Delirium Flashcards
Common cuases of delirium?
PINCH ME/DELIRIUM
PINCH ME:
Pain, Infection, Nutrition, Constipation, Hydration, Medication, Environment
DELIRIUM:
Drugs, Epilepsy/Electrolyte imbalance, Liver failure, Infection, Reterntion (urine/faecal), Intracranial, Uraemia, metabolism
What is delirium?
Complex neuropsychiatric syndrome characterised by acute onset of altered consciousness and fluctuating cognitive impairment but is reversible
Delirium is often seen in hospital settings and can be mistaken for other conditions.
What are the risk factors for delirium?
- Age - 65+++
- Pre-existing cognitive impairment e.g. dementia
- Sensory impairment - hearing loss
- Comorbidities - cardiac, renal or hepatic disease
Risk factors increase the likelihood of developing delirium, especially in older adults.
What are common causes of delirium?
- Environmental change - being in hospital
- Systemic disease: UTI/Pneumonia
- Drugs: Anticholinergics, sedatives, opioids
- Substance misuse + alcohol
- Metabolic abnormalities
- Neurological insults - TBI
- Surgery + anaesthesia
Various factors can trigger delirium, often related to stressors or changes in the patient’s environment.
What are the types of delirium?
- Hyperactive
- Hypoactive
- Mixed
Each type presents differently, affecting the patient’s behavior and level of awareness.
What are the symptoms of delirium?
** symptoms can fluctuate **
* Attention deficits
* Altered level of consciousness
* Cognitive impairment + visuospatial impairment
* Sleep-Wake cycle disturbances
* Emotional disturbances
* Psychomotor disturbance: Hyperactive, Hypoactive, Mixed
Symptoms can fluctuate and may coexist with other conditions, complicating the diagnosis.
What is the Confusion Assessment Method (CAM) used for?
Diagnosis/Assessment of delirium
The CAM is a standardized tool for identifying delirium based on specific criteria.
What tool is used to determine an altered conscious state QUICKLY?
4AT:
Altertness - ask patients name and address
AMT4 - Age, DOB, location, current year
Attention - recite months of year backwards
Acute or fluctuating courses - within last 2 weeks and still persistant is last 24hrs
Score = 4 or more = signs of delium/confusion
Diagnosis requires acute onset + inattention AND (disorganized thoughts OR altered level of consciousness).
What is included in the management of delirium?
- Bloods: Confusion screen
- Bedside test: Blood sugar + UTI (not in over 65)
- Imaging: If indicated (CXR, Head CT)
Comprehensive management involves investigating potential underlying causes and ensuring patient safety.
What bloods are tested on a confusion screen?
Confusion screen - FBC/U&Es (hypercalcaemia)/LEFT/CRP/Clotting/TFTs/Mg/B12+folate/Blood cultures (sepsis)
What drug treatments may be used for severe hyperactive delirium after unsuccessful 1:1 nursing and descalation techniques?
- Anti-psychotics: Haloperidol, Olanzapine, Lorazepam
Caution is needed when using antipsychotics in Parkinson’s patients as it may worsen their symptoms.
What is the prognosis for patients with delirium?
- Often full recovery - but many take a while
- May experience persistent cognitive impairment
- Increased risk of dementia
Prognosis can vary based on underlying causes and patient age.
What are some differential diagnoses to consider for delirium?
- Dementia
- Depression
- Psychosis
Differentiating delirium from these conditions is crucial for appropriate treatment.
What is the use of anti-psychotics in delirium management?
Sedation using Oral/IM Lorazepam and Oral/IM Haloperidol
These medications are commonly prescribed to manage symptoms of delirium.
What is a contraindication for using Oral/IM Lorazepam?
Sleep Apnoea
Lorazepam can exacerbate respiratory issues in patients with sleep apnea.
What conditions contraindicate the use of Oral/IM Haloperidol?
Parkinson’s disease, Dementia with Lewy Bodies
Haloperidol can worsen symptoms in these conditions.
What is the association of antipsychotics with mortality in dementia patients?
Significant rise in mortality
Antipsychotics should be used with caution in individuals with dementia due to increased risk.
What common condition can cause delirium in the elderly?
Constipation
Constipation is often overlooked but can significantly impact mental status.
What should be avoided when treating delirium?
Sleeping tablets
Certain sleeping tablets, particularly benzodiazepines, anticholinergics, and melatonin, can exacerbate delirium.
Fill in the blank: Certain sleeping tablets can potentially _______ or even trigger delirium.
exacerbate
This is especially concerning in older adults.
