Delirium Flashcards
Delirium
- a syndrome of disturbed consciousness, attention, cognition, and perception; a complex interaction between medical conditions, cognitive functioning, and behaviour.
- life-threatening and can lead to permanent cognitive damage.
- often the first indicator of a newly emerged underlying physical illness.
- reversible if it is recognized as an acute change and precipitating causes are removed in a timely manner.
CAM
confustion assessment method.
Screening tool used to screen for delirium.
4 features
1) acute onset and fluctuating course
2) inattention
3) disorganized thinking
4) altered level of consciousness.
Hyperactive Delerium
vigilent: can starts tasks but inattention won’t ket them finish it
increased motor activity, restlessness, agitation, aggression, wandering, hyper alertness, hallucinations and delusions, and inappropriate behaviour
Hypoactive Delerium
- Somenolent/Lethargic delirium
- Dangerous cause people think your just sleepy.
- inactivity or reduced motor activity, sluggishness, abnormal drowsiness, or seeming to be in a daze.
Mixed Delirium
has symptoms of hyperactive delirium at times and symptoms of hypoactive delirium at other times. They will switch between these symptoms over the day or from one day to the next. For example, they could be very agitated at one time and then later become very drowsy.
Subsyndromal delirium
a frequent condition characterized by a less severe cognitive impairment in comparison to delirium, in which some, but not all, diagnostic criteria for delirium are met
Have 1 or 2 features but not all of them
Why isn’t delirium caught as often as it could be?
Nurses don’t chart effectively enough to pick up delirium. Vauge terminology, LOCx2, increased confusiuon.
Chart instead about changes in behaviour. Try testing them a bit if yu notice a difference
Pathophysiology
- Disruption of neurotransimission
- Cholinergic deficiency
Trigger for delirium is unkown. The older you get the more likely you get.
Can be triggered by UTIs, sepsis
Diagnostic criteria for delirium caused by a general medical condition are:
1) a disturbance of consciousness (reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention
2) a change in cognition (memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not accounted for by preexisting, established, or evolving dementia
3) a disturbance that develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day
4) evidence from the history, physical examination, or laboratory findings indicates that the disturbance is caused by the direct consequence of a medical condition
Identifying underlying medical conditions : Use mnemonic DELIRIUM.
Drugs
Electrolytes
Low oxygen states (strokes, MI)
Infection – UTI, pneumonia
Reduced sensory input
Intracranial(TIA, seizures)
Urinary/fecal retention
Myocardial (congestive heart failure, MI, arrhythmia) ….sometimes the only sx of MI
Treatment plan is to find out what’s going on to cause it.
Have there been a change in their meds? An increase or decrease in something?
Are they eating? Are they drinking?
Inpacted/comnstipation
common Symptoms
- Sudden onset, fluctuating symptoms
- Behavioral changes: restless/agitated, hypoactive, fluctuating
- Speech that is difficult to follow
- Perceptual disturbances – misinterpretation of the environment to visual hallucinations
- Memory impairment – particularly to recent events and time and place
- Affective signs of fear, anxiety, and/or anger
May have recent disordered sleep-wake cycle
Plan to assess delirium 3
1) identify that delirium is present, and
2) take action in determining contributing medical conditions and other factors and
3) treat/remove them.
