acute confusion Flashcards
what is delirium
acute brain failiure, acute onset, impaired attention and altered awareness, cognitive and neuropsychiatric disturbances
what is delirium drawing upon dsm 5
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
what are potential risks of delirium
increase hospital stay, increased risk of falls, makes dementia worse, death, functional disability, faulty cognitions
what is hyperactive delirium
aggressive restless, hallucinations, disturbed sleep, less cooperative
what is hypo active delirium
poor appetite, tired reduced movement withdrawn less aware.
what is mixed delirium
person goes between hypo and hyperactive delirium
how do you assess delirium
65 years older, hip fracture, cognitive impaired, severe illness, dementia any of these THINK delirium be alert
what is confusion assesment method for diagnosing delirium
you need to have acute onset and fluctauate course, and altered awareness and attention. plus either disorganised thinking, or being hypo or hyper alert
how do you asses patient attention
counting numbers and months backwards, difficulty doing tasks
how do you asses acute or continuous fluctuations in delirium
talk to night shift team, has their been a change from baseline and single question in delirium
how do you assess disorgansied thinking in delirium
problems making sense of whats going on, rambling, hallucinations, misinterpretation of environment , beliefs they are being persecuted
name some differential diagnosis for delirium
depression, dementia, non convulsive epilepsy, another psychiatric disease
how do you manage delirium
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
how do you optimise enviroment for delirium patient
clocks calendars, avoid moving patient, natural light, tidy enviroment reduce falls, calm and quiet
what drugs can you give to delirium patient what should you be careful of
haloperidol, lorazepam, chlordiazepoxide, be wary of qt interval
when can you try to treat delirium pharmacologicaly
patient risk to self or others, severely distressed, urgent medical interventions are needed start on low dosage
what 6 delirium risk factors are targeted by hospital elder life program
Targets 6 Delirium Risk Factors • cognitive re-orientation program • non-pharma sleep protocol • mobilization: walking • vision: glasses, vision aids • hearing aids, amplifiers • hydration program
what bother strategies can prevent delirium
Geriatric medicine proactive consultation for hip
fracture patients
• BIS-guided anaesthesia for post-operative delirium
how does delirium patient effect family
- Distress at seeing patient with delirium
* Increased anxiety on follow up
how does delirium affect healthcare staff
Effects of delirium on healthcare staff
• Stressful –may be related to increased delirium
severity and presence of perceptual disturbances
how can you reduce stress on staff caused by delirium patient
Reducing distress for staff
• ? Training and education for staff
how can you reduce stress on family by delirium patient
Pre-emptive information about delirium
• Recognition of delirium and providing information
when delirium occurs
what can long term effect of delirium be on patient
ptsd and increased anxiety and depression at follow up
what role and impact can patient and carers have on delirium patient
• Presence of family member may be helpful to orientate
and reassure
• Patients can perceive staff as positive or negative
presence
