Week 5: Delirium Flashcards
What are the main reasons/causes for confusion in older people?
Infection
- Hypoglycaemia
- Side effects of drugs
- Untreated pain
- Dehydration
- Hypoxia
- Anxiety, depression, psychosis
- Delirium
- Underlying pathophysiology: dementia
According to the DELIRIUM pneumonic, what are potential causes for delirium in pts?
Dehydration
Electrolyte imbalance – emotional stress
Lung, liver, heart, kidney, brain disorders
Infection, especially UTI, pneumonia, sepsis
Rx* drugs
Immobility
Untreated pain, unfamiliar environment
Metabolic disorders
What are the 4 features related to delirium according to the CAM assessment?
What signifies a positive CAM assessment?
- Acute onset and fluctuating course
- Inattention
3.Disorganized thinking - Altered level of consciousness
-1st and 2nd feature with either 3rd or 4th
What negative consequences are related to untreated delirium?
-Mortality, prolonged length of stay, reduced functional + cognitive recovery, increased need for LTC after discharge
What are potential risk factors for delirium?
-Age, medications, post-op, sleep deprivation, ventilation, end of life, pre-existing cognitive impairment, comorbid conditions, impaired sensory, infection, pain, dehydration, electrolyte disturbances, depression
Define hypoactive delirium:
characterized by reduced motor activity, decreased consciousness, sleepy, unaware of surroundings, staring into space
Define hyperactive delirium:
characterized by increased motor activity, pt is restless, agitated and possibly aggressive, increased wandering, hyper alertness, hallucinations and delusions and inappropriate behaviour
Which populations are at high risk for delayed delirium diagnoses?
Homeless population, indigenous communities, racial and ethnic minorities
Aside from the CAM features, what are other S&S of delirium?
poor executive functioning
* disorientation
* anxiety
* agitation/irritability
* poor recall
* delusional thinking
Visual hallucinations
- Compared with dementia, which signs are unique to delirium? Select all that apply.
a. Irritability
b. Incoherent speech
c. Visual hallucinations
d. Long-term memory loss
e. A slow decline in cognition
f. Changing levels of consciousness
A, B, C, F
Describe the physical changes you should make to the environment of a pt with delirium to promote safety
-Ensure proper lighting but not too bright-reduce unnecessary stimuli (radio, tv)
-Write date and location on whiteboard
-Clear room of unnecessary clutter
-Provide familiar objects such as pictures of family
-Reorient to healthcare staff at each interaction
-Bed in low position, call bell in reach, max 2 side rails
What interventions can you use to promote orientation? Select all that apply.
a.Place the television on a news channel
b.Refrain from administering pain medications
c.Have him wear his hearing aid and eyeglasses
d.Orient M.M. of person, place, and time, as needed
e.Encourage his family to “go along” with his hallucinations
f.Reintroduce him to health care providers with each contact
C, D, F
Which tasks are appropriate to assign to the UAP?
Select all that apply.
a. Keeping the call light within M.M.’s reach
b.Ambulating M.M. to the chair and bathroom
c.Assisting M.M. with performing oral hygiene
d.Emptying the two Jackson-Pratt drains each shift
e.Obtaining routine vital signs and M.M.’s daily weight
A,B,C,E
