Delirium

Question 1

Delirium definition CCAP CBM

Answer 1

A syndrome of disturbed:
consciousness, cognition, attention, perception.
A complex interaction between:
cognitive functioning, behaviour, medical conditions

Question 2

For many older adults it is the first and primary

indicator of

Answer 2

a newly emerged underlying physical illness

Question 3

Is delirium reversible?

Answer 3

IF recognized as and acute change and precipitating causes removed in timely manner.
The longer to assess and tx, the longer to reverse.

Question 4

Hyperactive CHAR - they are burnin’ up!

Answer 4

combative, hyperalert, agitated, restless

Question 5

Hypoactive – LASS MAS

Answer 5

lethargy, apathy, somnolent, stuporous

↓ movement / alertness / speech

Question 6

Mixed variant

Answer 6

Sx of both hyper and hypo w/ patients cycling b/w the two. 50% of cases.

Question 7

4 diagnostic criteria for delirium caused by a general medical condition

Answer 7

1) disturbed consciousness w/ reduced ability to focus/sustain/shift attention
2) cognition change or develop perceptual disturbance not accounted for by dementia
3) rapid onset and fluctuates over day
4 hx/exam/lab evidence indicates not the direct consequence of a medical condition

Question 8

Risk factors in delirium. Fran loves a PPIE.

Answer 8

Physiological Pharmacological Individual Environmental

Question 9

Risk factors - Physiological (4)

Answer 9

infx, dehydration/malnutrition, hypoxia, anemia, electrolyte imbalance

Question 10

Risk factors - Pharmacological (4)

Answer 10

alcohol/drug withdrawal, OTCs, newly prescribed med.

Question 11

Risk factors - Individual (4)

Answer 11

sleep disordered, sensory impaired, restraints, pain

Question 12

Risk factors - Environmental (4)

Answer 12

absence of clock/watch, reading glasses, dentures

relocation (loss of all cues), stress, isolation

Question 13

Evaluation of client should be focused on

1-2-3 IDT

Answer 13

1) ID that delirium is present
2) Determine contributing medical conditions/other factors
3) Treat/remove them

Question 14

Knowledge of these two things is PIVOTAL.

Answer 14

1) client’s cognitive baseline*
INCLUDING
2) detail of onset of current symptoms
* When transferring > charting, staff convos, family very important as source

Question 15

Confusion Assessment Method (CAM) – 4 features

AIDA

Answer 15

1) acute onset, fluctuating course
2) inattention
3) disorganized thinking
4) altered consciousness

Question 16

It is the nurse’s duty to support and protect the client while underlying causes are
determined and tx’ed. 3 Fran-isms for how to do.
CAM

Answer 16

Calming, help them trust you, reduce fear/anxiety
Avoid restraints/drugs
Maximize dignity, autonomy, self-esteem

Question 17

Clients/residents need what 3 general types of support?

Answer 17

psychosocial, behavioural, environmental

Question 18

Promote recovery, prevent complications, maintain safety, and maximize function. How can this best be accomplished following a first episode of delirium?

Answer 18

DOCUMENT
What were the things we learned after the fact?
What worked?!
– v. important to pass on what you learned to staff and family
PREVENTION
Zero in quickly next time. After the first incident, the person becomes more vulnerable

Question 19

Fran STRESSES to us: “Get right on to prevention on admission. Delirium not uncommon with transition.” Areas in which to be proactive?
(7 ideas)

Answer 19

• Diet/hydration
• Sleep
• Med reviews + decrease polypharm
• Urinary/bowel elimination
• Pain management
• Sensory impairment
• Social activity (physical/intellectual stimulation)

Question 20

More chunks of info. re. how to help.

FAT BIRRD

Answer 20

Fluids and food intake - encourage
Avoid restraints/drugs
Try to understand mind of client
Be present
Invite family who are calming
Reorient to routines (explain), 
Reduce stimulation
Dim lights