Delirium

Question 1

What are the associated features of delirium?

Answer 1

delusions (often paranoid)

emotional changes (anxiety, fear, depression)

motor changes (slowness, restlessness, agitation)

hallucinations (often formed and animated)

Question 2

What are the subtypes of delirium? (put in %s)

Answer 2

Hypoactive (40%)

Hyperactive (25%)

Mixed (35%)

Question 3

What is the most common type of delirium?

Answer 3

Hypoactive

Question 4

Why is hypoactive delirium often not recognised?

Answer 4

It is often mistaken for depression

Question 5

In what way are pts with hyperactive delirium often mistreated?

Answer 5

With sedating drugs

Question 6

What is CAM and how does it relate to delirium?

Answer 6

Confusion Assessment Method (CAM) and it is a diagnostic tool for delirium

Question 7

What are the diagnostic categories for CAM for delirium?

Answer 7

Requires features 1 and 2 and EITHER 3 or 4:

1) Acute Onset and Fluctuating Course
2) Inattention
3) Disorganised thinking
4) Altered level of consciousness

Question 8

In what way can consciousness level be altered in delirium?

Answer 8

vigilant [hyperalert]

alert [normal]

lethargic [drowsy, easily aroused]

stupor [difficult to arouse]

coma [unarousable]

Question 9

What are the risk factors (predisposing) for delirium?

Answer 9

Physical fraility

Older age (>65years)

Sensory impairment (e.g. vision)

Multiple co-mobidities

Dementia

Question 10

What are the precipitating factors for delirium?

Answer 10

Systemic infection

Drug initiation/withdrawal

Acute brain disease

Surgery

Metabolic abnormalities

hypoxia

Question 11

How should delirious patients be managed?

Answer 11

Orientate pt + put in familar surroundings

Keep hydrated + fed

Reduced medication

Promote night time sleep

Minimise provocation (noise, tubes, etc)

Question 12

Which medications are particularly bad regarding delirium?

Answer 12

anticholinergic/antimuscarinic drugs especially

opiates

Question 13

Other than CAM what else can aid in the diagnosis of dementia? (how is it interpreted)

Answer 13

Abbreviated Mental Test Score (AMT)

10 factual questions, if they get less than 8 then the pt is cognitively impaired

Question 14

What are the four main elements in managing delirium?

Answer 14

Identify and treat the underlying cause

Management of the symptoms of delirium

Prevention of complications

Patient and relative explanations

Question 15

What are some key points in the management of symptoms of delirium?

Answer 15

Closed bays are ideal (may not be possible due to safety)

1 to 1 nursing is ideal

Regular clinical updates, ideally with relatives

Promote orientation (e.g. clock in view of bed)

Question 16

What are some key complications of delirium?

Answer 16

Pressure ulcers

Incontinence

Question 17

Why should sedative medication due to agitated in delirium be kept to a minimum?

Answer 17

As it often has an underlying cause

As sedative medication can precipitate delirium

Question 18

What are some causes of agitation in delirium?

Answer 18

pain

constipation

frustration at inability to communicate needs

being frightened by delusions or altered perceptions

Question 19

When should sedative medication be used in delirium?

Answer 19

When other forms of management have been tried

Question 20

What are the two uses of sedative drugs in delirium?

Answer 20

Rapid tranquillisation (if at immediate risk of harm or danger)

Short term control of distress

Question 21

What sedative drugs are used in delirium? (via what route)

Answer 21

Haloperidol

Lorazepam

(IV or IM)