Delerium

Question 1

What are causes/precipitating factors of delerium?

Answer 1

PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration 

Medications
Electrolytes
+Sensory impairment (glasses, hearing aids)

Question 2

Two medications can exacerbate delerium?

Answer 2

opioids, benzodiazepines, anticholinergics, antibiotics

Question 3

Which scoring system can be used to determine severity of delerium?

Answer 3

4AT

Question 4

List three non pharmacological management options for delerium

Answer 4

1. Re-orientation (continuity of staff, visible clocks, visit from family and friends, maintain sleep-wake cycle)
2. De-escalation (listening, follow convrersation, don’t challenge, safe and quiet environment)
3. 1:1 nursing care if possible

Question 5

If non-pharmacological interventions have not helped, which medication should be used?

Answer 5

halloperidol 500 mg - 1g oral or IM available. Use if no contraindications

Question 6

What are the contraindications for halloperidol?

Answer 6

parkinson’s disease. lewy body dementia, multiple system atrophy, other drugs which prolong QTc

Question 7

If a patient has parkinson’s disease and requires pharmacological intervention for their delerium, which is the drug of choice?

Answer 7

lorazepam (antipyschotics are contraindicated in movement disorders)

Question 8

If halloperidol is contraindicated but patient has no movement disorder, which drug can be used to manage delerium?

Answer 8

risperidone

Question 9

Which legislative document should be used in hospital if patient is seriously delerious and lack capacity?

Answer 9

AWI= adults with incapacity.

Question 10

Which legislative document is used if delerious patient is trying to leave hospital?

Answer 10

Emergency detention

Question 11

Two predisposing factors for delerium in adults?

Answer 11

old age
cognitive impairment
depression
malnourishment
CKD
alcohol misuse
polypharmacy
male
hearing impairment
past hx

Question 12

Three clinical features of delerium?

Answer 12

Inattention
Altered arousal
Hallucinations
Delusions
Altered mood
Altered sleep

Question 13

Name the delerium assessment tool

Answer 13

4AT

Question 14

What are the components of the delirium assessment tool?

Answer 14

4AT
[1] Alertness
[2] AMT4: Abbreviated Mental Test - 4. 
[3] Attention test: Months of the Year Backwards
[4] Acute change or fluctuating course

Question 15

Two differentials for delerium?

Answer 15

depression
psychotic disorders
dementia

Question 16

List three complications of delirium

Answer 16

falls
pressure sores
aspiration pneumonia
dehydration
malnourishment
immobility