Delirium Flashcards
what is delirium
acute confusional state caused by illness or trauma
an acute disturbance in attention/ change in cognition
develops over a short period
what are some symptoms of delirium
change in mood change in alertness agitation drowsiness hallucinations delusions
who are at increased risk of delirium
those with demetia
the elderly
those with hearing/sight impairment
key differences between delirium and dementia
dementia is slow and insidious
delirium is sudden (hours, days)
what are the 2 presentations of delirium
hyperactive
hypoactive
how does hyperactive delirium present
patient agitates, aggressive, wandering
how does hypoactive delirium present
lethargic, withdrawn, coma
what are some predisposing factors for delirium (risk factors)
advanced age dementia co-morbidity post-op periods terminal illness sensory impairment (no glasses/hearing aid) polypharmacy depression alcohol dependency malnutrition
what are some precipitating factors for delirium
medications (opiates, anti-cholingerics, sedatives) hypoxia biochemical abnormality alcohol excess dehydration Hospital acquired pneumonia UTI environment catheters infection CVD constipation Urinary retention
what are the 4 hallmarks of delirium
Acute and fluctuating
Inattention
Altered level of consciousness
Disorganised thinking
what is used to diagnose delirium
4AT
- alertness
- AMT4 (age, mother, time, current year act)
- attention
- acute change
what is CAM
confusion assessment method - diagnostic algorithm
what CAM score means the patient has delirium
features 1,2 and either 3 or 4
What are the 4 features in the CAM assessment
feature 1: acute onset and fluctuating course
2: inattention
3: disorganised thinking
4: altered level of consciousness
how do you manage delirium
- call it delirium
- identify and reverse underlying cause
- environmental and supportive factors
- engagement of relatives/carers
- symptom control
- clinic review and follow up
