Delirium Flashcards
what are the three defining features of delirium?
(1) disturbance in attention
(2) change in cognition (memory deficit, disorientation, language disturbance, perceptual disturbance)
(3) develops over short period and fluctuates during day
what is the disturbance caused by?
direct physiologic consequence of a general medical condition, an intoxicating substance, medication use or more than one cause
does having dementia increase risk of developing delirium?
yes
and vice versa
for dementia, what is the following:
a) onset
b) course
c) duration
d) activity
e) alertness
f) attention
g) mood
h) thinking
i) perception
a) slow, insidious
b) progressive, not reversible
c) months to years
d) wandering, agitated
e) generally normal
f) generally normal
g) low mood may be present
h) word finding difficulties
i) usually normal in early stages
for delirium, what is the following:
a) onset
b) course
c) duration
d) activity
e) alertness
f) attention
g) mood
h) thinking
i) perception
a) sudden
b) short, fluctuating
c) hours to less than a month
d) agitation and restless (hyperactive) / sleepy and slow (hypoactive)
e) fluctuates
f) impaired
g) fluctuating emotions
h) disorganised
i) distorted
for depression, what is the following:
a) onset
b) course
c) duration
d) activity
e) alertness
f) attention
g) mood
h) thinking
i) perception
a) abrupt
b) worse morning
c) at least 2 weeks
d) withdrawn
e) normal
f) normal
g) depressed (lack of interest)
h) slow
i) usually intact but delusion in severe cases
what is the pathophysiology of delirium thought to be?
variable derangement of ACh
what toxic insults to brain contribute to delirium?
drugs
hypoxia
low sodium
low glucose
what aberrant stress responses contribute to delirium?
cortisol
prostaglandins
cytokine release
serum cholinesterase activity
what are risk factors for delirium?
advanced age dementia co-morbidity post op period terminal illness sensory impairment polypharmacy (eg opiates and anti-cholinergic) depression alcohol dependency malnutrition
what scoring systems are used to diagnose delirium?
4AT and CAM
what 4AT score suggests delirium?
4 = high suspicion 1-3 = cognitive impairment
what are the two subtypes of delirium?
hyperactive = agitated, aggressive, wandering
hypoactive = withdrawn, apathetic, sleepy, coma
how is delirium managed?
identify and treat underlying cause
environmental and supportive factors
symptom control
rarely medication
what environmental measures can you take to make patient with delirium more comfortable?
quiet and calm environment low night lighting visible clocks and calendars familiar people put bed low with no rails sleep pattern glasses and hearing aids ensure adequate diet listen to patient reduce background noise
