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#Phase 2.2: Elderly & Chronic Care > Delirium > Flashcards

Delirium Flashcards

1
Q

What is Delirium?

A

Acute confusion state

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2
Q

What is Delirium characterised by? (2 things)

A
  1. Disturbed consciousness
  2. Reduced cognitive function
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3
Q

What percentage of elderly patients on Medical / Surgical Wards will have Delirium at any one time?

A

15%

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4
Q

What are the 3 types of Delirium?

A
  1. Hypoactive Delirium (most common)
  2. Hyperactive Delirium
  3. Mixed Agitation
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5
Q

What are the CF Hypoactive Delirium? (2 things)

A
  1. Lethargy
  2. Reduced motor activity
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6
Q

What are the CF Hyperactive Delirium? (4 things)

A
  1. Agitation / Aggression
  2. Increased motor activity
  3. Delusions
  4. Hallucinations
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7
Q

What is Mixed agitation marked by?

A

Fluctuations throughout the day

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8
Q

What are the titles of the differences between Delirium n Dementia? (4 things)

A
  1. Onset
  2. Short-Term course
  3. Attention
  4. Delusions / Hallucinations
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9
Q

What is the difference in ONSET between Delirium vs Dementia?

A
  • Delirium: Acute
  • Dementia: Gradual
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10
Q

What is the difference in the SHORT-TERM COURSE between Delirium vs Dementia?

A
  • Delirium: Fluctuating
  • Dementia: Constant
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11
Q

What is the difference in ATTENTION between Delirium vs Dementia?

A
  • Delirium: Poor
  • Dementia: Good
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12
Q

What is the difference in DELUSIONS / HALLUCINATIONS between Delirium vs Dementia?

A
  • Delirium: Common
  • Dementia: Less Common
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13
Q

What are the RF for Delirium? (6 things)

A
  1. Age 65+
  2. Male
  3. Multiple co-morbs
  4. Underlying Dementia
  5. Renal impairment
  6. Sensory impairment (hearing / visual)
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14
Q

What are the causes of Delirium? (11 things)

A
  • C - Constipation
  • H – Hypoxia
  • I – Infection
  • M – Met Disturbance
  • P – Pain
  • S – Sleeplessness
  • P – Prescriptions
  • H – Hypothermia / Pyrexia
  • O – Organ dysfunction (hepatic / renal impairment)
  • N – Nutrition
  • E – Environmental changes
  • D – Drugs / Dehydration

CHIMPS PHONES

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15
Q

When do you usually get the Hypoxia that causes Delirium?

A

Post-op

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16
Q

What infections can cause Delirium? (2 things)

A
  1. UTI
  2. LRTI
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17
Q

What Met Disturbances can cause Delirium? (3 things)

A
  1. Hyponatraemia
  2. Hypernatremia
  3. Hypercalcaemia
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18
Q

What Drugs can cause Delirium? (5 things)

A
  1. Benzodiazepines
  2. Diuretics
  3. Opioids
  4. Steroids
  5. Drug withdrawal (e.g Alcohol)
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19
Q

What info is important to get from Hx / Collateral Hx? (5 things)

A
  1. Symptoms of possible Underlying Cause
  2. Previous episodes
  3. Onset + Course of confusion
  4. Drug Hx
  5. Co-morbs
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20
Q

What screening tools can you use to assess pt cognition? (3 things)

A
  1. Abbreviated Mental Test Score (AMTS)
  2. MMSE
  3. ACE-III
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21
Q

Why is it important to do screening tools for Delirium pts?

A

To monitor for Improvement / Deterioration over time

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22
Q

What examinations can you do to give you a clue to what caused the Delirium?

A
  1. Vital signs
  2. Consciousness (e.g GCS / AVPU)
  3. Evidence of Head trauma
  4. Source of infection
  5. Asterixis (flapping hands)
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23
Q

What signs from the Vital signs might give you a clue to what caused the Delirium? (2 things)

A
  1. Fever: Infection
  2. Low SpO2: Pneumonia
24
Q

What sign of a Source of Infection might give you a clue to what caused the Delirium?

A

Suprapubic tenderness: UTI

25
Q

What does Asterixis suggest the cause of Delirium is? (2 things)

A
  1. Uraemia
  2. Encephalopathy
26
Q

What Investigations can you do to give you a clue to what caused the Delirium? (10 things)

A
  1. FBC
  2. UnE
  3. LFT
  4. Coagulation / INR
  5. TFT
  6. Calcium
  7. B12 / folate
  8. Glucose
  9. Blood cultures
  10. Urinalysis
27
Q

What causes of Delirium can a FBC reveal? (3 things)

A
  1. Infection
  2. Anaemia
  3. Malignancy
28
Q

What causes of Delirium can a UnE reveal? (2 things)

A
  1. Hyponatraemia
  2. Hypernatraemia
29
Q

What cause of Delirium can a LFT reveal?

A

Liver failure w Secondary encephalopathy

30
Q

What cause of Delirium can a Coagulation / INR test reveal?

A

Intracranial bleeding

31
Q

What cause of Delirium can a TFT reveal?

A

Hypothyroidism

32
Q

What cause of Delirium can a Calcium test reveal?

A

Hypercalcaemia

33
Q

What cause of Delirium can a B12 / Folate test reveal?

A

B12 / Folate deficiency

34
Q

What causes of Delirium can Glucose test reveal? (2 things)

A
  1. Hypoglycaemia
  2. Hyperglycaemia
35
Q

What cause of Delirium can Blood cultures reveal?

36
Q

What cause of Delirium can Urinalysis reveal?

37
Q

What Imaging can you do to give you a clue to what caused the Delirium? (2 things)

A
  1. CT head
  2. CXR
38
Q

When should you for a CT head in Delirium?

A

If concerned abt Intracranial pathology (bleeding / ischaemic stroke / abscess)

39
Q

When should you for a CXR in Delirium?

A

If concerned abt Lung pathology (pneumonia / pulmonary oedema)

40
Q

What is the Definitive Mx of Delirium?

A

Identify + TUC

41
Q

What should be given if Delirium was caused by INFECTION?

42
Q

What should be given if Delirium was caused by HYPOXIA?

A

Nasal oxygen

43
Q

What should be given if Delirium was caused by CONSTIPATION?

44
Q

How do you prevent worsening of Delirium? (3 things)

A
  1. Encourage oral fluid intake
  2. Analgesia (PRN)
  3. Monitor bowels
45
Q

Although Sedatives should be used sparingly, what Sedatives are recommended by NICE? (2 things)

A
  1. Haloperidol (FIRST LINE)
  2. Lorazepam

#Phase 2.2: Elderly & Chronic Care (8 decks)

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