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Y3 Medicine for the Elderly > Delirium > Flashcards

Flashcards in Delirium Deck (22)
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1
Q

what is delirium?

A

acute deterioration in mental functioning arising over days or hours

2
Q

how long can delirium last?

A

days - months

3
Q

name five risk factors for delirium

A
elderly 
cognitive impairment 
sensory impairment
previous history of delirium
depression
4
Q

what is the mnemonic for causes of delirium and what does this stand for?

A

DELIRIUM

drugs
electrolyte disturbances
lack of drugs (withdrawal)
infection 
reduced sensory input
intracranial 
urinary retention
metabolic
5
Q

describe the onset and course of delirium

A

acute onset

fluctuating course

6
Q

describe the cognitive effects of delirium

A

altered conscious level
inattention/decreased awareness
disorganised thinking

7
Q

what are the two types of delirium?

A

hyperactive

hypoactive

8
Q

describe the presentation of hyperactive delirium

A

patients are agitated, aggressive and wander

9
Q

which type of delirium is easier to diagnose?

A

hyperactive

10
Q

describe the presentation of hypoactive delirium

A

patients are withdrawn, apathetic and sleepy

11
Q

which type of delirium has a higher mortality?

A

hypoactive

twice that of hyperactive

12
Q

which patients should be screened for delirium on admission to hospital?

A

all patients >65

13
Q

what is the recommended screening tool for delirium and what score is suggestive of delirium?

A

4-AT score

> 4

14
Q

what is the next step after screening for delirium if they meet the criteria?

A

TIME bundle

15
Q

what is involved in a TIME bundle for delirium?

A
T = think, exclude + treat triggers
I = investigate and intervene to correct causes
M = management plan
E = engage and explore
16
Q

what examinations should be performed in the investigation of delirium?

A

neuro

MSK

17
Q

what needs to be reviewed when investigating patients with delirium?

A

their medications

18
Q

what bloods should be done when a patient has delirium?

A

glucose, FBC, U+E, LFTs, CRP, calcium, B12/folate, Mg, TSH

cultures if septic

19
Q

what non-pharmacological management can be done for delirium?

A

optimise underlying chronic disease
activity, food, fluid and bowel charts
allow mobilisation
re-orientate patients

20
Q

when should pharmacological management of delirium be considered?

A

non-pharm methods have failed
symptoms threaten theirs/others safety
significantly distressing psychotic symptoms

21
Q

what is the first line management of delirium?

A

haloperidol 500mcg orally/IM if unable to take oral

22
Q

when should haloperidol not be given as first line for delirium and what is the alternative?

A

history of parkinson’s or Lewy body dementia

lorazepam 500mcg-1mg oral