Delirium Flashcards
1
Q
What are the clinical features of delirium?
A
- Acute behavioural changes
- Altered cognitive function
- Inattention
- Disorganised thinking
- Altered perception
- Altered physical function
- Altered social behaviour
- Altered level of consciousness
2
Q
What are the potential warning signs for delirium?
A
- Falling
- Loss of appetite
3
Q
How do symptoms of delirium change throughout the day?
A
- Lucid intervals during the day
- Worsening of symptoms at night
4
Q
What are the types of delirium?
A
- Hyperactive
- Hypoactive
- Mixed
5
Q
Which type of delirium is most common?
A
Hypoactive
6
Q
Describe hyperactive delirium.
A
- Increased sensitivity to immediate surroundings
- Agitation, restlessness, sleep disturbance, and hypervigilance
- Wandering is also common
7
Q
Describe hypoactive delirium.
A
- Patient may be lethargic
- Reduced mobility and movement
- Lack of interest in daily activities
- Reduced appetite
- Quiet and withdrawn
8
Q
What are the predisposing factors to delirium?
A
- Older age (over 65 years)
- Cognitive impairment (such as dementia)
- Frailty/multiple comorbidities (such as stroke or heart failure)
- Significant injuries such as hip fracture
- Functional impairment (for example immobility or the use of physical restraints such as cot sides)
- Iatrogenic events (such as bladder catheterization, polypharmacy, or surgery)
- History of, or current, alcohol excess
- Sensory impairment (such as visual impairment or hearing loss)
- Poor nutrition
- Lack of stimulation
- Terminal phase of illness
9
Q
What are the precipitating factors to delirium?
A
- Infection
- Metabolic disturbance (blood glucose, electrolytes)
- Medication (benzos, opiates, anti-Parkinson meds, TCAs, lithium, antipsychotics etc)
- Uncontrolled pain
- GI (constipation, faecal impaction, malnutrition)
- Alcohol intoxication or withdrawal
- Urinary retention
- Cardio/resp/endo/neuro disorders
10
Q
What investigation might be done when investigating the cause of delirium?
A
- Vitals (inc blood glucose)
- Urinalysis
- Sputum culture
- FBC
- Folate and B12 deficiency
- U&Es
- HbA1c
- Calcium
- LFTs
- ESR, CRP
- Drug levels
- TFTs
- CXR
- ECG
11
Q
What are the supportive management strategies for delirium?
A
- Consistent nursing and medical team, gentle re-orientation, calm and consistent care
- Access to aids such as glasses, hearing aids, walking aids
- Enable the patient to do what they can for themselves
- Access to a clock and other reminders of date/time
- Familiar objects where possible
- Involvement of family, friends, carers
- Control noise level around patient
- Adequate lighting and temperature
12
Q
What is the medical management of delirium?
A
- Haloperidol (oral, IV, IM) –> do not give to Parkinson patients
- Lorazepam
- Levomepromazine –> do not give to Parkinson patients
- Quetiapine –> Parkinson’s disease
