Delirium

Question 1

define delirium

Answer 1

acute confusional state

Question 2

why is it important to prevent dehydration in a patient with delirium?

Answer 2

can exacerbate/cause delirium

patients can go off food/drink

Question 3

what environment should someone with/at risk of delirium be kept in?

Answer 3

side room
well lit, quiet environment
have familiar things in the room

Question 4

what is the risk of death 1 year after delirium presents?

Answer 4

35-40%

Question 5

what patients are particularly at risk of delirium?

Answer 5

patients with dementia
visual/hearing loss pts
patients with many comorbidities
depressed patients

Question 6

“early morning wakening”

Answer 6

depression

Question 7

name some precipitants of delirium

Answer 7

polypharmacy 
infection
urinary retention/incontinence
depression
dementia
social/environmental factors
hip operation

Question 8

what kind of operation puts patients at most risk of delirium?

Answer 8

hip fracture operations

Question 9

“old lady with sudden onset confusion who has recently had surgery for a neck of the femur fracture”

Answer 9

DELIRIUM

Question 10

what medication can cause delirium?

Answer 10

strong painkillers ie opiates

sedatives

Question 11

why should catheters be removed in a patient with delirium?

Answer 11

they’ll pull them out and cause trauma

Question 12

vascular causes of delirium?

Answer 12

AF
stroke
MI

Question 13

name the 4 A’s of the 4AT

Answer 13

alertness
age etc
attention
acute changes

Question 14

what is done in the “attention” part of a 4AT

Answer 14

ask the patient to count the months of the year backwards

Question 15

what is done in the “age etc” part of a 4AT?

Answer 15

ask the patient to state:
name
age
DOB
current year

Question 16

how should delirium be treated?

Answer 16

tackle the precipitants first eg if hypoxic give O2, if blood sugar is low give glucose
medication if all else fails

Question 17

1st line medication for delirium

Answer 17

haloperidol

Question 18

how can thiazide diuretics cause delirium?

Answer 18

cause an electrolyte imbalance which can lead to a metabolic cause

Question 19

haloperidol acts on __ receptors

Answer 19

D2

Question 20

how would you be able to pick up a change in a patient’s mood?

Answer 20

memory problems
disoriented state
mumbling, slurred speech

Question 21

confused patient with suspected UTI who is agitated…

Answer 21

delirium

Question 22

a positive CAM needs…

Answer 22

acute fluctuating change PLUS inattention AND/OR:
disorganised thinking
altered level of consciousness

Question 23

how should haloperidol be given?

Answer 23

PO

Question 24

starting dose of haloperidol?

Answer 24

0.25-5mg

Question 25

when would you give quetiapine for delirium?

Answer 25

if the patient has parkinsons/lewy body dementia

Question 26

what drug should be given to someone in delirium who is undergoing alcohol withdrawal?

Answer 26

benzodiazepines eg lorazepam

Question 27

when should you give benzodiazepines for delirium?

Answer 27

alcohol withdrawal

seizures