acute confusion

Question 1

what is delirium

Answer 1

acute brain failiure, acute onset, impaired attention and altered awareness, cognitive and neuropsychiatric disturbances

Question 2

what is delirium drawing upon dsm 5

Answer 2

attention/awareness disturbed, attention disturbance over short period of time acute, additional disturbance in cognuition e.g vision, perception, memory loss, disorientated

disturbances not explained by another preexisting neurocognitve disorder or in coma

here is evidence from the history, physical examination, or laboratory findings
that the disturbance is a direct physiological consequence of another medical
condition, substance intoxication or withdrawal

Question 3

what are potential risks of delirium

Answer 3

increase hospital stay, increased risk of falls, makes dementia worse, death, functional disability, faulty cognitions

Question 4

what is hyperactive delirium

Answer 4

aggressive restless, hallucinations, disturbed sleep, less cooperative

Question 5

what is hypo active delirium

Answer 5

poor appetite, tired reduced movement withdrawn less aware.

Question 6

what is mixed delirium

Answer 6

person goes between hypo and hyperactive delirium

Question 7

how do you assess delirium

Answer 7

65 years older, hip fracture, cognitive impaired, severe illness, dementia any of these THINK delirium be alert

Question 8

what is confusion assesment method for diagnosing delirium

Answer 8

you need to have acute onset and fluctauate course, and altered awareness and attention. plus either disorganised thinking, or being hypo or hyper alert

Question 9

how do you asses patient attention

Answer 9

counting numbers and months backwards, difficulty doing tasks

Question 10

how do you asses acute or continuous fluctuations in delirium

Answer 10

talk to night shift team, has their been a change from baseline and single question in delirium

Question 11

how do you assess disorgansied thinking in delirium

Answer 11

problems making sense of whats going on, rambling, hallucinations, misinterpretation of environment , beliefs they are being persecuted

Question 12

name some differential diagnosis for delirium

Answer 12

depression, dementia, non convulsive epilepsy, another psychiatric disease

Question 13

how do you manage delirium

Answer 13

treat underlying medical problem causing deliriium, treat hypoxia, maintain hydration, review psychoactive drugs, involve family and give a stable peaceful environment.

stay safe, avoid catheter, think about falls risk, promotwe normal sleep cycle, write down infor for patient easier to follow

Question 14

how do you optimise enviroment for delirium patient

Answer 14

clocks calendars, avoid moving patient, natural light, tidy enviroment reduce falls, calm and quiet

Question 15

what drugs can you give to delirium patient what should you be careful of

Answer 15

haloperidol, lorazepam, chlordiazepoxide, be wary of qt interval

Question 16

when can you try to treat delirium pharmacologicaly

Answer 16

patient risk to self or others, severely distressed, urgent medical interventions are needed start on low dosage

Question 17

what 6 delirium risk factors are targeted by hospital elder life program

Answer 17

Targets 6 Delirium Risk Factors
• cognitive re-orientation program
• non-pharma sleep protocol
• mobilization: walking
• vision: glasses, vision aids
• hearing aids, amplifiers
• hydration program

Question 18

what bother strategies can prevent delirium

Answer 18

Geriatric medicine proactive consultation for hip
fracture patients
• BIS-guided anaesthesia for post-operative delirium

Question 19

how does delirium patient effect family

Answer 19

• Distress at seeing patient with delirium

* Increased anxiety on follow up

Question 20

how does delirium affect healthcare staff

Answer 20

Effects of delirium on healthcare staff
• Stressful –may be related to increased delirium
severity and presence of perceptual disturbances

Question 21

how can you reduce stress on staff caused by delirium patient

Answer 21

Reducing distress for staff

• ? Training and education for staff

Question 22

how can you reduce stress on family by delirium patient

Answer 22

Pre-emptive information about delirium
• Recognition of delirium and providing information
when delirium occurs

Question 23

what can long term effect of delirium be on patient

Answer 23

ptsd and increased anxiety and depression at follow up

Question 24

what role and impact can patient and carers have on delirium patient

Answer 24

• Presence of family member may be helpful to orientate
and reassure
• Patients can perceive staff as positive or negative
presence