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Integrative Care > Delirium > Flashcards

Delirium Flashcards

1
Q

What is delirium?

A

An acute and fluctuating disturbance in level of consciousness, attention and cognition, with associated behavioural changes.

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2
Q

How quick is the typical onset time for delirium?

A

Hours to days

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3
Q

What cognitive impairments are seen with delirium?

A 
Worsened concentration 
Slow responses 
Confusion 
Disorientation
Marked memory deficit
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4
Q

What perceptual impairments are seen with delirium?

A

Visual or auditory hallucinations (usually visual).

Range from distortions to hallucinations - often transient and fragmented and may not remember them by morning. Content can be related to trauma in early life.

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5
Q

What physical function problems are seen with delirium?

A 
Reduced mobility
Restlessness
Agitation 
Change in appetite 
Sleep disturbance 
Speech disorders - slurring, chaotic
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6
Q

What social changes are seen in delirium?

A

Lack of cooperation with reasonable requests
Withdrawal
Altered mood
Altered personality

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7
Q

Do symptoms tend to be worse during day or night?

A

Night

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8
Q

Do patients with delirium have insight?

A

No

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9
Q

What are the types of delirium?

A

Hyperactive - restlessness, mood lability, agitation or aggression
Hypoactive - slow and withdrawn
Mixed

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10
Q

What are the causes of delirium?

A

Think delirium

Trauma (including post surgery)
Hypoxia - respiratory or cardiac failure 
Increasing age
NOF fracture 
SmoKer or alcohol withdrawal 
Drugs or drug withdrawal 
Environment changes - ward moves 
Lack of sleep 
Imbalances in electrolytes 
Retention 
Infections e.g pneumonia, uti, wounds, IV lines 
Uncontrolled pain 
Medical conditions e.g stroke, MI
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11
Q

What are some differentials?

A 
Dementia
Alcohol withdrawal
Mania
Post ictal 
Anxiety 
Psychosis
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12
Q

What drugs can cause delirium

A 
Anticholinergics 
Antiemetics
Antipsychotics 
Corticosteroids 
Digoxin
Levodopa
TCAs
Opioids
Alcohol
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13
Q

What features are diagnostic according to the CAM (confusion assessment method) tool?

A

Acute change in cognition which fluctuates during the day
Inattention
Disturbance of consciousness
Disorganised thinking

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14
Q

When diagnosing delirium what parts of the history taking process are especially important?

A

Collateral history - determine if changes are recent and establish normal function
Drug history including alcohol
MMSE - likely showing elicits in attention

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15
Q

During examination, what in particular should be looked for?

A

Sites of infection

Focal neurological signs - suggesting a structural CNS disorder

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16
Q

How should delirium be managed?

A

Treat underlying cause e.g if infection, treat that
Medication review and discontinue unnecessary agents
Avoid moving people to different ward
Talk to patient to reorientate them
Continuity of care
Introduce stimulating activities
Good fluid and nutrition intake
Monitor bowel habit
Encourage mobilisation after surgery
Address any sensory impairments e.g ensure hearing aids present
Promote good sleep pattern and sleep hygiene

Agitation can be managed with haloperidol or lorazepam but should be avoided as can worsen or prolong delirium

17
Q

Delirium affects what percentage of inpatients over 65?

A

50%

Associated with longer admission, more complications and higher mortality

18
Q

What is the leading risk factor for delirium?

A

Dementia

Delirium itself confers a greater risk of subsequently developing dementia

19
Q

Alcohol withdrawal can cause delirium, what factors may point towards this?

A

Patient history of alcohol abuse
2 to 5 days post admission
Raised LFTs
Increased MCV

20
Q

What metabolic changes can cause delirium?

A 
Uraemia 
Liver failure
High or low glucose level
Low Hb
Malnutrition - B12 deficiency, thiamine
21
Q

What tests should be done?

A 
Look for cause - uti, pneumonia, MI
FBC
LFTs
U&E
Blood glucose
ABG
Septic screen - urine dipstick, CXR, blood cultures

Integrative Care (11 decks)

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