delirium W3 Flashcards
what is delirium
syndrome of acute cognitive impairment often precipitated by an insult such as illness or surgery
how many hospital inpatients does delirium affect
25%
features of delirium
acute deterioration - changes over hours to days, fluctuates over time
cognitive impairment
psychiatric disturbance
cognitive impairment features (delirium)
attentional impairment
disorientation to location
short-term and long-term memory loss
psychiatric disturbance features (delirium)
anxiety and agitation (sometimes violent)
visual/auditory hallucinations
delusions
psychomotor patterns of delirium?
hyperactive delirium (agitated, restless, violent)
hypoactive delirium (sedation, lethargy, drowsy)
what is lethargy
state of exhaustion
risk factors for delirium - pre-existing?
frailty
previous delirium
dementia and cognitive impairment
psychiatric disorder
polypharmacy (taking multiple medicines)
alcohol and substance abuse
isolation, social deprivation
acute insults causing delirium?
infection
surgery
hospitalisation/institutionalisation
bowel/bladder
dehydration
medication
sleep deprivation
sensory impairment
delirium and dementia link?
dementia risk factor for delirium
delirium risk factor for dementia
delirium and dementia new baseline?
people with dementia who suffer delirium from an acute insult may struggle to recover fully
delirium clinical assessment - screening tool?
screening tool 4AT - standard of care for older adults admitted to hospital - alertness, orientation, attention span
diagnosis for delirium?
full history and examination
collateral history and baseline function
‘delirium screen’ investigations
medication review
social history
clinical management of delirium - how to prevent?
address risk factors!
intervention for bowel and bladder (delirium risk factor)
assess and treat constipation
avoid urinary catheters
intervention for dehydration (delirium risk factor)
regular assessment and prompting for fluids and food
environmental interventions for delirium prevention?
orientation and cognitive stimulation activities
avoid ward moves
intervention for medications (delirium risk factor)
medication review, stopping or reducing culprit drugs
sleep disturbance intervention (delirium risk factor)
noise reduction (ear plugs)
non-pharmacological sleeping aids
sensory impairment intervention (delirium risk factor)
screen for visual and hearing impairments
adaptive equipment (large text, hearing aids etc)
immediate management of delirium?
standard acute assessment (inc resuscitation)
reassurance
consider safety of patient and staff
emergency detention under mental health act may be necessary to protect patient
treatment of delirium?
comprehensive and systemic assessment of potential precipitating factors
speciality involvement
