Delirium Flashcards
Define delirium.
Disturbance in attention
Change in cognition
Develops over a short period
Fluctuates
Who might you need to take a history from?
Family
Friends
GP
Carer
What is delirium associated with?
Increased mortality Longer hospital stay Increased complications Increased costs Long-term disability
What does delirium represent?
An ‘atypical’ presentation of an acute illness
What does delirium increase the risk of for patients?
Longer hospital stay
DEMENTIA
Complications from hospital e.g falls, clots, pressure sores
Death
Onset?
Sudden - hours to days
Course?
Short and fluctuating
Reversible?
Yes
Duration?
Hours to less than months
Activity?
Hyperactive OR hypoactive
Alertness?
Fluctuates
Attention?
Impaired
Mood?
Fluctuating emotions
Thinking?
Disorganised
Perception?
Distorted
What might cause delirium?
Neurotransmitter fault (ACh)
Direct toxic insult (drugs, low O2, low Na, low glucose)
Decreasing stress hormone response
Predisposing factors?
Old Dementia Co-morbidity Post-op (hip fractures) Terminal illness Polypharmacy Depression Alcohol Malnutrition Sensory Impairment
Precipitating factors?
Polypharmacy – strong painkillers, sedatives (e.g benzodiazepines), OPIATES Hypoxia Low glucose or salt Dehydration Alcohol Infection UTI Environmental Catheters (foreign body) Cardio e.g MI Hip fracture Urinary retention Constipation
Hallmarks of delirium?
Acute and fluctuating
Inattention
Altered level of consciousness
Disorganised thinking
What type of delirium is worse and why?
Hypoactive
More difficult to diagnose and higher mortality
What tools are used to diagnose delirium?
4AT and CAM
CAM
1 + 2 + 3/4 Acute and fluctuating Inattention Altered level of consciousness Disorganised thinking
How is delirium managed?
DIAGNOSE
Find and reverse all causes
Support
Follow up
How could you review a patient?
Redo 4AT to see if score has gone down
The cause of delirium is always…
Multifactorial
Name some environmental support.
Sleep chart Food and fluid chart Mobilise as much as possible Glasses and hearing aids Review Buzzer
When should you sedate a patient?
Only if they are a danger to themselves or others
How is delirium prevented?
Assess bowel and bladder function Early mobilisation Early nutrition Hydration Pain management Sleep enhancement
Name some medications for delirium
Haloperidol
Quitiapine (can use in Parkinson’s)
Benzodiazepines
