Confusion Flashcards
In the event that a confused elderly patient cannot give a full history who should you get a collateral history from?
Their carer, general practitioner or any source with good knowledge of the patient
What tool can be used to quickly aid in the diagnosis of delirium?
the confusion assessment method
True or false only psychiatric-ally trained clinicians can use the confusion assessment method?
False
What is the first and most important action for the treatment of delirium?
Identification and treatment of the underlying cause
What special measures nursing wise need to be made for a patient with delirium.
A good sensory environment with a reality orientation approach and with the involvement of a multi-disciplinary team
How frequently should a delirious patient’s patient’s medication be reviewed?
At least once daily
What is the one drug recommended for treating delirium?
Haloperidol
How should Haloperidol be administered?
Starting at the lowest possible dose then increasing in increments if necessary every 2 hours. One to one care should be provided while the drug is titrated up to a safe controlled dose
In what proportion of cases can delirium be prevented?
one third
What risks are posed to a patient with delirium compared to non delirious patients?
increased mortality, length of stay, complication and institutionalization rates.
What proportion of older patients in the emergency department have delirium
one in seven
what proportion of older patients develop delirium after hip fractures.
43-61%
Over what period of time do the symptoms of delirium precipitate?
Hours or days
What are the predisposing factors for delirium
Old age, severe illness, dementia, physical frailty, admision with dehydration or infectio, visual/hearing impairment, polypharmy, surgery (e.g. fractured neck of femur) Alcohol excess, renal impairment.
What are the precipitating factors for delirium?
Immobility, use of physical restraint, use of urinary catheter, iatrogeny (e.g. general anesthesia), malnutrition, psychoactive medications, inter-current illness, dehydration, benzodiazepine or alcohol withdraw
What is the typical pattern one sees in delirium symptoms throughout the day?
Diurnal pattern (worse at night)
What four features allow one to make the diagnosis of dementia?
Acute onset, Disturbance of consciousness, impaired cognition or perceptual disturbance not due to preexisting dementia, clinical evidence of an acute general medical condition such as intoxication or substance withdraw
what are the two main patterns of delirium according to the ICD?
hyperactive delirium (agitated and wandering) and hypoactive delirium (quiet and withdrawn)
What extra concern needs to be taken with hypoactive delirium?
that it doesn’t get overlooked or get misdiagnosed as a mood disorder
What does the differential diagnosis of delirium include?
dementia, depression, hysteria, mania, schizophrenia, dysphasia, seizures
What types of seizures can be a differential for delirium?
temporal lobe and non convulsive status epilepticus
What four common drug groups can cause delirium in older people?
opioid analgesics, drugs with anticholinergic properties, sedating drugs, corticosteroids
What environmental factors can be modified to prevent delirium?
avoiding overstimulation, ensure the patient is not deprived of spectacles or hearing aids and providing environmental and personal orientation
Apart from environmental factors what nine measures can be taken to prevent and manage delirium?
Minimize discontinuity of care, encourage mobility, reduce medicines where possible (while maintaining adequate analgesia, maintain adequate fluid intake and nutrition, maintain normal sleep patern, avoid constipation, involve relatives and carers, ensure regular medical, nursing and therapy reviews
