WEEK 6: DDD

Question 1

DELIRIUM

Answer 1

• A complex reversible, neuropsychiatric syndrome characterised by fluctuating change in mental status with inattention and altered levels of consciousness
• Common
• 25% elective surgery and 50% trauma surgery

Question 2

8 COMMON CAUSES OF DELIRIUM

Answer 2

• Dementia
• Electrolytes
• Lungs
• Infection
• Rx (Treatment)
• Injury stress
• Unfamiliar environment
• Metabolic

Question 3

DELIRIUM MANAGEMENT: Treat the underlying cause

Answer 3

• The cause of delirium, usually medical should be promptly treated
• Common causes→ infections, adverse drug reactions (especially analgesics, anticholinergics, parkinson’s medications, sleeping and anxiolytic drugs) dehydration and metabolic abnormalities

Question 4

DELIRIUM MANAGEMENT: Supportive Treatment to Reduce Expressive Behaviours

Answer 4

• The management should start with non-pharmacological multi component interventions
• Reduce sensory distress by having glasses on having aids in
• Having a familiar person with them if possible
• ALERT: All patients with delirium require falls risk alerts, assessment and management

Question 5

MAIN TYPES OF DELIRIUM (3)

Answer 5

• Hyperactive
• Hypoactive (Easily missed by staff)
• Mixed

Question 6

3 MAIN TYPES OF DELIRIUM: HYPERACTIVE

Answer 6

The resident feelts alert and active, and may have any of the following symptoms:

• Confusion and forgetting people, place and time
• Easily angered, restless or excited
• False beliefs about themselves and the area around the them e.g. delusions
• Hearing, smelling, seeing, tasting, touching things that are not there e.g. hallucinations
• Losing focus or attention on what they are doing

Question 7

3 MAIN TYPES OF DELIRIUM:: HYPOACTIVE (EASILY MISSED BY STAFF)

Answer 7

• Feel very tired or sleepy
• Not caring about what happens around them, and not wanting to eat
• Not knowing where they are, where you are or the date or time
• Slow to think, move or respond to people

Question 8

3 MAIN TYPES OF DELIRIUM:: MIXED

Answer 8

May have signs and symptoms of the other 2 types of delirium

Question 9

DEMENTIA

Answer 9

• Usually a progressive and irreversible syndrome of the brain with persistent memory loss combined with→
• Dysfunction within 1 or more functions of the brain impacting on ADLs (can include organisation, planning, problem solving, speech, insight and behaviour)
• 101 different kinds of brain illnesses which all come under the 1 umbrella- dementia
• Dementia is NOT a normal part of ageing but is more common after the age of 65 years

Question 10

LOW BODY DEMENTIA

Answer 10

• Fluctuation in mental state
• Vivid visual hallucinations
• Parkinsonism- gait changes
• Difficulties judging distances and communicating

Question 11

VASCULAR DEMENTIA

Answer 11

• Single strategic stroke
• Multiple small strokes
• Thickening of walls of arterioles
• Haemorrhage

Question 12

FRONTOTEMPORAL DEMENTIA

Answer 12

• Atrophy only of the frontal and temporal areas (until advanced disease)
• Often asymmetrical

2 different proteins present

• Tau
• Progranulin

Question 13

ALZHEIMER’S DISEASE

Answer 13

• Deterioration in social skills and language
• Memory problems
• Word finding difficulties
• Taking longer with routine tasks

Question 14

DEMENTIA AND DELIRIUM

Answer 14

• Dementia is a risk factor for developing delirium
  Reduced neurotransmitters
• Between 22-89% of patients with dementia will develop a delirium
• The use of restraint is more likely to have an adverse outcome especially in hyperactive delirium
• The patient is more likely to have a negative outcome if the patient has behavioural expression or BPSD prior to delirium

Question 15

WHAT DO DELIRIUM, DEMENTIA AND DEPRESSION HAVE IN COMMON?

Answer 15

• The physiological cause is not known but in neurotransmitter concentrations change
• Memory, mood and attention may be impaired, agitation, impaired judgement and lack of insight at times
• Changes in environment, stress or a traumatic event reduce coping ability
• Changes to arousal levels and sleep/wake cycles