Delirium Flashcards
What is Delirium?
An acutely disturbed state of mind
How can delirium be caused?
Pathophysiology
Direct insult to the brain via stop in neurotransmitters OR altered bodily response to stress.
What are causes of delirium?
Common in elderly, frail patients (>85 years) Vision/hearing impairment Environmental triggers Medications e.g. Opiates/Changes in medications (polypharmacy) Depression Dementia Infection Malnutrition/Dehydration Post-Operation Trauma e.g. falls, fractures (#NOF) Hypoxia Low sodium/glucose levels
What are the subtypes of delirium?
Hypoactive
Hyperactive
What are symptoms and features of delirium?
Acute, sudden onset over hours-days
Fluctuating course of symptoms
Hallucinations/illusions
Easily distracted/low attention span
If Hyperactive:
- Agitated
- Restless
- Anxious
- Pacing around
If Hypoactive:
- Sleepy/Drowsy
- Coma-like
- Lacking energy
Which subtype of delirium is more easily detected?
Hyperactive
Hypoactive goes under the radar and hence, has double the mortality rate as it is often missed
What are complications of delirium?
DVT Pressure sores Immobility and loss of strength Falls Masking of underlying illness
What screening tools are used to detect and diagnose delirium?
4 As Tool (4AT)
Confusion Assessment Method (CAM)
How does 4AT work? How does it diagnose delirium?
Assesses patients on the 4 As:
- Acute, sudden onset/fluctuation
- Alertness
- Attention
- AMT4
4+ out of 12 means patient has delirium
How does CAM work? How does it diagnose delirium?
Assesses patients on 4 features:
- Acute, sudden onset/fluctuation
- Inattention
- Disorganised thinking
- Altered levels of consciousness
Patients must have features 1 and 2 and EITHER OF 3 or 4 to have delirium
What should you do if delirium is suspected?
Prevent or reverse any precipitating factors of the delirium (if possible to reverse)
List investigations for delirium
Examination - look for injury NEWS Bloods - FBC, nutritional status, low sodium/glucose Oxygen saturations - hypoxia Fluid balance chart - dehydration
How is delirium managed?
Reverse any precipitating factors
Reduce/sort any environmental disturbances
Change/remove medications
Engage family members by ensuring they can contact and comfort patient
Bring in familiar items to comfort patient
Medications RARELY to relieve any symptoms
Assess patient capacity prior to any major treatment
What is the scheme for treating delirium effectively?
TIME Bundle
Think delirium
Investigate
Manage
Engage relatives and staff
What must be done following delirium treatment?
Document management
