delirium W3

Question 1

what is delirium

Answer 1

syndrome of acute cognitive impairment often precipitated by an insult such as illness or surgery

Question 2

how many hospital inpatients does delirium affect

Answer 2

25%

Question 3

features of delirium

Answer 3

acute deterioration - changes over hours to days, fluctuates over time
cognitive impairment
psychiatric disturbance

Question 4

cognitive impairment features (delirium)

Answer 4

attentional impairment
disorientation to location
short-term and long-term memory loss

Question 5

psychiatric disturbance features (delirium)

Answer 5

anxiety and agitation (sometimes violent)
visual/auditory hallucinations
delusions

Question 6

psychomotor patterns of delirium?

Answer 6

hyperactive delirium (agitated, restless, violent)
hypoactive delirium (sedation, lethargy, drowsy)

Question 7

what is lethargy

Answer 7

state of exhaustion

Question 8

risk factors for delirium - pre-existing?

Answer 8

frailty
previous delirium
dementia and cognitive impairment
psychiatric disorder
polypharmacy (taking multiple medicines)
alcohol and substance abuse
isolation, social deprivation

Question 9

acute insults causing delirium?

Answer 9

infection
surgery
hospitalisation/institutionalisation
bowel/bladder
dehydration
medication
sleep deprivation
sensory impairment

Question 10

delirium and dementia link?

Answer 10

dementia risk factor for delirium
delirium risk factor for dementia

Question 11

delirium and dementia new baseline?

Answer 11

people with dementia who suffer delirium from an acute insult may struggle to recover fully

Question 12

delirium clinical assessment - screening tool?

Answer 12

screening tool 4AT - standard of care for older adults admitted to hospital - alertness, orientation, attention span

Question 13

diagnosis for delirium?

Answer 13

full history and examination
collateral history and baseline function
‘delirium screen’ investigations
medication review
social history

Question 14

clinical management of delirium - how to prevent?

Answer 14

address risk factors!

Question 15

intervention for bowel and bladder (delirium risk factor)

Answer 15

assess and treat constipation
avoid urinary catheters

Question 16

intervention for dehydration (delirium risk factor)

Answer 16

regular assessment and prompting for fluids and food

Question 17

environmental interventions for delirium prevention?

Answer 17

orientation and cognitive stimulation activities
avoid ward moves

Question 18

intervention for medications (delirium risk factor)

Answer 18

medication review, stopping or reducing culprit drugs

Question 19

sleep disturbance intervention (delirium risk factor)

Answer 19

noise reduction (ear plugs)
non-pharmacological sleeping aids

Question 20

sensory impairment intervention (delirium risk factor)

Answer 20

screen for visual and hearing impairments
adaptive equipment (large text, hearing aids etc)

Question 21

immediate management of delirium?

Answer 21

standard acute assessment (inc resuscitation)
reassurance
consider safety of patient and staff
emergency detention under mental health act may be necessary to protect patient

Question 22

treatment of delirium?

Answer 22

comprehensive and systemic assessment of potential precipitating factors
speciality involvement