Delirium

Question 1

Types of delirium

Answer 1

Hypoactive, hyperactive, mixed

Question 2

What is delirium

Answer 2

Acute, transient, global organic disorder CNS functioning resulting in impaired consciousness and attention

Question 3

Risk factors for delirium

Answer 3

> 65
Dementia
Renal impairment
Sensory impairment
Recent surgery
Multiple comorbidities
Physcial frailty
Male sex
Prev episodes
severe illness

Question 4

Routine investgiations for delirium

Answer 4

Urine dipstick and culture - exclude UTI
Bloods
ECG
CXR

Question 5

Screening for infection in delirium

Answer 5

Urine dipstick and culture
FBC - WCC
CRP
Blood culture

Question 6

Why test for U+Es and calcium in delirium

Answer 6

Electrolyte imbalances

Question 7

What can cause delirium and lead to LOC that you can test for in an A-E?

Answer 7

Hypoglycaemia
hyperglycaemia can aslo cause delirium

Question 8

What tests for hyperthyroidism in delirium

Answer 8

TFTs

Question 9

What nutritional deficiencies can cause delirium

Answer 9

B12, folate, iron-ferritin, nicotinic acid

Question 10

What investgiation fo you do if concerned about head injury, intracranial bleed or CVA?

Answer 10

CT head

Question 11

What clinical suspicion would mean you do a LP in delirium?

Answer 11

Meningitis, encephalitis

Question 12

What does an EEG test for?

Answer 12

Epilepsy

Question 13

Management of delirium - initial

Answer 13

Treat underlying cause
Correct electrolyte disturbances, treat infections, stop offending drugs
Laxatives for faecal impaction
Temporary catheterisation - urinary retention
Analgesia if sus pain

Question 14

Why is it important to monitor bowel and urine passing in elderly patients?

Answer 14

Both constipation and urinary retention can cause delirium

Question 15

Appropriate environment for delirious patients

Answer 15

Quiet, well lit side room, consistency in care and staff, rassure nurses, encourage family and friends, optimise sensry acuity eg glasses, well lit, orientation aids

Question 16

Medication for delirium

Answer 16

Oral low dose haloperidol 0.5-4mg
olanzapine 2.5-10mg

Question 17

HE ISNT MAD delirium causes

Answer 17

Hypoxia
Endocrine
Infection
Stroke
Nutritional
Theatre
Metabolic
Abdominal
Alcohol - intoxication or withdrawl
Drugs

Question 18

Features of DELIRIUM

Answer 18

Disordered thinking, slowed irrational incoherent thoughts
Euphoric, fearful, depressed or angry
Language impaired: rambling speech, repetitive and disruptive
Illusions, delusions - transient persecutory or misidentificatino
Reversal of sleep wake pattern
Inattention
Unaware/disorientated - time, place and person
Memory deficits

Question 19

Screening tools delirium

Answer 19

Abbreviated Mental test score AMTS
Confusionassessmnet method CAM
4AST

Question 20

Drugs that cause delirium

Answer 20

Benzodiazapines, opioids, anticholinergics, anti-parkinsonian meds, steroids

Question 21

Abdo causes of delirium

Answer 21

Hypoxia, electrolyte disturbance, hypoglycaemia, hepatic and renal impairment

Question 22

Infections causing delirium

Answer 22

Pneumonia, UTI, encephalitis, meningitis

Question 23

Endocrine causes of delirium

Answer 23

Hypo/erglycaemia, hypo/erthyrodisim, cushings syndrome

Question 24

Causes of hypoxia -> delirium

Answer 24

Resp failure, MI, cardiac failure, PE

Question 25

CAM diagnosis of delirium

Answer 25

Acute onset and fluctuating course
Inattention
Disorganised thinking
Altered consciousness

Question 26

AMTS parameter for cognitive impairment

Answer 26

<8 correct out of 10

Question 27

Questions on AMTS

Answer 27

Age
Time
Recall address at end - 42 west street
What year is it
Where are you right now
Identify two people
DOB
When did WW2 end
Who is current monarch
Count backwards from 20 to 1

Question 28

4AT

Answer 28

1) Alertness
2) AMT4
3) Attention
4)Acute change or fluctuating

4 or above = possible delirium +/- cognitive impairment
1-3 = possible cognitive impairment