Elderly- Delirium Flashcards
What is Delirium?
An acute and fluctuating disturbance in level of consciousness, attention and global cognition.
What is required with delirium to prevent brain damage?
Prompt treatment
What are the main features of delirium?
Acute onset and fluctuant
Disturbed consciousness
Change in cognition-
How is cognition disturbed with delirium?
It can be
• Hypoactive
• Hyperactive
• Mixed
What changes in cognition can be seen with delirium?
- Memory
- Perceptual
- Language
- Illusions
- Hallucinations
What are other common features seen with delirium?
- Disturbance of sleep wake cycle
- Disturbed psychomotor behaviour –Affects physical function
- Emotional disturbance
What are the psychiatric symptoms of delirium?
- Disorientation (time/place/person);
- Inattention;
- illusions/hallucinations;
- Altered personality;
- Mood disorders;
How do delirium symptoms present?
Fluctuate over the course of the day and tend to be worse at night.
What are possible CNS causes of delirium?
- Stroke
- Abscess
- Tumour
- Subdural haematoma
What are some drug or withdrawal causes of delirium?
- Anticholinergics
- Antiemetics
- Antipsychotics
- Alcohol
What are some endocrine causes of delirium?
- Hyperparatyroidism
* hyper/hypothyroidism
What infections can cause delirium?
- Encephalitis
- Meningitis
- Pneumonia
- Sepsis
- UTI
What are other possible causes of delirium?
- Sleep depravation
- Constipation/Urinary retention
- Dehydration
What is done as soon as someone starts to present with delirium?
4AT
Why would you do a collateral history on someone presenting with Delirium?
To determine if the changes in mental status are recent and the patients normal level of functioning.
What is done to diagnose delirium?
CAM-Confusion Assessment Method (CAM)
Which features does CAM state are diagnostic?
- Acute change in cognition which fluctuates during the day;
- Inattention;
- Disturbance of consciousness;
- Disorganised thinking.
What else should be done when a patient presents with delirium?
Drug history and alcohol history
A mini-mental state examination- deficits in attention
Examined for potential signs of infection
What is the difference in onset between delirium and dementia?
Delirium has sudden onset and fluctuating course over days – weeks
Dementia has a • Gradual onset, slowly progressive over months – years
How is consciousness impacted in delirium vs dementia?
In delirium, there is Variation in level of consciousness
In dementia, consciousness is unimpaired
How is attention affected in delirium vs dementia?
In delirium, there is impaired attention
In dementia, attention is preserved
What type of changes do you tend to see with delirium?
Psychomotor changes
What is the first step in the management of delirium?
Treat the underlying cause or removing aggravating drugs
What is the environmental management of delirium?
Nurse patients in a quiet and well-lit room.
Minimise sensory deficits
Why is it important to discharge a patient ASAP?
What medical management can be used for agitation?
- Haloperidol (0.5-1.0mg PO)
* Lorazepam (0.5-1.0mg PO)
Why should you avoid giving medical management for agitation?
It may worsen or prolong the delirium
What is 4AT?
screening instrument designed for rapid initial assessment of delirium and cognitive impairment.
