- Delirium
Link:www.nice.org.uk/guidance/cg103/resources/guidance-delirium-pdf
- Acute disturbance in cognitive function
- Can be hyperactive, hypoactive or a mixture
- Differentials include psychiatric disorders, dementia, depression.
- Common, occurs in 60-80% of ITU patients
- Screening
- CAM-ICU
- Acute onset or fluctuating course
- Inattention
- Altered level of consciousness
- Disorganised thinking
- 1 and 2 AND 3 or 4 = CAM +ve
- iCDSC
- Risk factors
- Age
- Alcoholism
- Pre-existing cognitive impairment
- Depression
- Hypertension
- Smoking
- Medication
- Sleep deprivation
- Immobilisation
- Hip fracture
- Treatment
- Haloperidol 2.5mg IV doubled every 30 mins until settled and prescribed regularly every 4-6 hrs and tapered off over a few days
- Olanzepine 5mg po can be used.
- MDT approach
- Involve family
- Modify environment
- Appropriate lighting
- Re-orientate patient
- Introduce cognitively stimulating activities
- Clock for wake/sleep cycle
- Encourage to drink/rehydrate
- Treat any hypoxia/infection
- Encourage mobilisation if able
- Review medications
- Resolve any cause of impairment (eg ear wax), ensure hearing aid/visual aids working
- Reduce noise to minimum
- Avoid procedures during the night
- Avoid restraint if possible
- Bedside sitter
- Diagnosis
- Cognitive function
- Slow responses, confusion
- Perception
- Auditory or visual hallucinations
- Physical function
- Reduced mobility, movement, restlessness, aggitation, sleep disturbances
- Social behaviour
- Lack of co-operation, withdrawal, alteration in attitude
- Use CAM-ICU
- CEACCP
Link:ceaccp.oxfordjournals.org/content/9/5/144.full.pdf