Confusion Flashcards
How do you rapidly test for delirium?
4AT 1 - alertness 2 - AMT4 (age, DOB, place, current yr) 3 - attention 4 - acute change or fluctuating course
What are the symptoms of delirium?
- Impairment of consciousness
- Fluctuation of symptoms: worse at night, periods of normality
- Abnormal perceptions (illusions and hallucinations)
- Agitation, fear
- Delusions
What would you review for a patient with delirium?
- Review observation chart
- Review medications
- Stool chart
- Fluid balance
- Food record chart
What are the causes if delirium?
PINCHME • Pain • Infection • Nutrition • Constipation (+/- urinary retention) • Hydration • Medication • Environment
What is an anticholinergic burden?
Cumulative effect of taking 1+ medications with anticholinergic activity -> strong predictor of cognitive and physical impairment
What are the SE of anticholinergic medications?
o Urinary retention
o Drowsiness
o Dry mouth
o Constipation
What drugs contribute to the anticholinergic burden?
o Promethazine o Furosemide o Codeine/opiates o Amitriptyline o Ramipril o Atenolol
What is the non-pharmacological management of delirium?
- Reassurance
- Re-orientate patient
- Encourage mobility
- Have familiar items from patient’s home in their room
- Promote normal sleep-wake cycle
- Encourage oral intake of food and fluids
- Provide staff continuity
- Encourage visitation of family and friends
What is the drug that can medically manage delirium?
- Haloperidol
What are the CI for haloperidol?
- Prolonged QTc interval on ECG
- PD or Lewy Body Dementia
- Hx torsade de pointes, ventricular arrhythmia or recent cardiac event
What are the features of hyperactive delirium?
- Strong
- Wandering
- Difficult to reason with
- Hyper-alert
- Aggressive
- Insomnia
What are the features of hypoactive delirium?
- Drowsy
- Quiet
- Distracted/withdrawn
- Reduced alertness
- Abnormal hand movements
What are the consequences of delirium?
- Early-onset dementia
- Increased mortality
- Increased institutionalisation
- Increased hospital LOS (length of stay)
- Increased risk of falls
- Increased risk of functional decline
Why do you not order urine dipsticks in >65yrs?
High false positive rate due to asymptomatic bacteriuria
What are bulk-forming laxatives?
Contain soluble fibre which result in increased fluid retention within the stool and increase overall faecal mass and stimulate peristalsis
