Delirium

Question 1

is delirium acute or chronic

Answer 1

acute

Question 2

what can cause delirium

Answer 2

ANYTHING!!! - drugs, infection, hospital admission

Question 3

is delirium common

Answer 3

yes

Question 4

why is having a catheter a risk factor for delirium

Answer 4

increased infection risk

Question 5

why is hospital admission a risk factor for delirium

Answer 5

change in environment

Question 6

what is the biggest risk factor for delirium

Answer 6

being elderly

Question 7

what social history must you always ask in relation to delirium

Answer 7

alcohol
illicit drugs

• BOTH can cause delirium

Question 8

what is the pathophysiology of delirium

Answer 8

abnormal response to stress

Question 9

how does delirium present (3)

Answer 9

cognition deterioration eg confusion, visual hallucinations
consciousness change eg drowsiness, agitation
emotional disturbance - anxiety, irritability

Question 10

why is delirium important

Answer 10

it is usually the first presentation of acute illness in the elderly!

Question 11

how does hypoactive delirium present

Answer 11

drowsiness
confusion
withdrawn
doesn’t care

HARDER TYPE TO IDENTIFY

Question 12

how does hyperactive delirium present

Answer 12

hallucinations
agitation
disorientation
disruptive during the night

= increased risk of falls

Question 13

what is the course of delirium like

Answer 13

transient and fluctuating (one hour theyre normal, the next hour theyre not)

Question 14

how long does delirium usually last

Answer 14

1-4 weeks (days to months)

Question 15

what screening tools are used for delirium

Answer 15

4AT or CAM (or MMSE, ACE-R etc)

Question 16

a 4AT score of what suggests delirium

Answer 16

> 4

Question 17

what do the 4 As stand for in the 4AT assessment tool for delirium

Answer 17

alertness
AMT4 (abbreviated mental test) eg DOB, age, place, current year
attention
acute or fluctuating course

Question 18

how do you test someone attention in the 4AT test

Answer 18

ask them to count the months of the year backwards

Question 19

what is CAM score for delirium

Answer 19

cognitive assessment methods

Question 20

how do you use the CAM score for delirium (what are the criteria that suggest delirium)

Answer 20

1 - acute onset and fluctuating course
2 - inattention
3 - disorganized thinking
4 - altered level of consciousness

need 1 and 2 and 3 OR 4 = delirium

Question 21

what investigations might you do for delirium and why

Answer 21

urinalysis - for UTI
blood glucose - for hypoglycemia
CXR - for pneumonia
FBC

Question 22

what measures can help someone with delirium

Answer 22

fix cause
orientate them well - IsOLATED ROOM (home preffered), calendar, clocks
correct sensory deficits - glasses and hearing aids
fluids - if ?infection
sedation eg haloperidol, lorazepam - LAST LINE, not recommended

Question 23

delirium complication s(2)

Answer 23

dementia

depression

Question 24

what is the first line for sedation in delirium (last line measure)

Answer 24

haloperidol

Question 25

when is haloperidol contraindicated for delirium (ast line measure)

what would you give instead

Answer 25

parkinsons or lewy body dementia

lorazepam

Question 26

what is confabulation (not specific to delirium, but common in old people)

Answer 26

their mind ‘filling in the blanks’ in a story - may look as if theyre lying but they genuinely cant remember and don’t want to be embarrassed by this (so make stuff up instead)