Delirium

Question 1

define delirium

Answer 1

acute deterioration in mental functioning over hours, triggered by acute illness, trauma or drugs

Question 2

list some risk factors for delirium

Answer 2

elderly 
pre-existing cognitive impairment 
history of delirium 
sensory impairment 
use of anaesthesia in surgery 
drug/alcohol dependence 
depression
polypharmacy

Question 3

list some causes of delirium

Answer 3

infection
fractures 
hospital admission 
dehydration/poor nutrition 
constipation 
fluid overload 
urinary retention

Question 4

what are the clinical features of delirium

Answer 4

acute onset
fluctuating course - dementia is progressively worse
altered conscious level - hypo or hyper active
inattention
disorganised thinking - confusion
none of these features are explained by another condition

Question 5

describe hyperactive delirium

Answer 5

agitated
aggressive
wandering
easy to diagnose

Question 6

describe hypoactive delirium

Answer 6

sleepy
not eating much
easy to miss, twice the mortality

Question 7

what screening tool is used to assess a patient for potential cognitive impairment

Answer 7

4AT

Question 8

describe the components of the 4AT

Answer 8

alertness - are they awake, sleepy, very abnormal
AMT - can they state age, dob, place, current year
attention - state the months of the year backwards
acute change/fluctuating - significant change

Question 9

a 4AT score of what is potentially suggestive of delirium

Answer 9

4 or more

Question 10

describe a TIME bundle

Answer 10

T - think of triggers
I - investigate and intervene
M - management
E - engage and help family

Question 11

list some potential investigations for delirium

Answer 11

history + collateral history 
neuro exam 
basic obs and NEWS 
blood glucose 
medication review 
baseline bloods inc CRP, calcium, B12, folate 
ECG
bladder scan

Question 12

outline the non-pharmacological management of delirium

Answer 12

optimise chronic disease management
correct sensory input with glasses and hearing aids
food and fluids charts
bowel charts to prevent constipation
reorientate patient with clock and buzzer

Question 13

when is pharmacological management of delirium indicated

Answer 13

when non-pharmacological management has failed to control symptoms
the patient is unsafe to themselves or others

Question 14

outline the pharmacological management for delirium

Answer 14

1st line is 500mcg haloperidol orally

2nd line is benzodiazepines or in a patient with history of Lewy Body dementia or Parkinson’s disease