Delirium Flashcards
0
Q
What is delirium?
A
** medical emergency Syndrome characterized by: 1. Acute onset 2. Fluctuating course 3. Disturbances in: - thought - memory - attention** - behaviour - perception (hallucinations) - orientation - consciousness - speech (disorganized, unclear) ** unidentifiable underlying medical cause
1
Q
What are the three behavioural subtypes of delirium?
A
- Hypoactive
- Hyperactive
- Mixed
2
Q
What is delirium?
A
** medical emergency Syndrome characterized by: 1. Acute onset 2. Fluctuating course 3. Disturbances in: - thought - memory - attention** - behaviour - perception (hallucinations) - orientation (person, place, time) - consciousness - speech (disorganized, unclear) ** unidentifiable underlying medical cause
3
Q
What are the characteristics of hypoactive delirium?
A
- slowed movement
- paucity of speech
- non responsiveness
*more unnoticed .. May lead to death
4
Q
Development and duration of delirium
A
- Delirium develops over a short period of time (hours or days)
- Can fluctuate over the course of the day, usually affecting sleep and wake cycle
- can persist over months
5
Q
Prevalence of delirium
A
Critically ill older adults have an 80% rate
Long term care 70%
6
Q
What can you give postoperatively to prevent delirium?
A
Anitcholinergics
7
Q
Risk factors for long term care residents to have delirium
A
Dementia Functional dependency Pain Depression Behavioural disturbances Number of medications Dehydration Malnutrition
9
Q
Common factors increase risk of delirium
A
INFECTION: watch for atypical presentation Advanced age Pain Dementia Surgery: general anesthetic Medications psychological disturbances (change to meds) Pathological conditions Impaired functioning Cognitive status alcohol prolonged sleep deprivation Environment: change, admit to ICU
9
Q
Nursing assessment for delirium
A
- frequent assessment and monitoring of mental assessment
- CAM
- Past medical history, including any psychiatric history
- Current medications
- Family history
- ***Pre episode cognitive and functional status
- Assess for any significant events (such as
falls, injury, changes in diet, medications,
etc)
10
Q
Nursing assessment for delirium
A
- frequent assessment and monitoring of mental assessment
- CAM
- I WATCH DEATH
- Past medical history, including any psychiatric history
- Current medications
- Family history
- ***Pre episode cognitive and functional status
- Assess for any significant events (such as
falls, injury, changes in diet, medications,
etc)
11
Q
What assessment tool is used for delirium?
A
The Confusion Assessment Model (CAM)
12
Q
What is the CAM assessment?
A
- ACUTE ONSET AND FLUCTUATING COURSE- is there evidence of acute change in mental status from baseline or abnormal behaviour that tends to come and go or increase or decrease
- INATTENTION: does the patient have difficulty focusing or keeping track of what is being said? Are they easily distracted?
- DISORGANIZED THINKING: is the patient’s thinking or conversations coherent, disorganized or illogical? Do they switch topics?
- ALTERED LEVEL OF CONSCIOUSNESS
13
Q
Nursing interventions for delirium?
A
- requires multidisciplinary approach **
Some
1. Provision for aids to orientation (clocks, callenders)
2. Aids for sensory function (glasses, hearing aids)
3. Frequent verbal orientation
4. Environment modifications (noise reduction)
5. Identify adverse medications
6. Adequate pain management
7. Social support
14
Q
What nursing interventions can be done for acute confusion?
A
- Anxiety reduction
- Behaviour reduction
- Cognitive stimulation
- Delirium management
- Energy management
- Environment management
- Fluid/electrolyte management
- Hallucination management
- Medication management
- Mood management
- Pain management
- Reality orientation **
- Sedation management
- Surveillance: safety
