Delirium Symptom list, from Confusion Assessment Method (CAM). Suspect if patient presents with both 1. & 2. and either 3. OR 4.
1. Sudden change in mental status
2. Change in behaviour that fluctuates from normal to abnormal over a 24-hr period
3. Difficulty in focusing attention
4. Disorganized thinking and/or altered level of consciousness
Always consider patient’s trajectory in the disease process, wishes and goals of care. Discuss treatment with care team and Substitute Decision Maker.
| Symptom |
Assessment |
Consideration |
| Drugs-Toxicity? |
- 6 or more medications, especially:
- Narcotics
- Antipsychotics
- Anticholinergics
- Antidepressants
- Anticonvulsants
- Age 75 or older receiving a medication for more than 5 years
|
|
| Electrolyte Disturbances |
- Gastrointestinal problems
- Immobility for more than 1 day in persons previously mobile
- Abdominal distention
- Decreased number of bowel movements or constipated stool
- Decreased fluid intake – dehydration
- Decreased food intake, especially bulk
- Hyperglycemia / Hypoglycemia/ Hypercalcemia
|
- Initiate appropriate bowel regimen, e.g. enema
- Order blood test as indicated
|
| Lack of Drugs? |
- Long-term sedatives (including alcohol and sleeping pills) are stopped
- Pain drugs are not being given adequately.
|
- Pain management team
- Family support/ education
|
| Infection |
- Elevation in baseline temperature
- History of chronic infection
- Recent episode of falling
|
- Appropriate diagnostic tests as indicated:
- urinalysis, / chest X-ray, / sputum cultures
|
| Reduced Sensory Input |
- What is the baseline normal sleep pattern?
- Psychosocial/Environmental?
- Grief/loss
- Alteration in personal space
- Recently admitted to hospital
- Increase or decrease in sensory stimulations
|
- Identify causes of sleep disturbances, e.g. medications / pain / environment
- Initiate assessment:
- ADLs / Safety / User-friendly environment / Supports
- Encourage family involvement
|
| Intracranial |
- Changes in chronic illness?
- Diabetes Mellitus
- COPD/Hypoxia
- Cancer
- Dementia
- Substance Misuse
|
- Request appropriate diagnostic tests (Exacerbation may be accompanied by increased levels of pain and/or decreased functional abilities)
|
| Urinary Problems |
- History of incontinence, retention, or indwelling catheter
- Signs or symptoms of dehydration, tenting, increased BUN
- Decreased urinary output
- Taking anticholinergic medication
- Abdominal distention
|
- Request in-out catheterization for postvoid residual and/or incontinence assessment, or both.
|
| Myocardial |
- New disease process?
- Silent MI / CHF
- GI bleed
- Other
|
- Request appropriate diagnostic tests (e.g., PE, pulse oximetry, EKG, hemoglobin and hematocrit, chemistry screen, electrolytes, TSH, specific test for cancer detection, CAT)
|
|
Download Tip of the Month
PDF – Searching for the Cause of Delirium
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