Week 4 - Delirium Flashcards
What is delirium? (3)
- acute, short-term change in cognition
- acute confessional state
- MEDICAL EMERGENCY
What percentage of older medical patients experience delirium at some point in hospitalization?
- 30%
What do individuals with delirium experience? (8)
- dulled awareness
- reduced ability to focus
- sustain and shift attention
- memory and judgment impaired
- disorientation
- change in speech
- emotional swings
- restlessness
What is the Confusion assessment method used to assess?
- used to identify delirium
How can you identify a CAM positive?
- if features 1 and 2 and either 3 or 4 are present
What are the 4 features of the CAM?
- Acute onset and fluctuating course
- Inattention
- Disorganized thinking
- Altered level of consciousness
What does feature 1 of CAM assess? (4)
- acute onset and fluctuating course
- usually obtained from a family member or nurse and is shown by positive responses to the following question
- is there evidence of an acute change in mental status from the patient’s baseline?
- did the (abnormal) behaviour fluctuate during the day, that is, tend to come and go, or increase and decrease in severity
What does feature 2 of CAM assess? (3)
- Inattention
- shown by a positive response to the following:
- did the patient have difficulty focusing attention, for example, being easily distracted or having difficulty keeping track of what was being said?
What does feature 3 of CAM assess? (4)
- disorganized thinking
- positive response to:
- was the patient’s thinking disorganized or incoherent, such as rambling or irrelevant conversation?
- unclear of illogical flow of ideas or unpredictable switching from subject to subject?
What does feature 4 of CAM assess? (7)
- altered LOC
- Shown by any answer other than”ALERT” to the following:
Overall, how would you rate this patient’s LOC?
- Alert (normal)
- vigilant (hyper-alert)
- lethargic (drowsy, easily aroused)
- stupor (difficult to arouse)
coma (unarouseable)
Delirium vs Dementia chart!
How can we manage delirium? (3)
- Prevention
- Recognize the condition
- Uncover and treat/correct the underlying conditions
How can we prevent delirium? (2)
- eliminate/avoid factors known to cause or aggravate delirium
- multiple meds, dehydration, immobilizaton, sensory impairment, disruption of sleep-wake cycle
How can we promote prevention of delirium? (6)
- sleep and rest
- fluid intake
- nutrition
- elimination
- pain control
- comfort
How can we treat the CAUSE of delirium? (6 points, 7)
- Infection-antibiotics
- Pain-analgesia
- Sleep-related sedatives
- some meds can have confusion side effects - Dehydration/nutrition/fluids/elctrolytes
- Decreased oxygen
6.may need IV, O2
