Delirium Flashcards
what are the symptoms of delirium
impairment of consciousness - cloudiness, drowsiness, sopor (abnormally deep sleep), coma
disturbance of cognition- disorientation, impaired memory attention and thinking, perceptual disturbance- hallucinations and illusions (commonly visual)
psychomotor (hyperalert/active- agitated, disorientated, hallucinations, delusions, sometimes aggressive or hypoalter/active- confusion sedation or mixed)
disturbance of sleep-wake cycle- insomnia, sleep loss, reversal of sleep cycle, nocturnal worsening of symptoms- sundowning, disturbing dreams and nightmares
emotional disturbances- anxiety, fear, irritability, euphoria, apathy, perplexity, aggression
what is the onset and course of delirium like
rapid onset
fluctuates
lasts days to months depending on cause
what can cause delirium
anything
more likely to get it if older/ more ill
what drugs can cause delirium
anticholinergic agents anticonvulsants antiparkinsonian drugs steroids cimetidine (H2 antagonist) opiates sedatives alcohol illicit drugs
withdrawal from what commonly causes delirium
alcohol
sedatives (benzos)
barbiturates
illicit drugs
what seizures condition can cause delirium
epilepsy
does delirium have to have an identifiable cause to be diagnosed
no
sudden onset of confused state= what until proven otherwise
delirium
what are the risk factors for delirium
old age cognitive deficit- dementia existing sensory deficit- deafness/ blindness previous episode preoperative extremes in sensory experience (hypo/hyperthermia) immobility social isolation new environment stress
what investigations into delirium
history and full exam
4AT screening test
Ix for cause: urinalysis, bloods, TFT, LFTs, CRPs, B12 and folate, CXR, MRI/CT brain
what is the management for delirium
identify and treat cause - sedation may be necessary to allow exams and investigations
begin treatment ASAP
manage environment and provide support- educate staff, reality orientate (communication, clock, calendar), correct sensory impairments, bright sideroom, reduce unnecessary noise, remove unsafe objects, ensure basic needs met, reassure patient- will be frightened
prescribe- benzos for alcohol withdrawal, antipsychotics (haloperidol 1-10mg)- will not treat delirium but can help if agitated or distressed
review frequently (can improve/worsen quickly - suffer seiures, injuries, sudden death)
repeat cognitive assessment to avoid misdiagnosis of dementia
why should you be careful about sedation in delirium
can worse it by increasing confusion and unsteadiness
if patient scared reassure instead of prescribe
how can you manage the environment for a patient with delirium
quiet side room constant orientation- clock, calendar encourage minimal staff changes well lit remove unnecessary equipment meet basic needs
what drugs to treat distress in delirium
haloperidol 0.5-5 mg orally than IM, up to 10mg in 24 hours
lorazepam (NOT DIAZEPAM) 0.5-2mg up to 2x in 24 hours for parkinsons, lewy body dementia, neuroleptic sensitivity
what is the prognosis of delirium
1-4 weeks, longer in elderly
minority can become chronic
