Delirium Flashcards
What is delirium?
Acute onset, fluctuating cognitive impairment and behavioural abnormalities, usually seen in hospital patients in response to brain insults.
Sleep cycle disturbed
What are the causes of delirium?
Infection Metabolic Intracranial Endocrine Substance Misuse/Withdrawal Pain Sensory Disturbance Urinary isses Hypoxia
What are infective causes of delirium?
UTI Chest Infection Wound abscess Cellulitis IE Meningitis
What are metabolic causes of delirium?
Anaemia Electrolytes (Ca, Na, K, Mg, Ph) Hepatic encephalopathy Uraemia Cardiac failure Hypothermia Acidosos/alkalosis Thiamine
What are intracranial causes of delirium?
CVA Head Injury Primary or met tumour Postictal Raised ICP Encephalitis
Endocrine causes of delirium?
Pituitary
Thyroid
Parathyroid
Adrenal Disease (DM, hypoglycaemia, vit deficiencies)
Substance causes of delirium
Alcohol Lithium Benzos Diuretics Antihypertensives Anticonvulsants Digoxin Steroids NSAIDs Heavy metals
What are the urinary causes of delirium?
AKI
Dehydration
Constipation
Urinary Retention
What are the 3 presentations of Delirium?
Hyperactive (96% cases)
Hypoactive
Mixed
What is hyperactive delirium?
Increased arousal
Psychomotor agitation
Delusions
Inappropriate behaviour
What is hypoactive delium?
Lethargy
Psychomotor retardation
(tends to be missed!)
What is important to consider on a ward setting?
Potential weapons
What are cognitive symptoms of delirium?
Cant direct or sustain attention Disorientated Impaired recent memory Perceptual distortions, illusions Hallucunations (LILLYPUTIAN- visual small animals) Poorly developed paranoid delusions Emotionally labile
Behavioural symptoms of delirium?
Sleep disturbance
INcreased arousal
Rambling incoherent speech
How do you go about treating delirium?
Identify cause and treat
Environmentally supportive including:
Isolation
Educate carers
Safety for them and everyone else
Noise- keep quiet
Mobilise patient often
Well lit
Correct any sensory impairment ie hearing aids and glasses ON
As few staff as possible to avoid confusion and clear communication
-AVoid sedation where possible- then use minimal dose once HALOPERIDOL oral or IV LORAZEPAM
