Delirium

Question 1

What is it

Answer 1

acute, fluctuating syndrome of inattention, impaired level of consciousness, and disturbed cognition

Question 2

What are main types of delirium?

Answer 2

1. hyperactive - agitation, delusions, hallucinations, wandering, aggression
2. hypoactive - much easier to miss, can be confused w depression, lethargy, slowness w everyday tasks, XS sleeping, inattention

Question 3

What are the causes ?

Answer 3

Constipation
Hypoxia
Infection (e.g. UTI)
Metabolic disturbance
Pain
Sleeplessness
Prescriptions
Hypothermia/pyrexia
Organ dysfunction (hepatic/renal)
Nutrition 
Environmental changes
Drugs (OTC, illicit, recreational, pets, alcohol and smoking)

Question 4

What is part of a confusion screen?

Answer 4

1. EWS
2. CT head
3. Lab Ix
4. CXR
5. Blood cultures

Question 5

What is non-medical management ?

Answer 5

• Consistent nursing and med team
• Gentle reorientation
• Calm and consistent care
• Clear and concise communication
• Enable pt to do what they can for themselves - independent washing, dressing, eating, toileting and other activities may still be possible

Environmental adaptation
→ Access to clock
→ Familiarity of objects where poss
→ Control level of noise and aim for side room
→ Ensure lighting is adequate and temp is ambient

Question 6

What is medical management?

Answer 6

1. Haloperidol or olanzapine
2. Benzos (lorezepam) second line
3. Quetiapine in parkinsons