Delirium

Question 1

Define delirium.

Answer 1

Disturbance in attention
Change in cognition
Develops over a short period
Fluctuates

Question 2

Who might you need to take a history from?

Answer 2

Family
Friends
GP
Carer

Question 3

What is delirium associated with?

Answer 3

Increased mortality
Longer hospital stay
Increased complications
Increased costs
Long-term disability

Question 4

What does delirium represent?

Answer 4

An ‘atypical’ presentation of an acute illness

Question 5

What does delirium increase the risk of for patients?

Answer 5

Longer hospital stay
DEMENTIA
Complications from hospital e.g falls, clots, pressure sores
Death

Question 6

Onset?

Answer 6

Sudden - hours to days

Question 7

Course?

Answer 7

Short and fluctuating

Question 8

Reversible?

Answer 8

Yes

Question 9

Duration?

Answer 9

Hours to less than months

Question 10

Activity?

Answer 10

Hyperactive OR hypoactive

Question 11

Alertness?

Answer 11

Fluctuates

Question 12

Attention?

Answer 12

Impaired

Question 13

Mood?

Answer 13

Fluctuating emotions

Question 14

Thinking?

Answer 14

Disorganised

Question 15

Perception?

Answer 15

Distorted

Question 16

What might cause delirium?

Answer 16

Neurotransmitter fault (ACh)
Direct toxic insult (drugs, low O2, low Na, low glucose)
Decreasing stress hormone response

Question 17

Predisposing factors?

Answer 17

Old
Dementia
Co-morbidity
Post-op (hip fractures)
Terminal illness
Polypharmacy
Depression
Alcohol
Malnutrition
Sensory Impairment

Question 18

Precipitating factors?

Answer 18

Polypharmacy – strong painkillers, sedatives (e.g benzodiazepines), OPIATES
Hypoxia 
Low glucose or salt 
Dehydration 
Alcohol 
Infection
UTI
Environmental 
Catheters (foreign body)
Cardio e.g MI
Hip fracture
Urinary retention 
Constipation

Question 19

Hallmarks of delirium?

Answer 19

Acute and fluctuating
Inattention
Altered level of consciousness
Disorganised thinking

Question 20

What type of delirium is worse and why?

Answer 20

Hypoactive

More difficult to diagnose and higher mortality

Question 21

What tools are used to diagnose delirium?

Answer 21

4AT and CAM

Question 22

CAM

Answer 22

1 + 2 + 3/4
Acute and fluctuating
Inattention
Altered level of consciousness
Disorganised thinking

Question 23

How is delirium managed?

Answer 23

DIAGNOSE
Find and reverse all causes
Support
Follow up

Question 24

How could you review a patient?

Answer 24

Redo 4AT to see if score has gone down

Question 25

The cause of delirium is always...

Answer 25

Multifactorial

Question 26

Name some environmental support.

Answer 26

``` Sleep chart Food and fluid chart Mobilise as much as possible Glasses and hearing aids Review Buzzer ```

Question 27

When should you sedate a patient?

Answer 27

Only if they are a danger to themselves or others

Question 28

How is delirium prevented?

Answer 28

``` Assess bowel and bladder function Early mobilisation Early nutrition Hydration Pain management Sleep enhancement ```

Question 29

Name some medications for delirium

Answer 29

Haloperidol Quitiapine (can use in Parkinson's) Benzodiazepines