Delirium Flashcards
1
Q
Define delirium
A
- Acute confusional state
- Disturbed consciousness
- Reduced cognitive function
2
Q
3 main types of delirium
A
- Hypoactive - lethargy, reduced motor activity
- Hyperactive - agitation and increased motor activity
- Mixed agitation - fluctuations throughout day
3
Q
Delirium vs dementia
A
- Onsets differ - delirium is acute, dementia is gradual
- Course of condition - delirium fluctuates, dementia is constant
- Attention - poor in delirium, good in dementia
- Delusions and hallucinations - common and simple, fleeting in delirium, dementia they are less common and more stable
4
Q
RF for delirium
A
- Aged over 65
- Multiple co-morbidities
- Underlying dementia
- Renal impairment
- Male
- Sensory impairment - hearing or visual
5
Q
Most common causes delirium
A
- Hypoxia
- Infection - UTI or LRTI
- Drug induced eg benzos, diuretics, opioids, steroids
- Drug withdrawal - alcohol or benzos
- Dehydration
- Pain
- Constipation
- Urinary retention
- Abnormal electrolytes
6
Q
Assessment of acutely confused post op patient - what to ask
A
Collateral history often needed, need to acertain:
* Onset and course of confusion
* Symptoms of underlying cause?
* Co-morbids, baseline function
* Previous episodes
* Drug history inc alcohol
7
Q
What tests can be used to assess patient?
A
- Abbreviated mental test (AMT) or mini mental state examination (MMSE)
- Compare with previous
- Can also do confusional assessment method to quantify delirium
8
Q
Examining post op confused patient
A
- Review obs
- Drug chart
- Check for signs of infection inc surgical sites
- Check for pain
- Signs of constipation/retention?
- Neurological exam to rule out stroke or subdural haematoma etc
9
Q
Components of abbreviated mental test
A
- Age
- Time - to nearest hour
- give address - for recall at the end
- Year
- Name of home address
- Recognition of two objects
- DOB
- Year of first/second world war
- Name of current monarch
- Count backwards 20-1
- recall address
10
Q
What investigations are included in ‘confusion screen’ if you are unsure of the cause of confusion?
A
- Bloods - FBC, U&E, Ca2+, TFTs, glucose, B12, folate
- Blood cultures +/- wound swabs
- Urinalysis +/- CXR
- CT head if relevant
11
Q
General management of confused patient post op
A
- Treat underlying cause (of course)
- Quiet area
- Regular routines
- Clocks to orientate to time and place
- Promote regular sleeping pattern
12
Q
Management to prevent delirium worsening
A
- Encourage oral fluid intake
- Adequate analgesia
- Monitor bowels
13
Q
When to use sedatives in delirium?
A
- Try to avoid
- Only give if absolutely necessary
- Haloperidol 1st line (oral if possible)
- Lorazepam may be needed esp in elderly)
14
Q
A
