Module 4 - Delirium

Question 1

what is delirium?

Answer 1

a common and serious medical condition characterised as an acute state of confusion

Question 2

which age group is delirium most common in? why is this?

Answer 2

most common in older people due to their increased risk factors and comorbidities

Question 3

older people with delirium are more likely to experience what sort of outcome?

Answer 3

an adverse one. more likely to be admitted permanently to a residential facility, to stay in hospital longer and experience iatrogenic complications, even more likely to die

Question 4

two types of delirium

Answer 4

hypoactive and hyperactive

Question 5

decreased physical activity, withdrawal, lethargy

Answer 5

hypoactive delirium

Question 6

decreased speed and amount of speech, staring, listlessness

Answer 6

hypoactive delirium

Question 7

drowsiness and reduced awareness of surroundings

Answer 7

hypoactive delirium

Question 8

increased physical activity, hyper arousal, hyper alterness

Answer 8

hyperactive delirium

Question 9

hallucinations, delusions and agitation

Answer 9

hyperactive delirium

Question 10

rambling speech and restlessness

Answer 10

hyperactive delirium

Question 11

onset of delirium

Answer 11

quickly, in days or hours

Question 12

how long can delirium last for?

Answer 12

up to a month

Question 13

what can make delirium difficult to catch on to?

Answer 13

it fluctuates throughout the day, and behaviours can change quickly

Question 14

delirium can cause deterioration of what?

Answer 14

the memory

Question 15

risk factors - demographic

Answer 15

over 65yrs

Question 16

risk factors - cognitive state

Answer 16

prior episode of delirium, dementia or depression

Question 17

risk factors - comorbidities

Answer 17

acute or chronic medical condition

Question 18

risk factors - sensory impairment

Answer 18

visual or hearing loss

Question 19

risk factors - surgery

Answer 19

procedure requiring general anaesthetic or sedation

Question 20

risk factors - medications

Answer 20

polypharmacy, withdrawal from drugs or alcohol

Question 21

risk factors - hospital related (iatrogenic)

Answer 21

overstimulation/understimulation, ICU admission, multiple ward changes

Question 22

decreased sensation of thirst and chewing strength and taste can result in what?

Answer 22

dehydration and malnutrition, both which are risk factors for delirium

Question 23

musculoskeletal degeneration and disturbed sleep patterns can result in what?

Answer 23

pain and mobility issues, lack of sleep > both which are risk factors for delirium

Question 24

ineffective drug metabolism and suppressed immune response can result in what?

Answer 24

build up of toxins and hidden signs of infection > both which are risk factors for delirium

Question 25

3 nursing interventions for delirium

Answer 25

- physical and verbal orientation cues - assessing and treating pain regularly - collaboration with multidisciplinary team

Question 26

3 more nursing interventions for delirium

Answer 26

- supporting and educating family and friends - assisting the person with eating and drinking - managing surrounds (sound and lighting)

Question 27

prolonged delirium can cause

Answer 27

a dementia process to develop in the brain

Question 28

in older people, delirium may be the only sign of what?

Answer 28

an underlying acute medical condition

Question 29

does a dementia diagnosis guarantee delirum?

Answer 29

no

Question 30

the first step to recognising delirium is noticing what?

Answer 30

behavioural changes

Question 31

2 most commonly use assessment tools for delirium

Answer 31

- confusion assessment tool (CAM) | - the 4AT

Question 32

the recognition of delirium by CAM requires the presence of...

Answer 32

feature 1 and 2 AND either 3 or 4

Question 33

feature 1 of CAM

Answer 33

acute onset and fluctuating course

Question 34

acute onset and fluctuating course

Answer 34

- is there evidence of an acute change in mental status from the person's usual state? - does the behaviour fluctuate during the day, coming and going or decrease/increase in severity?

Question 35

feature 2 of CAM

Answer 35

inattention

Question 36

inattention

Answer 36

does the person have difficulty focusing their attention? are they easily distracted or having trouble keeping track of what is being said?

Question 37

feature 3 of CAM

Answer 37

disorganised thinking

Question 38

disorganised thinking

Answer 38

is the person's thinking disorganised or incoherent? are they rambling? switching from subject to subject or showing an illogical flow of ideas?

Question 39

feature 4 of CAM

Answer 39

altered level of consciousness

Question 40

altered level of consciousness

Answer 40

any response other than 'alert' to rating consciousness - alert: normal - vigilant; hyper alert - lethargic; drowsy, easily roused - stupor; difficult to rouse - coma; unrousable

Question 41

the 4AT

Answer 41

score of 4 or more indicates delirium

Question 42

causes of delirium - D

Answer 42

drugs; newly introduced ones, dosage changes or polypharmacy

Question 43

causes of delirium - E

Answer 43

electrolyte abnormalities and pain

Question 44

causes of delirium - L

Answer 44

lack of drugs; withdrawal from alcohol, nicotine, benzodiazepines

Question 45

causes of delirium - I

Answer 45

infection; UTI, respiratory infections

Question 46

causes of delirium - R

Answer 46

reduced sensory input; hearing/visual impairment, darkness, change in environment

Question 47

causes of delirium - I (second one)

Answer 47

intracranial problems; stroke, meningitis, seizures, dementia

Question 48

causes of delirium - U

Answer 48

urinary retention, constipation

Question 49

causes of delirium - M

Answer 49

myocardial problems; myocardial infarction, heart failure and arrhythmia

Question 50

what are the 5 P's of delirium?

Answer 50

pee, poo, pain, pus, pills

Question 51

PEE

Answer 51

UTIs, dehydration (leading to decreased urinary output), urinary retention, indewlling catheter insertion

Question 52

POO

Answer 52

constipation and diarrhoea

Question 53

PUS

Answer 53

infection of any kind can cause delirium

Question 54

PAIN

Answer 54

unidentified/unmanaged pain can also cause delirium

Question 55

PILLS

Answer 55

interactions and adverse effects of medications can bring on delirium

Question 56

environment for those with hyperactive delirium

Answer 56

too much noise or overstimulation can induce/worse the symptoms. often need single room or quieter environment to foster recovery

Question 57

in investigating delirium, what information should be gathered when obtaining the person's history? (4 things)

Answer 57

- full head to toe assessment - set of vitals - identify recent medication changes - identify any comorbidities

Question 58

4 investigations used to screen for causes of delirium

Answer 58

- urinalysis, MSU - blood tests - chest x-ray - electrocardiogram (ECG)

Question 59

blood test to determine cause for delirium should test for?

Answer 59

- kidney function - electrolytes - glucose - calcium - liver function - cardiac enzymes - B12 - folate - thyroid function

Question 60

if a fever or cough is present (shown by chest x-ray or in chest ausculation), what order may be made?

Answer 60

blood or sputum cultures

Question 61

if pt is SOB, has a cough, or pathology has detected anything abnormal in the chest, what order may be made?

Answer 61

arterial blood gases (ABGs)

Question 62

if pt has a history of falls, is on anticoagulants, or has neurological signs present, what test may be ordered?

Answer 62

CT brain scane

Question 63

if headache, fever and meningism are present, what may be ordered?

Answer 63

lumbar puncture

Question 64

what test may assist in determining differential diagnosis such as a non-convulsive status epilepticus?

Answer 64

electroencephalogram (EEG)