Delirium Flashcards
define delirium
acute confusional state
why is it important to prevent dehydration in a patient with delirium?
can exacerbate/cause delirium
patients can go off food/drink
what environment should someone with/at risk of delirium be kept in?
side room
well lit, quiet environment
have familiar things in the room
what is the risk of death 1 year after delirium presents?
35-40%
what patients are particularly at risk of delirium?
patients with dementia
visual/hearing loss pts
patients with many comorbidities
depressed patients
“early morning wakening”
depression
name some precipitants of delirium
polypharmacy infection urinary retention/incontinence depression dementia social/environmental factors hip operation
what kind of operation puts patients at most risk of delirium?
hip fracture operations
“old lady with sudden onset confusion who has recently had surgery for a neck of the femur fracture”
DELIRIUM
what medication can cause delirium?
strong painkillers ie opiates
sedatives
why should catheters be removed in a patient with delirium?
they’ll pull them out and cause trauma
vascular causes of delirium?
AF
stroke
MI
name the 4 A’s of the 4AT
alertness
age etc
attention
acute changes
what is done in the “attention” part of a 4AT
ask the patient to count the months of the year backwards
what is done in the “age etc” part of a 4AT?
ask the patient to state: name age DOB current year
how should delirium be treated?
tackle the precipitants first eg if hypoxic give O2, if blood sugar is low give glucose
medication if all else fails
1st line medication for delirium
haloperidol
how can thiazide diuretics cause delirium?
cause an electrolyte imbalance which can lead to a metabolic cause
haloperidol acts on __ receptors
D2
how would you be able to pick up a change in a patient’s mood?
memory problems
disoriented state
mumbling, slurred speech
confused patient with suspected UTI who is agitated…
delirium
a positive CAM needs…
acute fluctuating change PLUS inattention AND/OR:
disorganised thinking
altered level of consciousness
how should haloperidol be given?
PO
starting dose of haloperidol?
0.25-5mg
when would you give quetiapine for delirium?
if the patient has parkinsons/lewy body dementia
what drug should be given to someone in delirium who is undergoing alcohol withdrawal?
benzodiazepines eg lorazepam
when should you give benzodiazepines for delirium?
alcohol withdrawal
seizures
