Confused Patient VIVA Flashcards
(20 cards)
What are the most common causes of acute confusion in the elderly?
Delirium, dementia, drugs (including alcohol), depression, delusions/psychosis, disease (e.g. infection, trauma), environmental change, pain.
How do you distinguish between delirium and dementia in the history?
Delirium: acute onset (hours–days), fluctuates, inattention, altered consciousness, hallucinations.
Dementia: gradual onset (months–years), progressive memory loss, disorientation, preserved attention early on.
What symptoms in the history support a diagnosis of delirium?
Fluctuating awareness, inattention, acute onset, disorganised thinking, hallucinations/delusions, sudden change noticed by carers/family.
What physical examinations are important in a confused patient?
Vital signs, cardio/resp exam, abdominal exam, full neuro exam, skin exam, hydration/nutrition check, pain assessment.
What are your top differential diagnoses in a confused elderly inpatient pulling out lines?
Delirium (due to infection or environment), pain, drug effects, stroke, metabolic causes, alcohol withdrawal.
What initial investigations would you order for a confused elderly patient?
Bloods: FBC, U&E, CRP, LFTs, glucose, B12/folate, TFTs.
Urinalysis & culture.
CXR.
ECG.
CT head if neuro signs or trauma.
Collateral history.
How do you manage delirium in a hospitalised patient?
Treat cause (e.g. infection), review/stop harmful meds, reorient environment (clock, family, lighting), support hydration/nutrition, prevent complications.
What non-pharmacological strategies help manage delirium?
Calm, familiar environment; clear communication; clocks/calendars; normal day–night routine; avoid room changes; involve family; ensure safety.
How do you assess autonomy and consent in a confused patient refusing care?
Assess capacity: if lacking, act in best interests; involve family or legal rep; document clearly; choose least restrictive option.
What ethical principle is involved when a confused patient refuses care?
Autonomy — balanced against beneficence and duty of care when capacity is impaired.
What are risk factors for developing delirium?
Age >65, cognitive impairment/dementia, infection, sensory impairment, dehydration, medications, surgery, and unfamiliar environment
What are some common medications that can contribute to delirium in the elderly?
Benzodiazepines, opioids, anticholinergics, corticosteroids, antihistamines, and polypharmacy in general
How can constipation contribute to delirium?
Constipation causes discomfort and pain, can lead to urinary retention, and may alter cognition due to metabolic changes, especially in the elderly.
Why is pain a common trigger for delirium in older adults?
Uncontrolled pain is a stressor that can disrupt cognition and attention, especially in cognitively vulnerable individuals.
What are the key features of hypoactive delirium?
Lethargy, reduced motor activity, drowsiness, withdrawal, reduced verbal communication. It is often under-recognised and mistaken for depression or fatigue.
What should be included in a collateral history for delirium assessment?
Baseline cognition, ADLs, recent changes, medication history, alcohol use, recent infections, pain, sleep, and usual behaviour.
Which lab abnormalities are commonly associated with delirium?
Hyponatraemia, hypercalcaemia, hypoglycaemia, uraemia, elevated CRP/WCC (infection), liver failure markers (ammonia).
How does sensory impairment (vision/hearing) relate to delirium?
Sensory impairment leads to misinterpretation of environment, social isolation, and disorientation, increasing delirium risk.
Why is early mobilisation important in delirium prevention and treatment?
It helps maintain function, reduce risk of complications (e.g. pressure sores, pneumonia), and supports cognitive engagement and reorientation.
What is ‘sundowning’ and how does it relate to delirium?
‘Sundowning’ refers to increased confusion and agitation in the late afternoon or evening, commonly seen in delirium and dementia.
