Delirium

Question 1

What is Delirium?

Answer 1

Acute confusion state

Question 2

What is Delirium characterised by? (2 things)

Answer 2

1. Disturbed consciousness
2. Reduced cognitive function

Question 3

What percentage of elderly patients on Medical / Surgical Wards will have Delirium at any one time?

Answer 3

15%

Question 4

What are the 3 types of Delirium?

Answer 4

1. Hypoactive Delirium (most common)
2. Hyperactive Delirium
3. Mixed Agitation

Question 5

What are the CF Hypoactive Delirium? (2 things)

Answer 5

1. Lethargy
2. Reduced motor activity

Question 6

What are the CF Hyperactive Delirium? (4 things)

Answer 6

1. Agitation / Aggression
2. Increased motor activity
3. Delusions
4. Hallucinations

Question 7

What is Mixed agitation marked by?

Answer 7

Fluctuations throughout the day

Question 8

What are the titles of the differences between Delirium n Dementia? (4 things)

Answer 8

1. Onset
2. Short-Term course
3. Attention
4. Delusions / Hallucinations

Question 9

What is the difference in ONSET between Delirium vs Dementia?

Answer 9

• Delirium: Acute
• Dementia: Gradual

Question 10

What is the difference in the SHORT-TERM COURSE between Delirium vs Dementia?

Answer 10

• Delirium: Fluctuating
• Dementia: Constant

Question 11

What is the difference in ATTENTION between Delirium vs Dementia?

Answer 11

• Delirium: Poor
• Dementia: Good

Question 12

What is the difference in DELUSIONS / HALLUCINATIONS between Delirium vs Dementia?

Answer 12

• Delirium: Common
• Dementia: Less Common

Question 13

What are the RF for Delirium? (6 things)

Answer 13

1. Age 65+
2. Male
3. Multiple co-morbs
4. Underlying Dementia
5. Renal impairment
6. Sensory impairment (hearing / visual)

Question 14

What are the causes of Delirium? (11 things)

Answer 14

• C - Constipation
• H – Hypoxia
• I – Infection
• M – Met Disturbance
• P – Pain
• S – Sleeplessness
• P – Prescriptions
• H – Hypothermia / Pyrexia
• O – Organ dysfunction (hepatic / renal impairment)
• N – Nutrition
• E – Environmental changes
• D – Drugs / Dehydration

CHIMPS PHONES

Question 15

When do you usually get the Hypoxia that causes Delirium?

Answer 15

Post-op

Question 16

What infections can cause Delirium? (2 things)

Answer 16

1. UTI
2. LRTI

Question 17

What Met Disturbances can cause Delirium? (3 things)

Answer 17

1. Hyponatraemia
2. Hypernatremia
3. Hypercalcaemia

Question 18

What Drugs can cause Delirium? (5 things)

Answer 18

1. Benzodiazepines
2. Diuretics
3. Opioids
4. Steroids
5. Drug withdrawal (e.g Alcohol)

Question 19

What info is important to get from Hx / Collateral Hx? (5 things)

Answer 19

1. Symptoms of possible Underlying Cause
2. Previous episodes
3. Onset + Course of confusion
4. Drug Hx
5. Co-morbs

Question 20

What screening tools can you use to assess pt cognition? (3 things)

Answer 20

1. Abbreviated Mental Test Score (AMTS)
2. MMSE
3. ACE-III

Question 21

Why is it important to do screening tools for Delirium pts?

Answer 21

To monitor for Improvement / Deterioration over time

Question 22

What examinations can you do to give you a clue to what caused the Delirium?

Answer 22

1. Vital signs
2. Consciousness (e.g GCS / AVPU)
3. Evidence of Head trauma
4. Source of infection
5. Asterixis (flapping hands)

Question 23

What signs from the Vital signs might give you a clue to what caused the Delirium? (2 things)

Answer 23

1. Fever: Infection
2. Low SpO2: Pneumonia

Question 24

What sign of a Source of Infection might give you a clue to what caused the Delirium?

Answer 24

Suprapubic tenderness: UTI

Question 25

What does Asterixis suggest the cause of Delirium is? (2 things)

Answer 25

1. Uraemia 2. Encephalopathy

Question 26

What Investigations can you do to give you a clue to what caused the Delirium? (10 things)

Answer 26

1. FBC 2. UnE 3. LFT 4. Coagulation / INR 5. TFT 6. Calcium 7. B12 / folate 8. Glucose 9. Blood cultures 10. Urinalysis

Question 27

What causes of Delirium can a FBC reveal? (3 things)

Answer 27

1. Infection 2. Anaemia 3. Malignancy

Question 28

What causes of Delirium can a UnE reveal? (2 things)

Answer 28

1. Hyponatraemia 2. Hypernatraemia

Question 29

What cause of Delirium can a LFT reveal?

Answer 29

Liver failure w Secondary encephalopathy

Question 30

What cause of Delirium can a Coagulation / INR test reveal?

Answer 30

Intracranial bleeding

Question 31

What cause of Delirium can a TFT reveal?

Answer 31

Hypothyroidism

Question 32

What cause of Delirium can a Calcium test reveal?

Answer 32

Hypercalcaemia

Question 33

What cause of Delirium can a B12 / Folate test reveal?

Answer 33

B12 / Folate deficiency

Question 34

What causes of Delirium can Glucose test reveal? (2 things)

Answer 34

1. Hypoglycaemia 2. Hyperglycaemia

Question 35

What cause of Delirium can Blood cultures reveal?

Answer 35

Sepsis

Question 36

What cause of Delirium can Urinalysis reveal?

Answer 36

UTI

Question 37

What Imaging can you do to give you a clue to what caused the Delirium? (2 things)

Answer 37

1. CT head 2. CXR

Question 38

When should you for a CT head in Delirium?

Answer 38

If concerned abt Intracranial pathology (bleeding / ischaemic stroke / abscess)

Question 39

When should you for a CXR in Delirium?

Answer 39

If concerned abt Lung pathology (pneumonia / pulmonary oedema)

Question 40

What is the Definitive Mx of Delirium?

Answer 40

Identify + TUC

Question 41

What should be given if Delirium was caused by INFECTION?

Answer 41

Abx

Question 42

What should be given if Delirium was caused by HYPOXIA?

Answer 42

Nasal oxygen

Question 43

What should be given if Delirium was caused by CONSTIPATION?

Answer 43

Laxatives

Question 44

How do you prevent worsening of Delirium? (3 things)

Answer 44

1. Encourage oral fluid intake 2. Analgesia (PRN) 3. Monitor bowels

Question 45

Although Sedatives should be used sparingly, what Sedatives are recommended by NICE? (2 things)

Answer 45

1. Haloperidol (FIRST LINE) 2. Lorazepam