Delirium Flashcards
key features of delirium ? (5)
- Disturbed consciousness
- Hypoactive/hyperactive/mixed
- Change in cognition
Memory/perceptual/language/illusions/
hallucinations - Acute onset and fluctuant
onset of delirium - what do you get?
acute onset
fluctuating
worse at night - sleep during day
- affects psychomotor behaviour
WHAT PRECIPITATES it? (lots of examples)
- Infection (but not always a UTI!)
- Dehydration
- Biochemical disturbance
- Pain
- Drugs
- Constipation/Urinary retention
- Hypoxia
- Alcohol/drug withdrawal
- Sleep disturbance
- Brain injury
- Stroke/tumour/bleed etc
- Changes in environment/emotional stress
how common is delirium?
Commonest complication of hospitalisation
- 20-30% of all in-patients
- Upto 50% of people post surgery
- Upto 85% of people at end of their life
why is delirium an issue? (5)
- Massive morbidity and mortality
- Massive morbidity and mortality
- Longer length of stay
- Increased rates institutionalisation
- Persistent functional decline
what is the screening tool used?
4AT
DELIRIUM – what to do when you find it? 4 main categories
Treat the cause
Full history and exam (incl. neuro)
TIME bundle
Explain the diagnosis!
Pharmacological measures
Non-pharmacological measures
Delirium – non pharmacological treatment
- Re-orientate and reassure agitated patients
USE FAMILIES/CARERS - Encourage early mobility and self-care
- Correction of sensory impairment
- Normalise sleep-wake cycle
- Ensure continuity of care
- Avoid hospitalisation if possible avoid frequent ward or room transfers
- Avoid urinary catheterisation/venflons
- Discharge people (if in hospital) ASAP
what drug may be started and what dose?
12.5mg quetiapine orally
anti-psychotic
prevention
- sensory impairments corrected
- getting patients ip and out bed
- pain relief
- polypharmacy review
What is important that you consider?
CAPACITY
- decision specific
- POA
asymptomatic bacteriuria can be misleading because?
- leukocytes or nitrites present
- grow a bug
- they do not have an active infection
what do you not sue for UTI diagnosis in older people
dipstick tests
In elderly women (>65yrs), treatment of
asymptomatic bacteriuria does not ?
reduce mortality or symptomatic episodes. Antibiotic treatment
significantly increases the risk of adverse events (NNTH 3).
when would you decide to admit a patient - what make you sway more to hospital? (2)
- do they need tests, IV fluids etc
- what is his social status
