Delirium

Question 1

factors favouring delierium over dementia 6

Answer 1

acute onset

impairment of consciousness

flucation of symptoms: worse at night, periods of normality

abnormal perception oe illusions and hallucinations

agitation, fear

delusions

Question 2

how can causes for delirium be classified 8

Answer 2

infection

metabolic

medications

endocrine

neuro

nutrition

illicit

metals

Question 3

regarding causes of delirium give examples for the following:
Infection 1

Answer 3

sepsis
eg UTI, URTI, CNS, BBV(blood borne virus)

Question 3

regarding causes of delirium give examples for the following:
Infection 1

Answer 3

sepsis
eg UTI, URTI, CNS, BBV(blood borne virus)

Question 4

regarding causes of delirium give examples for the following:
metabolic 5

Answer 4

ANS instability

hypoglycaemia

dehydration

electrolyte distrubance

organ failure

Question 5

regarding causes of delirium give examples for the following:
metabolic 5

Answer 5

ANS instability

hypoglycaemia

dehydration

electrolyte distrubance

organ failure

Question 6

regarding causes of delirium give examples for the following:
medication 5

Answer 6

steroids

anticholinergics

psychotropic (benzos)

dopamine agnoists

opioids

Question 7

regarding causes of delirium give examples for the following:
endocrine 4

Answer 7

thyroid

PTH

adrenal

pituitraty

Question 8

regarding causes of delirium give examples for the following:
neuro 6

Answer 8

trauma

bleed

epilepsy

vasculitis

ICP (increased intracrainial pressure)

SOL (space occupying lesion)

Question 9

regarding causes of delirium give examples for the following:
nutrition 4

Answer 9

malnutrition

deficiencies:
-thiamine
-folate
-B12

Question 10

regarding causes of delirium give examples for the following:
illicit 3

Answer 10

alcohol

benzos

amphetatmins

Question 11

regarding causes of delirium give examples for the following:
metals 3

Answer 11

CO

lead

mercury

Question 12

who is at risk of delirium 10

Answer 12

old

young

underlying brain injury

blind/deaf

post-op

previous sustabnce misuse/psych issue

sleep depriviation

pain

stress

Question 13

clinical features of delirium 6

Answer 13

rapid fluctuation confusion (mins-hours)

clouding consciousness (clarity of awareness environment)

psychosis; delusions, hallucinations, illusions

emotional lability

sleep/wake distrubance, reversal

Question 14

describe the difference between hyperactive and hypoactive delirium 3v2

Answer 14

hyperactive- increased motor actiivyt , agitiaton, psychosis

hypoactive- reduced motor activity, drowsy (poor prognosis)

Question 15

assessment in delirium 6

Answer 15

clinical history

cognitive assessment

physical exam

blds

toxicology screen

infection screen

head imaging/LP

EEG

Question 16

assessment in delirium 6

Answer 16

clinical history

cognitive assessment

physical exam

blds

toxicology screen

infection screen

head imaging/LP

EEG

Question 17

describe the confusion assessment method (CAM) used in delirium 4

Answer 17

CAM:
1- Acute onset
2- Inattention
3- Disorganised thinking
4- consciousness (alter->hyperalert->drowsy->stupor->coma)

need 1+2 (+3 or 4)

Question 18

what are the domains of management for delirium 3

Answer 18

physical

environment

medical

Question 19

physical mangement of delirium 4

Answer 19

treat underlying cause
-stop/avoid offending drug
-O2
-hydration/nutirtion
-continence
-analgesia
-sleep e

Question 19

physical mangement of delirium 4

Answer 19

treat underlying cause
-stop/avoid offending drug
-O2
-hydration/nutirtion
-continence
-analgesia
-sleep e

Question 20

environmental managemnt of delirium 6

Answer 20

move to single room

avoid ward/hospital move

avoid restrianing

make environment safe

familitratiy:
-same staff
-allow TV
-visitors
-orientation- glassess/hearing aids
-windows
-low lighting at night
-clock
-clarity when speaking

Question 21

what are the domains of management for delirium 3

Answer 21

physical

environment

medication

Question 22

what are the domains of management for delirium 3

Answer 22

physical

environment

medication

Question 23

medication mangement of delririum

Answer 23

last resort
-lowest dose possible
Rapid transquilization protocols
-benzos
-antipsychotics (atypical > typical)

Question 23

medication mangement of delririum

Answer 23

last resort
-lowest dose possible
Rapid transquilization protocols
-benzos
-antipsychotics (atypical > typical)

Question 24

when should antipsychotics not be used in management of delirium 2

Answer 24

if concenrs about lewy body dementia or parkinsons

Question 25

what should be monitored if medication used for delirium management 2

Answer 25

RR

BP

1hr post adminions

Question 25

what should be monitored if medication used for delirium management 2

Answer 25

RR

BP

1hr post adminions

Question 26

risks with benzo use for delirium 3

Answer 26

oversedation

airway compromise

falls

Question 27

risks with antipyschotic use in delirirum mangement 5

Answer 27

cardio-respiroatyr collapse

interactions with illicity medications

prolonged QTc (esp Haloperidol- ideally ECG before)

increased stroke risk in elderly

damage to therapeutic relationship

Question 28

examples of drugs that can cause prolonged QTc 5

Answer 28

amiodarone

levofloxacin/cirpofloxacin

amitriptyline

haloperidol/quetiatpins

sumatriptan

Question 29

state the three types of observation level 3

Answer 29

general

constant-eyeline

special- arms reach

Question 30

what legalities are used in care of delirium and when

Answer 30

AWI-section 47
-medical interventions
-ward care

MHA (EDC)
-if trying to leave ward
-requiring restraint