tomi1's version from 2017-02-13 20:45

Section 1

Question Answer
define delirium acute fluctuation in LOC,cognition and attention
prevelance15% in patients -higher elderly- esp post op/pre-death
complicationsearly mortality, prolonged hospitalisation, pressure sores,dementia, ITU
presentation hyperactive deliriumaggressive, stimuli sensitive, psychotic,loud
presentation hypoactive delirium lethargic,slow,quiet, poverty of speech, withdrawn

Section 2

Question Answer
causes of DELIRIUM Drugs, electrolyte disturbance, level of pain, infection (post op), RF (high CO2,low O2), Impacted faeces (constipation), ,Urinary retention,Metabolic (MI,DM,liver or kidney)
NERUO drugs causing deliriumAED,L-dopa
PSYCH drugs causing delirium ALL= antidepressants, lithium, anxiolytics
PAIN drugs causing delirium opiates,corticosteroids,antihistimines
drugs causing delirium think psychaitric, neuro and pain related medications
commonly missed causes of delirium chest infection, lack of sleep, constipation, urinary output

Section 3

Question Answer
triggers for delirium CNS=stroke GI=bleed,constipation, urinary retention CHEST=infection,RF HEART=MI LIFESTYLE
environmental triggersmoving around hospital, no watch, no hearing aid, changing staff
CNS triggersstroke, SDH
endocrine triggershyperparathyroidism, thyroid
metabolic triggersvitb12 deficiency, hepatic encephalopathy

Section 4

Question Answer
HX red flagspee + poo/ booze +drugs withdrawal / insulin (HYPO)
Hx must never forgetdrug and alcohol history
investigation for delirium history-collateral history-screening-bloods-imaging-urine dip
screening tools CAM or 4AT
CAM confusion assessment method 1.acute fluctuating course 2.inattention 3.disorganised speech 3.altered LOC
how to test inattention 20-1 test
4AT1.alertness 2.AMT4 3.attention (months of year backwards) 4.acute or fluctating change over last 2 weeks
components of AMT4abbreviated mental state test 1.age 2.DOB (current location) 4.year0
exminations must never forgetPRE and glucose

Section 5

Question Answer
Management delirium address trigger/preciptant factor + regular orientation on the ward + avoid
Monitoring should always startstart fluid chart, bowels diary, avoid bright lights and noises
CIantipsychotics (esp in PD/Lewy body dementia)

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