Delirium Flashcards
SIGN definition of delirium?
Delirium is an acute deterioration in mental functioning arising over hours or days that is triggered mainly by acute medical illness, surgery, trauma or drugs.
List some risk factors for delirium? (9)
increasing age (as you get older less needs to happen to cause delirium) pre-existing cognitive impairment post-operative sensory impairment (makes orientation worse) previous episode of delirium drug/ alcohol dependence depression multiple co-morbidities ICU admission
List some common causes of delirium?
D- drugs E- electrolyte disturbance L- lack of drugs e.g. withdrawal I- Infection R- reduced sensory input I- intracranial U- urinary retention M- metabolic
What are most common drugs that can precipitate delirium?
Benzodiazepines, narcotics, anticholinergics
Onset of delirium is ____ and the course is ______
acute
transient and fluctuating
Delirium can last _________
days to months depending on underlying cause
Some signs and symptoms of delirium?
acute onset lucid intervals altered consciousness inattention and impaired memory emotional disturbance sleep cycle reversal insomnia disturbing dreams and nightmares disorientation hallucinations and illusions
Contrast hallucinations in delirium vs in psychiatric conditions such as schizophrenia?
in delirium hallucinations tend to visual vs other psychiatric disorders where hallucinations are more commonly auditory
Explain the two different types of delirium? Which is easier to diagnose?
Hyperactive- agitated, aggressive, wandering, easy to diagnose
Hypoactive- withdrawn, apathetic, sleepy, coma, harder to diagnose
Which type of delirium has the higher mortality rate?
hypoactive
Describe who screening should be done in for delirium?
All patients over 65 should be screened on admission to hospital
even if showing no symptoms the test then provides a baseline incase they develop delirium
Should consider screening when reviewing unwell patients on the ward
In tayside what tool is used to screen for delirium?
4AT score
ALERTNESS
AMT4 (ask patient age, dob, place, year)
ATTENTION (can they say months of year backwards)
ACUTE CHANGE OR FLUCTUATING COURSE
Describe tests and investigations to identify delirium precipitants?
THINK DELIRIUM TIME BUNDLE
- history and physical exam (neuro exam important)
- NEWS- think sepsis
- blood glucose
- medication review
- pain review
- assess for urinary retention and constipation
- assess hydration and fluid balance
- bloods- fbc, u and e, Ca, LFTs, CRP, Mg, glucose
- symptoms and signs of infection
- ECG
- imaging depends on findings
Overview of management of delirium?
treat cause manage environment and provide support prescribe review frequently and follow up may new AWI act or mental health act
Explain management of environment and providing support in treatment of delirium?
educate staff
reality orientation: communicate, clock, calendar in room
correct sensory impairments: glasses and hearing aids
bright side room with unnecessary noise reduced, “unsafe” objects removed
ensure basic needs are met
