Module 4 - Delirium Flashcards
What is delirium?
An acute state of confusion.
Occurs in all age groups but most common in older people. Can involve visual and auditory hallucinations.
How would you assess delirium?
Delirium Screen for Older Adults: Confusion Assessment Method (CAM).
What are some common investigations to determine delirium?
- Urinalysis and midstream urine (MSU) test (if urinalysis abnormal)
- Blood tests (urea, electrolytes, glucose, calcium, liver function tests, cardiac enzymes, B12, folate, thyroid function)
- Chest X-ray
- Electrocardiogram (ECG)
What are the risk factors for delirium?
- Demographics: 65 year old’s and over.
- Prior episode of delirium.
- Infection (i.e. UTI)
- Pain Dehydration - older adults have decrease sensation of thirst.
- Malnutrition
- Constipation
- Cognitive status : Dementia or depression.
- Co-morbidities
- Sensory impairment - visual or hearing.
- Surgery
- Medication - polypharmacy.
- Substance Use
- Hospital related environment (under or over stimulating).
- Admission to ICU.
What are the two types of delirium?
Hypoactive and Hyperactive.
What are the signs and symptoms of Hypoactive delirium?
- decreased physical activity
- withdrawal
- lethargy
- decreased speed and amount of speech
- staring
- listlessness
- drowsiness
- reduced awareness of surroundings.
What are the signs and symptoms of Hyperactive delirium?
- Increased physical activity
- Hallucinations
- Delusions
- Agitation
- Rambling Speech
- _Hyper-_arousal
- _Hyper-_alertness
- Restlessness
Can a person present with a mixed range of delirium?
YES
What is the onset of delirium?
Sudden. Over hours or days.
What is the course of delirium?
Short and fluctuating.
Often worse at night or on waking.
Is delirium reversible?
YES
Can there be residual affects of delirium?
YES.
Older persons can be affected for months after delirium is resolved.
What are some nursing interventions when treating delirium?
- Introduce yourself to the person and address them by name.
- Provide physical and verbal orientation cues (ie clock),
- Regularly assess and treat pain
- Collaboration with multidisciplinary team
- Support and educate family and friends in regards to delirium.
- Manage surrounding (Light and noise levels)
- Remove hazards and clutter to reduce falls risk.
- Ensuring has glasses or hearing aids within reach.
- Document appropriately.
- Ensure mobility aids are nearby (Walking frame).
- Assisting with eating and drinking; check swallowing and chewing.
- Minimise room and bed transfers.
THE CONSEQUENCES OF DELIRIUM
Older people who experience delirium are more likely to.. .List 3 things that could happen as a result of experiencing delirium as a older person.
- Stay in hospital longer
- Have more complications such as pressure injuries and falls.
- More likely to be admitted into permanent care
What are the 5 Ps of Delirium?
PEE - urinary tract infections, dehydration (leading to a low urinary output), urinary retention, indwelling catheter insertion can all cause delirium
POO - constipation and diarrhoea can both cause the onset of delirium
PUS - infection of any kind in the body can contribute to the onset of delirium
PAIN - unidentified or unmanaged pain can cause delirium
PILLS - interactions and adverse effects of medications can bring on delirium
What history needs to be obtained to diagnose delirium?
- Full head to toe assessment including vital observations (look for signs of infection, bladder and bowel function, dehydration)
- Cognitive screening
- Identify any recent changes to medication
- Identify any co-morbidities (such as dementia or stroke) and if the person has experienced an episode of delirium before
All of this information can be obtained from family members/friends, medical records from previous admissions, gentle consultation with the person with delirium, their general practitioner and/or other health care professionals.
What are the 4 features mentioned on the Confusion Assessment Method (CAM) assessment?
FEATURE 1: Acute Onset and Fluctuating Course
FEATURE 2: Inattention
FEATURE 3: Disorganised thinking
FEATURE 4: Altered Level of Consciousness
What is the Delirium Clinical Care Standard?
Produced by the Australian Commission on Safety and Quality in Health Care. It provides guidance to consumers, clinicians and health services on delivering appropriate care to people at risk of, or with, delirium.
How is delirium treated?
- Medication review by MO or pharmacist
- Identifying signs of infection and treating accordingly (antibiotics).
- Regular assessment and management of pain - Referral to acute Pain Service if appropriate.
- Assessment of hydration status - re-hydration plan with MO and/or dietician.
- Monitoring of bowel and bladder output.
- Managing metabolic disturbances ( hypoglycaemia, hypoxia).
