 Delirium  Is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional

deficits and generalized severe disorganization of behavior.  Involves other cognitive deficits, changes in arousal (hyperactive, hypoactive, or mixed), perceptual deficits, altered sleep-wake cycle, and psychotic features such as hallucinations and delusions.  Often caused by a disease process outside the brain, such as infection (urinary tract infection, pneumonia) or drug effects, particularly anticholinergics or other CNS depressants (benzodiazepines and opioids).  Itself is not a disease, but rather a clinical syndrome (a set of symptoms), which result from an underlying disease or new problem with mentation.  Predisposing factors:  Metabolic Causes a. Hypoxia b. Hypoglycaemia c. Hepatic encephalopathy, uremic encephalopathy d. Cardiac failure, cardiac arrhythmias e. Water and electrolyte imbalance f. Metabolic acidosis g. Fever, anemia, hpovolemic shock  Endocrine Cases a. Hypo/hyper pitutairism b. Hypo/hyper thyroidism c. Hypo/hyper parathyroidism d. Hypo/hyper adrenalism  Drugs and Poisions a. Digitalis, guanidine and anti hypertensives b. Alcohol, sedatives and hypnotics c. Trycyclic antidepressants and antipsychotics d. Anti convulsants-levo dopa e. Salicylates, steroids and penecilin f. Methyl alcohol and heavy metals  Nutritional Defeciencies a. Thiamin, Niacin, Folic Acid and B12  Systemic infections a. Acute or chronic infections (septicaemia, pneumonia and endocarditis)  Intracranial Causes a. Epilepsy b. Head injury c. Intracranial infections d. Stroke e. Focal lesions

Miscellaneous Causes a. Post operative states b. Sleep deprivation c. Heat, electricity and radiation Categories:  Delirium due to medical condition  In this type, the delirium is due to direct physiological consequences of a general medical condition.  Substance induced delirium  This disorder is characterized by the symptoms of delirium that are attributed to medication side effects.  Substance intoxication delirium  Delirium arises within minutes to hours after taking relatively high dose of certain drugs.  Substance withdrawal delirium  It occurs after reduction or termination of sustained usually high dose of certain substances.  Delirium due to multiple etiologies  It is associated with more than one cause.  It may be a result of combined effect of general medication and substance use. Common clinical features:  Impairment of Consciousness  Is the key feature that separates delirium from most other psychiatric disorders.  There is a fluctuation in intensity and symptoms that are often worse at night.  The patient may be unmistakably drowsy, they may manifest reduced performance, they may also manifest disorientation to time, place and person.  Appearance and behaviour  The patient looks unwell and behaviour may be marked by agitation or hypoactivity.  Mood  Is frequently labile, with perplexity, intermittent periods of anxiety and depression or occasionally of other mood states such and elation and irritability.  Speech  The patient may mumble and become incoherent.  Perception  Visual perception is the modality most often affected,  Illusions and misinterpretations are frequent.  Cognition  Memory registration, retention and recall are all affected.  Orientation 

 Teach them about the importance of safety. in order to lessen their worries. usually one at a time.  Orientation to person. Nursing Interventions  Assessment  Client history  Type. maintaining safety and achieving a familiarity and consistency for the patient.  Environmental Interventions  Environmental manipulations are directed toward providing the right amount of stimulation for the patient.  Memory  There is impaired registration. alternative explanations of events should be offered and frequent reassurance should be given. Management  4 key steps:  Addressing the underlying cause  Maintain behavioural control  Prevent further complications  Support functional needs  Physical Interventions  General measures to support cerebral function such as intravenous hydration and appropriate nourishment. time and place will be all disturbed.  Supplemental oxygen has been found to be highly effective in patients who develop delirium with pneumonia. short term recall and long term recall. encouraging sleep.  Cognitive Interventions    Reorientation is one of the most easily accomplished cognitive interventions.  Pharmacologic interventions  Administration of Thiamine and IV fluids.  Observe for evidences of disease of other organs. once a mainstay in the treatment of delirium are now used only when all pharmacological and nonpharmacological interventions have failed. Concentration  Is impaired.  Suggest that family members visit the patient.  Small doses of benzodiazepines or antipsychotics may be given orally or parenterally.  Provide reassurance to the family of the patient that delirium is often temporary and is the result of a medical condition. maximising the patient’s ability to perceive the environment accurately. frequency and severity of mood swings  Personality and behavioural changes  Catastrophic emotional reactions  Language difficulties  Orientation to time.  Sleep  Insomia begins to occur along with day time drowsiness. person and place  Appropriateness or social behaviour  Physical assessment  Observe for signs of damage to the nervous system. and provide and calm and structure environment.  Health Teaching  Educate the families and patients regarding the cause of delirium. Psychologic interventions  The delusions expressed by a patient should not be directly disputed.  Insight  Patient will have no understanding of why a psychiatric assessment has been requested.  .  Physical restraints. Instead.

Sign up to vote on this title
UsefulNot useful