NHG-standaard (Geneeskunde): Delier - M77

(Hetero)anamnese

De aard van de verschijnselen, het begin en beloop, fluctuatie van de symptomen over de dag moeten worden uitgevraagd bij verdenking op een delier. Verschijnselen van infectie, neurologische, cardiale, respiratoire, metabole en endocriene aandoeningen moeten worden uitgevraagd. Ook moet voeding en vochtinname nagevraagd worden, evenals de medicatie en zelfzorgmiddelen. Een slaaptekort, visus- en gehoorbeperking en pijn en urineretentie, obstipatie, recent trauma, medische ingreep, immobiliteit en anesthesie duiden allemaal op een delier.

Lichamelijk onderzoek

Het lichamelijk onderzoek bij verdenking op delier bestaat uit het verkrijgen van een algemene indruk, tekenen van hypoxie en de hydratatietoestand. Verder kan de bloeddruk, polsfrequentie en temperatuur gemeten worden. Het hart en de longen kunnen geausculteerd worden en er kan blaasonderzoek plaatsvinden. Er moet gelet worden op neurologische uitvalsverschijnselen en aanwijzingen voor uitwendig letsel, fractuur en factoren die de pijn luxeren.

Aanvullend onderzoek

Het aanvullend onderzoek dat direct kan uitgevoerd worden bij een delier zijn de glucosespiegel, nitriettest, zuurstofsaturatie. Verder kan de BSE, CRP, Hb, Ht, leukocyten en TSH bepaald worden, evenals creatinine, kalium calcium, ALAT, gamma-GT. Er kan ook een dipslide of urinesediment worden uitgevoerd.

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