Acute Confusion (Delirium)

MAJOR CRITERIA

  • Acute onset and fluctuating course
  • Disorder of attention (inattention)

MINOR CRITERIA         

  • Disorganized thinking
  • Alterations in sensorium

*diagnosis of delirium requires both major plus any one minor criteria

 PATIENT ID

 Chief Complaint*
* Need several iterations of the history, from several caregivers (may have large inter-observer differences in opinion)

History of Present Illness

  • Onset Acute
    • Chronic (acute if < 2 – 3 months, > 3 months represents a dementing state)
  • Progress (gradual decline, static, rate of fluctuation)
  • Palliating
  • Precipitating
  • Quality
    • AIDS, altered LOC, disorientation, memory, psychomotor agitation/retardation, altered sleep-wake cycle
  • Severity
    • ADL → getting out of bed, using the bathroom, dressing, ambulation
    • IADL → cooking, laundry, shopping, banking, paying bills, driving
    • Safety concerns
    • Cognitive function (MMSE)
  • Symptoms
    • Behaviour changes – agitation
    • SAH → thunderclap headache
    • Stroke → aphasia, paralysis
    • UTI → dysuria
    • Pneumonia → cyanosis, cough, sputum, fever



 

Functional History

  • ADLs
  • IADLs
  • Behaviour changes
  • Safety

Medication

  • Benzodiazepines
  • Beta-blockers
  • Anticholinergics

Past Medical History

  • Trauma
  • Stroke
  • CAD
  • Endocrinopathy
  • Kidney
  • Psychriatric history

Family History

  • Dementia
  • Depression

Social History

  • EtOH
  • Social support (caregiver stress)
  • Living arrangements

ROS

  • Sleep pattern
  • Visual changes
  • Hearing loss
  • Constipation
  • Incontinence

Differential Diagnosis

  • Drugs
  • Infection
  • Fluids/lytes
  • Multiple
  • Unknown

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