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Flashcards in Delirium Deck (20):
1

Delirium definition CCAP CBM

A *syndrome* of disturbed:
consciousness, cognition, attention, perception.
A complex interaction between:
cognitive functioning, behaviour, medical conditions

2

For many older adults it is the first and primary
indicator of

a newly emerged underlying physical illness

3

Is delirium reversible?

IF recognized as and acute change and precipitating causes removed in timely manner.
The longer to assess and tx, the longer to reverse.

4

Hyperactive CHAR - they are burnin' up!

combative, hyperalert, agitated, restless

5

Hypoactive – LASS MAS

lethargy, apathy, somnolent, stuporous
↓ movement / alertness / speech

6

Mixed variant

Sx of both hyper and hypo w/ patients cycling b/w the two. 50% of cases.

7

4 diagnostic criteria for delirium caused by a general medical condition

1) disturbed consciousness w/ reduced ability to focus/sustain/shift attention
2) cognition change or develop perceptual disturbance not accounted for by dementia
3) rapid onset and fluctuates over day
4 hx/exam/lab evidence indicates not the direct consequence of a medical condition

8

Risk factors in delirium. Fran loves a PPIE.

Physiological Pharmacological Individual Environmental

9

Risk factors - Physiological (4)

infx, dehydration/malnutrition, hypoxia, anemia, electrolyte imbalance

10

Risk factors - Pharmacological (4)

alcohol/drug withdrawal, OTCs, newly prescribed med.

11

Risk factors - Individual (4)

sleep disordered, sensory impaired, restraints, pain

12

Risk factors - Environmental (4)

absence of clock/watch, reading glasses, dentures
relocation (loss of all cues), stress, isolation

13

Evaluation of client should be focused on
1-2-3 IDT

1) ID that delirium is present
2) Determine contributing medical conditions/other factors
3) Treat/remove them

14

Knowledge of these two things is PIVOTAL.

1) client’s cognitive baseline*
INCLUDING
2) detail of onset of current symptoms
* When transferring > charting, staff convos, family very important as source

15

Confusion Assessment Method (CAM) – 4 features
AIDA

1) acute onset, fluctuating course
2) inattention
3) disorganized thinking
4) altered consciousness

16

It is the nurse's duty to support and protect the client while underlying causes are
determined and tx'ed. 3 Fran-isms for how to do.
CAM

Calming, help them trust you, reduce fear/anxiety
Avoid restraints/drugs
Maximize dignity, autonomy, self-esteem

17

Clients/residents need what 3 general types of support?

psychosocial, behavioural, environmental

18

Promote recovery, prevent complications, maintain safety, and maximize function. How can this best be accomplished following a first episode of delirium?

DOCUMENT
What were the things we learned after the fact?
What worked?!
– v. important to pass on what you learned to staff and family
PREVENTION
Zero in quickly next time. After the first incident, the person becomes more vulnerable

19

Fran STRESSES to us: "Get right on to prevention on admission. Delirium not uncommon with transition." Areas in which to be proactive?
(7 ideas)

• Diet/hydration
• Sleep
• Med reviews + decrease polypharm
• Urinary/bowel elimination
• Pain management
• Sensory impairment
• Social activity (physical/intellectual stimulation)

20

More chunks of info. re. how to help.
FAT BIRRD

Fluids and food intake - encourage
Avoid restraints/drugs
Try to understand mind of client
Be present
Invite family who are calming
Reorient to routines (explain),
Reduce stimulation
Dim lights