Delirium Flashcards

1
Q

What is delirium
What is it characterized by
What are the common causes
What are the consequences of delirium on dementia

A

Acute brain failure

  • Within hours/days and fluctuates
  • impaired attention, awareness
  • cognitive neuropsych issues (decreased Ach or increased D)
GENERALLY MULTIFACTORIAL
Dehydration
Electrolytes
Level of pain
Inflammation, infection
Resp failure
Impacted faeces
Urinary retention
MI/metabolic acidosis

Delirium increases dementia progression

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2
Q

What are the 3 forms of delirium

A

Hyperactive

  • increased confusion
  • hallucinations
  • disturbed sleep
  • less cooperative
  • restless, agitation

Hypoactive

  • decreased concentration
  • decreased awareness
  • decreased movement
  • decreased appetite
  • withdrawn, quiet, sleepy

Mixed, can move between the 2

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3
Q

How would you do the CAM (confusion assessment method)

A
  1. Acute and fluctuating
  2. Inattention
  3. Disorganized thinking
  4. Hypo/hyperalert

1&2 + 3/4

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4
Q

How would you assess if the delirium is acute and fluctuating in the CAM

A

Change from baseline

Collateral Hx (have they been more confused lately over the past few hours/days?)

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5
Q

How would you assess inattention in the CAM

A

Vague, non committant responses
Easily distracted
-months of the year forwards and backwards
-20=>1 counting

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6
Q

How would you assess disorganized thinking in the CAM

A

Misinterpret environment
Hallucinations/persecutory ideas
Mumbling/rambling

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7
Q

How would you do the 4AT assessment method for delirium?

A

Alert (0 or 4)
AMT4 (age, DOB, year, location) (0, 1, 2)
Attention (months backward) (0, 1, 2)
Acute change? (0 or 4)

4+ possible delirium
1-3 possible cognitive impairment
0 unlikely

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8
Q

What parts of the history would you focus more on in a delirious patient

A

Alcohol

Meds

  • Analgesic
  • Anti Ach
  • Sedatives
  • CS
  • D ag
  • Antidepressants

Take a collateral history if possible

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9
Q

What parts of the examination would you focus more on in a delirious patient

A

Presence, causes of delirium
AMT, MMSE cognitive test
Infection/dehydration/sensory impairment/pain

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10
Q

What investigations may you request and why?

A

Target potential causes

  • FBC, U&E, glucose, LFT, TFT, Ca
  • ECG, SaO2, CXR, ABG
  • Drug levels, B12. cortisol
  • Neuroimaging, EEG, lumbar puncture
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11
Q

What are the main characteristics of delirium

  • onset
  • alert
  • attention
  • sleep
  • thinking
  • perception
A

Onset
-sudden

Alert
-fluctuates

Attention
-fluctuates

Sleep
-pattern changes

Thinking
-disorganised

Perception
-hallucinations and delusions

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12
Q

What are the main characteristics of dementia

  • onset
  • alert
  • attention
  • sleep
  • thinking
  • perception
A

Onset
-gradual

Alert
-normal

Attention
-normal

Sleep
-can be disturbed

Thinking

  • Short term memory is poor
  • Can’t find right words

Perception
-normal

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13
Q

what are the main characteristics of depression

  • onset
  • alert
  • attention
  • sleep
  • thinking
  • perception
A

Onset
-gradual

Alert
-normal

Attention
-fluctuates

Sleep
-early morning waking

Thinking
-slow, -ve, hopeless

Perception
-normal

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14
Q

How would you manage delirium environmentally

A

Avoid moving patient around excessively
Natural light, calm, quiet, no uneccasery beeps
Clock, calendar
Decrease falls risk, tidy area

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15
Q

How would you manage delirium as an MDT

A
Address acute causes
Reorientate patients
Safety
Promote normal sleep patterns
Monitor progress, involve patient and family
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16
Q

How would you manage delirium pharmacologically

A

LAST RESORT

  • WHEN V DISTRESSED
  • RISK TO SELF AND OTHERS

Use must be documented with an exit strategy

  • Haloperidol (antipsychotic)
  • Lorazepam if antipsychotic CI
  • Chlordiazepoxide in alcohol withrawal
17
Q

How would you prevent delirium

6 approaches

A
Cognitive reorientation
Sleep schedule
Walking
Vision
Hearing aids
Hydration
18
Q

What is the prognosis for delirium patients

-3 outcomes

A

Persistent delirium
-linked to preexisting dementia

Dementia

  • delirium is a risk factor for dementia
  • needs follow up

Recall

  • v common
  • characterised by
    • strong emotions related to reality/unreality
    • clouded thought process
    • lack of control, halluciantions
    • hard to communicate