LEC 4: Delirium Flashcards
1
Q
What is delirium?
A
- A state of ACUTE mental confusion
- Patient’s have trouble remembering, happens quickly in a short amount of time
- Can last up to 4 to 6 weeks
- Preventable in 30 to 40% if cases - Medical emergency
- If you don’t treat the cause, the patient may die - Frequent in older adults
- Can occur in patients who have dementia
*Delirium is NOT dementia; the symptoms come on quickly and can be cured
2
Q
What is delirium associated with?
A
Is associated with:
- Higher rates of death
- Loss of functioning
- Longer hospitalization
3
Q
What causes delirium?
A
- Not completely understood
- Inflammation, hypoxia (lack of oxygen), chronic stress, neurotransmitter imbalance
- Interaction between patient’s underlying condition and a precipitating event
*Is a combination between patient’s condition and precipitation event
4
Q
What are the main causes of delirium?
A
- I WATCH DEATH
- Infections
- Withdrawals
- Acute metabolic
- Toxins, drugs
- CNS pathology
- Hypoxia
- Deficiencies
- Endocrine
- Acute vascular
- Trauma
- Heavy metals
5
Q
What are risk factors for delirium?
A
- > 65: Polypharmacy
- Male gender: Neurological disease
- Cognitive impairment: Surgery (esp. ortho and cardiac)
- Substance abuse: Environmental issues- ICU admission, restraints, catheter, pain, stress, sleep deprivation
- Coexisting medical conditons
- Functional disability
6
Q
What are core features of delirium?
A
- Disturbance of consciousness
- Cannot focus on the situation, easily distracted - Change in cognition
- Disorientated, don’t remember that they had surgery
- Memory deficit short term, may have hallucinations, miss perceptions - Develops over short period of time and fluctuates
- Will have period of clarity or as severe, gets undiagnosed or missed diagnosed
- Typically up all night and sleep all day
*Need to know the patient’s baseline
7
Q
What are the three types of delirium?
A
- Hyperactive
- Very active and loud - Hypoactive
- Goes miss diagnosed very often
- Sleepy, drowsy, not doing anything - Mixed
- Features of both at alternating times
8
Q
Diagnostic Exams
A
- Behavioural observation
- What are they doing, how are they acting
- Looking at level of consciousness
- Mini mental assessment - Results of mental status exam
- Confusion assessment method; if yes to any question, may have delirium
- Is there an acute change in mental status with fluctuating course?
- Is there inattention?
- Is there disorganized thinking?
- Is there altered LOC?
9
Q
What are other investigations you want to do for delirium?
A
- Key to find out the cause, then we can treat it
- Looking for other methods to test
- CBC, electrolytes, liver function tests
- Blood cultures
- Oxygen saturation/ arterial blood gases (ABGs)
- Urinalysis
- Chest X-ray
- ECG
10
Q
General Measures for Delirium
A
- Treat underlaying cause
- Attempt to prevent common complications
- Alleviate patient distress
- Maintain and improve functional abilities
- Referral to geriatric specialists
11
Q
Physiological Support for Delirium
A
- Treat infection
- Establish/ maintain normal
- Fluid and electrolyte balance
- Nutrition
- Elimination patterns
- Vital signs
- Regular toileting
- Avoid catheters
12
Q
Mobility and Functions for Delirium
A
- Maintain self-care abilities
- Want patient to be mobile, want them to maintain their strength and don’t want them to lose it while they are in our care - Allow free movment
- Least restraints (don’t use if at all possible), do not have an IV line or catheter makes them more mobile
13
Q
Safety for Delirium
A
- Prevent harm
- Want to prevent them from causing you harm, other patient harm, and themselves - Modify environment
- Area around them is clean and free of cluter
- Move them close to the nursing station
- Wear any yellow vest/ bands
- Lowest bed position
- Give them something familiar
- Minimize lines or attachments
14
Q
Communication with Patient’s who have Delirium
A
- Speak slowly, clearly, simple repeated instructions
- Short phrases - Discuss topics that are familiar
- Distractions; easily carry a conversation - Frequent orientation
- Always introduce yourself and where they are - Avoid rapid movements
- Explain what you are doing in simple terms
- Slow movements
- Keep their hands and legs in sights; always be aware of your surroundings
*May need to assess yourself; if your to frustrated may want to ask to look after another patient
15
Q
Behavioural Management for Delirium
A
- Convey warmth, respect, calmness
- Acknowledge emotions
- Present one stimulus at a time
- Look for agitation triggers
- Avoid confrontations
