Confusion

Question 1

Delirium

Answer 1

Disturbed consciousness
- Hypoactive/Hyperactive/mixed

Change in cognition
- Memory/perceptual/language/illusions/hallucinations

Acute onset and fluctuant

Disturbance of sleep wake cycle
Disturbed psychomotor behaviour (mobility)
Emotional disturbance

Question 2

Delirium is precipitated by

Answer 2

Infection
Dehydration
Biochemical disturbance
Pain
Drugs
Constipation/Urinary retention
Hypoxia
Alcohol/drug withdrawal
Sleep disturbance
Brain injury
Stroke/tumour/bleed etc
Changes in environment

Question 3

Delirium Investigations

Answer 3

Alertness
AMT4 (Date of Birth, Place, Age, Time of Year)
Attention
Acute change or fluctuating course

Question 4

Galantamine

Answer 4

mixed dementia

Question 5

Rivastigmine

Answer 5

Dementia with Lewy Bodies

Question 6

reversible causes of Dementia

Answer 6

Hypothyroidism
Intracerebral bleeds/tumours
B12 deficiency
Hypercalcaemia
Normal pressure hydrocephalus

Question 7

Metoclopramide

Answer 7

dopamine antagonist (prokinetic agent) - slows stomach emptying in diabetics

can exacerbate Dementia with Lewy Bodies

Question 8

Delirium – non pharmacological treatment

Answer 8

Re-orientate and reassure agitated patients
– USE FAMILIES/CARERS

Encourage early mobility and self-care
Correction of sensory impairment
Normalise sleep-wake cycle
Ensure continuity of care
Avoid hospitalisation if possible
avoid frequent ward or room transfers
Avoid urinary catheterisation/venflons
Discharge people (if in hospital) ASAP

Question 9

UTI in Elderly Rx and Ix

Answer 9

In elderly women (>65yrs),
Antibiotic treatment of asymptomatic bacteriuria
significantly increases the risk of adverse events

Do not use dipstick tests for the diagnosis of UTI in older people

Question 10

What to think when patient is Elderly?

Answer 10

Welfare POA or guardian
Remember capacity decision specific
Personal Wishes
Decide according to Delirum cause if they need hospitalisation

Question 11

Old man typical example of delirium development

Answer 11

Antedepresssants make you prone to falls

Fracture – Rx: Dehydrocodeine – SE: constipation so eat and drink less

Hyponatremic, hypercalcaemic bc dehydration

Question 12

Delirium – how to diagnose it

Answer 12

Alertness (difficult to rouse)

AMT-4 (Location, Age, Date of Birth, Year)

Attention (can you tell me the months in order?)

Significant change in fluctuation of alertness, cognition, mental function

Question 13

Rx only if danger to themselves or others or distress which cannot be settled in any other way

Answer 13

Start low and go slow

12.5mg Quetiapine orally

Question 14

Urinary retention

Answer 14

PR enema / catheter ?