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Y4 Geriatrics > Week 2 - Delerium > Flashcards

Week 2 - Delerium Flashcards

1
Q

What are the two assessment tools used to assess/diagnose delirium ?

A
  • 4AT
  • CAM (confusion assessment method)
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2
Q

What are some medication side effects that can contribute to delirium ?

A
  • poly pharmacy
  • hyponatraemia
  • constipation
  • drowsiness
  • hypotension
  • dehydration
  • high anticholinergic burden inhibiting the parasympathetic NS
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3
Q

Which patient demographic is not advised to be prescribed anticholinergic medications ?

A

the elderly (65+)

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4
Q

What is ‘anticholinergic burden’ ?

A

the cumulative effect of all drugs a patient is on which possess anticholinergic effects

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5
Q

What scoring system is used to calculate a persons anticholinergic burden risk ?

A

ACB score

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6
Q

What does a high anticholinergic burden (ACB score) but elderly patients at higher risk of ?

A
  • falls
  • delirium/confusion
  • death
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7
Q

What meds can be used in the case of delirium ?

A
  • meds to treat underlying cause
  • wouldn’t use meds to treat the symptoms of delirium unless Pt becomes harm to self or others = sedatives
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8
Q

What is a mneumonic used to list all the risk factors for delirium ?

A

PINCH ME + cognitive decline and previous delirium

Pain
Infection
Nutrition (malnurishment?)
Constipation/urinary retention
Hydration

Meds (psychotropics, analgesics, opioids, anticholinergics…)
Environment (new environment, necessary aids available e.g glasses or hearing aids)

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9
Q

What are some non-pharmacological methods to decrease delirium ?

A
  • orient patient to time and place
  • encourage mobility
  • surround Pt with familiar items
  • promote normal sleep cycle
  • encourage intake of food and fluids
  • provide necessary aids (glasses, frame, hearing aids etc)
  • friends/family visits
  • review med list
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10
Q

What is included in the 4AT assessment ?

A
  • alertness
  • oriented to age, DOB, place, current year
  • attention (list months backwards)
  • acute or fluctuating course (significant change to alertness, cognition or other mental fluctuation over past 2 weeks that is still evident in last 24hrs)
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11
Q

What does each of the 4AT scores suggest ?

A

0 = unlikely to be delirium or sever cognitive impairment

1-3 = possible cognitive impairment

4+ = possible delirium and/or cognitive impairment

highest 4AT score is 12

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12
Q

What are the criteria for a diagnosis of delirium according to the CAM assessment for delirium ?

A
  1. presence of acute confusion with fluctuation

AND

  1. inattention (difficult concentrating)

AND EITHER…

  1. disorganised thinking
    OR
  2. altered level of consciousness (heightened/agitated or drowsy)
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13
Q

Alcohol withdrawal can cause delirium, what should be used to treat alcohol withdrawal ?

A

oral benzodiazepines

e.g chlordiazepoxide

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14
Q

What legal document needs to be completed in a case where a delirious patient requires pharmacological sedation ?

A

DoLS
(Deprivation of Liberty Safeguards)

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15
Q

Name 3 drugs that can be used to sedate delirious patients (only when absolutely necessary)…

A
  • haloperidol
  • risperidone
  • lorazepam
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16
Q

What is the criteria for an assessment of mental capacity ?

A
  1. is there impairment/disturbance of mind or brain ?
  2. Pt lacks capacity if answer to Q1 was yes and they’re unable to do 1+ of the following:
    - understand relevant info
    - retain that info
    - weigh up pros and cons
    - communicate decision
17
Q

What causes delirium ?

A

the interaction between a vulnerable patient (elderly, frail, dementia, sensory impairment) and inflammatory stimulus (infection, surgery, drugs, dehydration)

18
Q

Which wards do you see the most incidence of delirium on ?

A
  • geriatric
  • orthopaedic (post surgery)
  • ITU
19
Q

What % of surgical patients are affected by delirium ?

A

50%

20
Q

What are some adverse outcomes associated with delirium ?

A
  • increased length of hospital stay
  • increased risk of falls
  • increased risk of functional decline
  • increased incidence of dementia
  • increased risk of institutionalisation
  • increased mortality
21
Q

What are the three subtypes of delirium ?

A
  • hyperactive delirium (aggressive, restless, insomnia, heightened state of arousal)
  • hypoactive delirium (drowsy, withdrawn, somnolence)
  • mixed delirium (fluctuates between the two types above)
22
Q

which type of delirium is least recognised and carries the highest risk of subsequent death ?

A

hypoactive

23
Q

what is the path o physiology of delirium ?

A

unclear - potentially inflammatory changes in brain causes by stressors

24
Q

Why are urine dipsticks not recommended to diagnose UTIs in elderly people?

A

because roughly 50% of older people have harmless bacteria in their urine, and the dipstick cannot differentiate between this bacteria and harmful bacteria

25
Q

What will a urine dipstick be positive for when there are any type of batteria in the urine ?

A

nitrites
leukocyte esterase (WBCs)

26
Q

What are common findings on a urine dip in an elderly patient ?

A
  • protein
  • glucose
  • nitrites
  • WBCs
27
Q

Why is it best not to urine dip an elderly person ?

A

it’s hard to ignore a positive urine dip, but that may not be indicative of infection in the elderly

  • don’t want to put elderly on unnecessary antibiotics as can lead to resistance and C.diff
28
Q

Instead of using a urine dip to diagnose UTI in elderly, what signs and symptoms should you look for ?

A
  • dysuria
  • frequency or urgency
  • new incontinence
  • delirium
  • suprapubic pain
  • haematuria
  • check catheter is draining
29
Q

What are the different types of laxative ?

A
  • bulk forming (retains water in stool to increase faecal mass and start peristalsis)
  • osmotic (draws water into bowels)
  • stimulant (stimulates peristalsis)
  • faecal softeners (increases fractal fluid to pass easier)
30
Q

which medication is given to patients experiencing agitational delirium, after treating the underlying cause and making evnvuronmental changes has failed ?

A

oral haloperidol
(an anyipsychotic)

31
Q

Which conditions/diseases are contraindicated in use of antipsychotics (e.g haloperidol) in elderly patients with hyperactive delirium ?

A

parkinson’s
leah body dementia

32
Q

What is an alternative sedative for patients with hyperactive delirium that also have parkinson’s disease ?

A

oral lorazepam

(instead of haloperidol, because that cna worsen symptoms of parkinson’s)

33
Q

What is one side effect caused by lorazepam in the elderly ?

A

increased risk of falls

34
Q

what is a contraindication of lorazepam ?

A

sleep apnoea

Y4 Geriatrics (6 decks)

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