delirium

Question 1

what is delirium

Answer 1

Acute and transient impaired cognition, consciousness, attention and perception

Question 2

symptoms of hyperactive delirium

Answer 2

Agitation
Delusions and hallucinations
Wandering
Aggression

Question 3

symptoms of hypoactive delirium

Answer 3

Lethargy
Increased sleeping
Inattention

Question 4

general clinical presentation of delirium

Answer 4

Disrupted sleep-wake cycle (often reversed)
Impairment of recent memory
Reduced awareness
Disorientation is most often in time

Question 5

acronym for causes of delirium

Answer 5

CHIMPS PHONED
C - Constipation
H - Hypoxia
I - Infection
M - Metabolic disturbance
P - Pain
S - Sleeplessness
P - Prescriptions (e.g. opiates and benzodiazepines)
H - Hypothermia/pyrexia
O - Organ dysfunction (hepatic or renal impairment)
N - Nutrition
E - Environmental changes
D - Drugs (over the counter, illicit, alcohol and smoking)

Question 6

which cognitive assessment can be used for delirium specifically

Answer 6

4AT
- alertness
- age, DOB, current year, where they are
- list the months of the year backwards
- acute or fluctuating mental impairment

Question 7

what tests are involved in a confusion screen

Answer 7

FBC (infection, anaemia, malignancy)
U&Es (+/-)
LFTs (liver failure + secondary encephalopathy)
Coagulation/INR (intracranial bleeding)
TFTs
Calcium (e.g. hypercalcaemia)
B12 + folate/haematinics
Glucose
Blood cultures
Urinalysis (in the elderly they must have symptoms of UTI + positive dipstick)

Question 8

supportive management for patients with delirium

Answer 8

Side room
Adequate lighting
familiar faces or objects (photos, their own clothes, blankets ect.)
A clocks, calendar/signs for date and day
access to aids like glasses, hearing aids or walking aids

Question 9

first line medication for delirium

Answer 9

haloperidol