Module 4 - Delirium

Question 1

What is delirium?

Answer 1

An acute state of confusion.

Occurs in all age groups but most common in older people. Can involve visual and auditory hallucinations.

Question 2

How would you assess delirium?

Answer 2

Delirium Screen for Older Adults: Confusion Assessment Method (CAM).

Question 3

What are some common investigations to determine delirium?

Answer 3

• Urinalysis and midstream urine (MSU) test (if urinalysis abnormal)
• Blood tests (urea, electrolytes, glucose, calcium, liver function tests, cardiac enzymes, B12, folate, thyroid function)
• Chest X-ray
• Electrocardiogram (ECG)

Question 4

What are the risk factors for delirium?

Answer 4

• Demographics: 65 year old’s and over.
• Prior episode of delirium.
• Infection (i.e. UTI)
• Pain Dehydration - older adults have decrease sensation of thirst.
• Malnutrition
• Constipation
• Cognitive status : Dementia or depression.
• Co-morbidities
• Sensory impairment - visual or hearing.
• Surgery
• Medication - polypharmacy.
• Substance Use
• Hospital related environment (under or over stimulating).
• Admission to ICU.

Question 5

What are the two types of delirium?

Answer 5

Hypoactive and Hyperactive.

Question 6

What are the signs and symptoms of Hypoactive delirium?

Answer 6

• decreased physical activity
• withdrawal
• lethargy
• decreased speed and amount of speech
• staring
• listlessness
• drowsiness
• reduced awareness of surroundings.

Question 7

What are the signs and symptoms of Hyperactive delirium?

Answer 7

• Increased physical activity
• Hallucinations
• Delusions
• Agitation
• Rambling Speech
• _Hyper-_arousal
• _Hyper-_alertness
• Restlessness

Question 8

Can a person present with a mixed range of delirium?

Answer 8

YES

Question 9

What is the onset of delirium?

Answer 9

Sudden. Over hours or days.

Question 10

What is the course of delirium?

Answer 10

Short and fluctuating.

Often worse at night or on waking.

Question 11

Is delirium reversible?

Answer 11

YES

Question 12

Is the residual affects of delirium?

Answer 12

YES.

Older persons can be affected for months after delirium is resolved.

Question 13

What are some nursing interventions when treating delirium?

Answer 13

• Introduce yourself to the person and address them by name.
• Provide physical and verbal orientation cues (ie clock),
• Regularly assess and treat pain
• Collaboration with multidisciplinary team
• Support and educate family and friends in regards to delirium.
• Manage surrounding (Light & noise levels)
• Remove hazards and clutter to reduce falls risk.
• Ensuring has glasses or hearing aids within reach.
• Document appropriately.
• Ensure mobility aids are nearby (Walking frame).
• Assisting with eating and drinking; check swallowing and chewing.
• Minimise room and bed transfers.

Question 14

THE CONSEQUENCES OF DELIRIUM

Older people who experience delirium are more likely to.. .List 3 things that could happen as a result of experiencing delirium as a older person.

Answer 14

• Stay in hospital longer
• Have more complications such as pressure injuries and falls.
• More likely to be admitted into permanent care

Question 15

What are the 5 Ps of Delirium?

Answer 15

PEE - urinary tract infections, dehydration (leading to a low urinary output), urinary retention, indwelling catheter insertion can all cause delirium

POO - constipation and diarrhoea can both cause the onset of delirium

PUS - infection of any kind in the body can contribute to the onset of delirium

PAIN - unidentified or unmanaged pain can cause delirium

PILLS - interactions and adverse effects of medications can bring on delirium

Question 16

What history needs to be obtained to diagnose delirium?

Answer 16

• Full head to toe assessment needs to be conducted, including vital observations and cognitive screening (look for signs of infection, bladder and bowel function, dehydration)
• Identify any recent changes to medication
• Identify any co-morbidities (such as dementia or stroke) and if the person has experienced an episode of delirium before

All of this information can be obtained from family members/friends, medical records from previous admissions, gentle consultation with the person with delirium, their general practitioner and/or other health care professionals.

Question 17

What are the 4 features mentioned on the Confusion Assessment Method (CAM) assessment?

Answer 17

FEATURE 1: Acute Onset and Fluctuating Course

FEATURE 2: Inattention

FEATURE 3: Disorganised thinking

FEATURE 4: Altered Level of Consciousness