Organic disorders: confusion, infection and trauma Flashcards
What is the appearance of a confused patient?
Disorientation - to time, place or person.
Misinterpretation - of events and information.
Misidentification - of people and places.
Auditory or visual hallucinations - depending on underlying cause of confusion.
Possible association with agitation, distress or aggression.
What 2 groups can the causes of confusion be divided into?
Transient causes
Enduring causes
What does transient confusion mean?
A confusional state that is likely to recover following resolution/elimination of the underlying cause.
Causes of transient confusion?
- Delirium
- Post ictal confusion (usually following tonic clonic seizure)
- Migraine
- Delirium tremens
- Physical ill health and chronic illness
- Medications
Delirium can also be referred to as an acute confusional state and is associated with physical insult or injury or environmental factors. True/false?
True
Onset of delirium?
Rapid in onset, 1-2 days after precipitating insult.
People at risk of delirium?
Older people with previous history of delirium and those with underlying cognitive deficits.
Characteristics of delirium?
Disorientation - time, place, person.
Agitation and distress
Auditory or visual hallucinations - often vivid
Inattention
The 3 common types of delirium?
Hypoactive - quiet, confused, drowsy, fearful patient.
Hyperactive - driven, wandering, agitated, shouting out and often aggressive.
Mixed - some periods of both of the above.
Delirium is regarded as a medical emergency with a 35-40% 1 year survival. True/false?
True since it significantly worsens patient mortality and morbidity.
How is delirium treatment usually carried out?
Ideally carried out in a medical environment to allow for physical health treatment. ALWAYS TREAT THE UNDERLYING CONDITION.
Can involve:
- Reassurance and reorientation
- Low stimulus environment
- Assistance with medications
- Assistance with activities of daily living during recovery.
- Pharmacological interventions to assist with distress, agitation and aggression.
What is post-ictal confusion?
An abnormal condition following a seizure (mainly Tonic Clonic seizure).
Begins when seizure ends and ends when patient has returned to baseline. Usually resolves in 30 mins but can last for hours or days.
Characteristics of post-ictal confusion?
- Drowsiness
- Nausea
- Confusion
- Exhaustion
Usually requires supportive management only and health promotion in the form of seizure prevention.
How many phases does a migraine have? What are they?
4 phases of migraine:
Prodrome (pre-headache) - problems concentrating, depression, nausea, fatigue.
Aura - seeing bright flashing dots/lights/sparkles, blind spots in vision, tinnitus, numb or tingling skin.
Headache - sensitivity to light, sound and/or odours. Loss of appetite, nausea+vomiting, speech changes, feeling tired.
Postdrome (migraine hangover) - feeling depressed, fatigue, euphoria, unable to concentrate.
What symptoms can be associated with migraines?
Confusion
Visual changes
Irritability
Low mood
De-realisation “nothing is real”
De-personalization “I am not real”
De’ja vu