 7

Sudden onset change, confusion, not their baseline

Question 8

What screening assessment should be done on patients with suspected delirium?

Answer 8

*AMTS

Question 9

What investigations should be done for a patient with delirium?

Answer 9

Dependent on cause:

• Vital signs
• Bloods: FBC, U&Es, LFTS, Clotting, TFTs, Glucose, Ca2+, blood cultures
• Urine dip
• CT head - stroke?

Question 10

What is the management of delirium?

Answer 10

1. Treat underlying cause
2. Supportive
   >consistent nursing and medical team
   >enable patient to care for self
3. Environment adaption
   >clock
   >familiar objects
   >involve family and friends
4. Medication
   >monitor
   >avoid sedation if possible as can worsen