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Aging and Complex medicine > Delirium/Acute confusional state > Flashcards

Delirium/Acute confusional state Flashcards

1
Q

By what mechanism can the following contribute to developing delirium

  • dihydrocodeine
  • bendroflumethiazide
  • ferrous sulfate
A

by causing

  • constipation
  • dehydration + low Na
  • constipation
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2
Q

name the 2 tools used to assess delirium

A

4AT

CAM

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3
Q

following an episode of delirium what are patients subsequently more likely to develop?

A

further episodes of delirium
+
dementia

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4
Q

Name 7 features that delirium presentations may include

A
  • disturbed sleep cycle
  • agitation or withdrawn
  • visual hallucinations
  • mood change
  • poor attention
  • disorientation
  • memory disturbances (short>long term)
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5
Q

name the 4 hallmarks for a diagnosis of delirium

A

1) acute onset
2) consciousness disturbed
3) impaired cognition not due to pre-existing dementia
4) clinical evidence of an acute general condition, intoxication or withdrawal

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6
Q

what are the 2 ways in which delirium can present

A

1) HYPERACTIVE DELIRIUM
- restlessness
- agitation
- heightened arousal
- aggression

2) HYPOACTIVE DELIRIUM
- drowsiness
- increased sleeping
- quiet
- withdrawn behaviour

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7
Q

Medications that can cause delirium (4)

A
  • Corticosteroids
  • Drugs with anticholinergic properties
  • (sedative drugs) Benzodiazepines
  • Opioid analgesics
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8
Q

name some causes of delirium

A
  • constipation
  • infection
  • electrolyte imbalance
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9
Q

What criteria does “CAM positive” consist of?

A

1) Acute onset and fluctuating course
2) inattention (counting backwards or decreased attention during review)
3) and either of the following
- disorganised thinking (incoherant disorganised speech)
- altered level of consciousness (hyperalert, hypoalert, or both)

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10
Q

what is the 4AT test?

A

It is a validated tool used to assess a patient for delirium; shortened version of the AMTS

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11
Q

what does AMTS stand for

A

abbreviated mental test score

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12
Q

what do the scores for 4AT equate to?

A
  • more than or equal to 4 = possible delirium with or without cognitive dysfunction
  • 1-3 = possible cognitive impairment
  • 0 = delirium or cognitive impairment unlikely
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13
Q

what are the 4 hallmarks of 4AT?

A

1) Alertness
2) AMT4
3) Attention
4) Acute + fluctuating course

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14
Q

Assess ALERTNESS on 4AT?

A 
normal and fully alert = 0 
clearly abnormal (drowsy or agitated) = 4
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15
Q

Assess AMT4? (4AT)

A

ask the patient the following questions

1) Age?
2) DoB?
3) Current year?
4) Current location?

0 = no mistake 
1 = 1 mistake 
2 = 2 or more mistakes
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16
Q

Assess ATTENTION? (4AT)

A

Ask the patient to name the months backwards starting at December

0 = 7 or more mistakes 
1 = less than 7 correct 
2= untestable/drowsy
17
Q

Assess acute and fluctuating course? (4AT)

A 
Yes = 4 
No = 0
18
Q

4 hallmarks for managing delirium?

A

1) treat underlying course
2) environmental changes
3) pharma measures
4) prevent complications

19
Q

pharmaceutical measures if the patient remains distressed despite conservative measures?

A

Haloperidol
(0.5 mg PO or 1 mg IM)

OR Olanzapine

20
Q

Haloperidol and Olanzapine are contraindicated in which conditions?

A
  • Parkinsonism

- Dementia with Lewy bodies

21
Q

Medication that can be given to patients with Parkinsonism or Lewy body dementia

A

Lorazepam

22
Q

how to treat alcohol withdrawal, as a cause of delirium?

A
  • benzodiazepine

- chlorodiazepoxide

23
Q

List the first line investigations for a patient presenting with delirium

A
  • blood cultures
  • CXR
  • MSU analysis
  • serum Calcium
  • FBC
  • U + E
  • LFTs
  • TFTs
  • ECG
  • Glucose
  • CRP
24
Q

name the 2nd line tests for a patient presenting with delirium

A

CT brain
ABG
cultures of; urine, wounds, sputum, blood, CSF

25
Q

first line management of delirium?

A

reorientation, reassurement, and treating the underlying cause

26
Q

delirium leads to:

A
  • increased risk of pressure ulcers and falls
  • increased incidence of dementia
  • increased rate of admission to long term care
  • longer hospital stays

Aging and Complex medicine (9 decks)

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