Delirium Flashcards
Delirium definition CCAP CBM
A syndrome of disturbed:
consciousness, cognition, attention, perception.
A complex interaction between:
cognitive functioning, behaviour, medical conditions
For many older adults it is the first and primary
indicator of
a newly emerged underlying physical illness
Is delirium reversible?
IF recognized as and acute change and precipitating causes removed in timely manner.
The longer to assess and tx, the longer to reverse.
Hyperactive CHAR - they are burnin’ up!
combative, hyperalert, agitated, restless
Hypoactive – LASS MAS
lethargy, apathy, somnolent, stuporous
↓ movement / alertness / speech
Mixed variant
Sx of both hyper and hypo w/ patients cycling b/w the two. 50% of cases.
4 diagnostic criteria for delirium caused by a general medical condition
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
Risk factors in delirium. Fran loves a PPIE.
Physiological Pharmacological Individual Environmental
Risk factors - Physiological (4)
infx, dehydration/malnutrition, hypoxia, anemia, electrolyte imbalance
Risk factors - Pharmacological (4)
alcohol/drug withdrawal, OTCs, newly prescribed med.
Risk factors - Individual (4)
sleep disordered, sensory impaired, restraints, pain
Risk factors - Environmental (4)
absence of clock/watch, reading glasses, dentures
relocation (loss of all cues), stress, isolation
Evaluation of client should be focused on
1-2-3 IDT
1) ID that delirium is present
2) Determine contributing medical conditions/other factors
3) Treat/remove them
Knowledge of these two things is PIVOTAL.
1) client’s cognitive baseline*
INCLUDING
2) detail of onset of current symptoms
* When transferring > charting, staff convos, family very important as source
Confusion Assessment Method (CAM) – 4 features
AIDA
1) acute onset, fluctuating course
2) inattention
3) disorganized thinking
4) altered consciousness
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
Calming, help them trust you, reduce fear/anxiety
Avoid restraints/drugs
Maximize dignity, autonomy, self-esteem
Clients/residents need what 3 general types of support?
psychosocial, behavioural, environmental
Promote recovery, prevent complications, maintain safety, and maximize function. How can this best be accomplished following a first episode of delirium?
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
Fran STRESSES to us: “Get right on to prevention on admission. Delirium not uncommon with transition.” Areas in which to be proactive?
(7 ideas)
- Diet/hydration
- Sleep
- Med reviews + decrease polypharm
- Urinary/bowel elimination
- Pain management
- Sensory impairment
- Social activity (physical/intellectual stimulation)
More chunks of info. re. how to help.
FAT BIRRD
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
