Delirium Flashcards
Risk factors of Delirium
Terminal illness >50%
Hip fracture 40-60%
Stroke >30%
Vascular surgery 20-40%
Why is Delirium important
Delirium increases risk of hospital acquired complications: Falls, pressure sores, infections
Halves chance of successful return home
Doubles length of stay
Increases risk of dying in hospital and after hospital
Commonest causes of cognitive impairment
Delirium and dementia
Dementia is a leading risk factor for delirium
delirium is independent risk factor for subsequent development of dementia
What are the difficulties with delirium
Often unrecognised
Early recognition and treatment improves outcomes
All members of healthcare team play an important role in identifying patient’s abnormal mental state
Non-medical staff have particular vital role in identifying delirium due to time they spend with patients – they can spot changes in mental state and/or behaviours
Drugs that may cause delirium
ALCOHOL (or lack of it!)
“A rigor and delirium from excessive drinking are bad” (Hippocrates,460-380BC)
Anti-depressants
Anti-psychotics
Anti-epileptics
Anti-parkinsonians
Anti-cholinergics
Opiates and other analgesics
Any drug that might act on the CNS
Main features of delirium
Rapid onset (hours, days)
No other common mental disorder presents with such rapid decline
Fluctuating symptoms
Disturbed levels of consciousness
Inability to focus, drowsiness
Cognitive impairment (may fluctuate)
Altered sleep wake cycle
Management of Delirium
TREAT THE UNDERLYING CAUSE
PREVENT IT
Maintain nutrition and fluids, mobilise, rehabilitate, wash hands, avoid constipation or retention
Recognise it Ask family, carers, GP, healthcare staff etc. “what are they normally like?” Spot the signs and symptoms BE AWARE of diagnostic criteria History of onset and course
Keep patient orientated
Reduce distress in patients and carers
Manage agitation with non-pharmacological means
Try to actively rehabilitate to prevent functional decline
Prevent complications e.g. pressure sores, dehydration
Communicate
Be understanding, orientate and explain frequently
explain all procedures and activities
Approach calmly, don’t startle or frighten patient
Ensure glasses and hearing aids
Work and used are correctly
Belong to the patient and are in reach
Recognizing Delirium
Repeated cognitive screening
Communicating with carers of patients with delirium
Carers Explain what’s happening Involve them in the care Get them to bring in familiar objects Keep noise to a minimum Pay attention to lighting levels Avoid unnecessary moves on or between wards Control pain Prevent complications Dehydration, falls, pressure sores, constipation Involve the MDT to prevent functional decline Seek specialist help
Causes of delirium
Infection
Stroke
New drugs
Acute illness
Investigating delirium
Cognitive screening
CT indicated when there is Hx of trauma or focal neurological deficit, and in Pts who fail to improve despite treatment
How to manage a delirious patient that is a risk to others
Give low dose haloperidol or benzodiazepine as last resort
Epidemiology of delirium
20% of adult patients on medical and surgical wards
What are the signs of delirium
8 signs
Disordered thinking, slow rambling irrational
Euphoric, fearful, depressed, or angry fluctuates
Language impaired speech reduced or gabbling
Illusions/delusions/hallucinations auditory or visual
Reversal of sleep/wake cycle- drowsy day active night
Inattention focusing, sustaining, attention is poor
Unaware/disoriented dnt know place his name date
Memory deficit - easily noticeable
Differentials of delirium
if agitated is it anxiety?
primary mental illness (schizo) but rare especcially if no PMH
Delirium is very common in ill patients
