Delirium Flashcards
What is delirium?
Acute, transient, reversible confusion often due to infection, drugs, dehydration
Affects 1 in 5 elderly patients on wards.
What are the two types of delirium?
Hyperactive and hypoactive delirium
Hyperactive: agitation, delusions, hallucinations, wandering, aggression. Hypoactive: lethargy, slow tasks, excessive sleeping, inattention.
What does the acronym CHIMPS PHONED stand for?
- Constipation
- Hypoxia
- Infection
- Metabolic disturbance
- Pain
- Sleeplessness
- Prescriptions
- Hypothermia/pyrexia
- Organ dysfunction
- Nutrition
- Environmental changes
- Drugs
A helpful mnemonic for assessing aetiology of delirium.
What should be included in the assessment of a confused patient?
- Comprehensive history
- Cognitive assessment
- Clinical examination
Includes vital signs and signs of infection.
What are some cognitive assessment tools used for delirium?
- Abbreviated Mental Test Score (AMTS)
- Mini-Mental State Examination (MMSE)
- Addenbrooke’s Cognitive Examination III (ACE-III)
These tools help monitor cognitive function.
What is included in a confusion screen?
- Blood tests (FBC, U&Es, LFTs, coagulation, TFTs, calcium, B12, folate, glucose, blood cultures)
- Urinalysis
- Imaging (CT head, chest X-ray)
Used to identify or rule out common causes of confusion.
True or False: Hypoactive delirium is commonly recognized.
False
Often missed or confused with depression.
What are the clinical features of hyperactive delirium?
- Agitation
- Delusions
- Hallucinations
- Wandering
- Aggression
This is the ‘typical’ presentation of delirium.
What are the clinical features of hypoactive delirium?
- Lethargy
- Slowness with everyday tasks
- Excessive sleeping
- Inattention
Less well known and often missed.
What are general supportive management strategies for delirium?
- Consistent nursing and medical team
- Gentle re-orientation
- Clear communication
- Access to aids (glasses, hearing aids)
Encourages patient independence.
What medications should be avoided in delirium management?
Unnecessary medications
Sedation should only be used if necessary.
What first-line medication is typically used for sedation in delirium?
Haloperidol (0.5mg starting dose)
Lorazepam (0.5mg) is also an option for benzodiazepines.
Fill in the blank: One in five elderly patients on medical and surgical wards are affected by _______.
delirium
This statistic highlights the prevalence of delirium.
What should families/carers be informed about delirium post-discharge?
- Delirium can continue after treatment
- Management of residual disorientation
- Importance of follow-up
Ensures proper support for recovery.
What steps should be taken to prevent episodes of delirium?
- Avoid precipitating drugs
- Monitor high-risk patients
- Address exacerbating factors (e.g. pain control)
Supportive/environmental approaches should be used for all patients.
