Kingdom of Saudi Arabia

The Ministry of Education
Al Baha university
Faculty of Applied Medical Sciences
Department of Nursing

Delirium
By: Morouj Ali

Dr. Naglaa
Outline

 Introduction
 Definition of delirium
 Symptoms of delirium
 Difference between delirium and dementia
 Diagnosis of delirium
 Cause of delirium and high risk factors
 Treatment and support of delirium
 Nursing management of delirium
 summary
Objective

■ By the end of this presentation I expect you able to :

■ Definition of delirium
■ Describe the symptoms of delirium
■ Distinguish between delirium and dementia
■ Know the diagnosis of delirium
■ Explain the causes and risk factors for delirium
■ Discuss treatment and support for delirium
■ Understanding the nursing management of delirium
Introduction

■ Delirium, or a confused mental state, occurs suddenly. A person has a change in mental
status and acts disoriented and distracted.
■ Delirium is more common in older adults, especially those with dementia, and people
who need hospitalization.
■ Prompt treatment is essential in helping a person with delirium recover.
?What is delirium

■ Delirium is sudden severe confusion due to rapid changes in brain function that occur

with physical or mental illness.
■ It’s much more common in older people, especially those with dementia
■ Delirium is usually temporary and can often be treated effectively.
What are the symptoms of delirium?

■ Symptoms of delirium often fluctuate (come and go)

■ There are three types based on the symptoms:
1. Hyperactive delirium

:A person with hyperactive delirium may

seem restless-
be agitated (for example, with more walking about or pacing)-
 resist personal care or respond aggressively to it-
.seem unusually vigilant-
Someone with hyperactive delirium can easily get very distressed due to not understanding
where they are or losing track of time. They may have delusions or hallucinations that
.carers are trying to harm them
2. Hypoactive delirium

:A person with hypoactive delirium may be

withdrawn, feeling lethargic and tired-
 drowsy-
unusually sleepy-
.unable to stay focused when they’re awake -
It can be easy not to notice that someone has hypoactive delirium, because they may be very quiet.
The person may stop eating as much or become less mobile than usual. They may spend more time
 .in bed
3. Mixed delirium

A person with mixed delirium has symptoms of hyperactive delirium at times and
symptoms of hypoactive delirium at other times. They will switch between these symptoms
over the day or from one day to the next. For example, they could be very agitated at one
time and then later become very drowsy.
How is delirium different from dementia?

■ Delirium is different from dementia. But they have similar symptoms, such as
confusion, agitation and delusions. If a person has these symptoms, it can be hard for
healthcare professionals who don’t know them to tell whether delirium or dementia is
the cause. When a person with dementia also gets delirium they will have symptoms
from both conditions at once.
How is delirium different from dementia?
(cont’d)
■ There are important differences between delirium and dementia. Delirium starts
suddenly (over a period of one to two days) and symptoms often also vary a lot over the
day. In contrast, the symptoms of dementia come on slowly, over months or even years.
So if changes or symptoms start suddenly, this suggests that the person has delirium.
How is delirium diagnosed?

■ It’s really important that a person’s delirium is diagnosed quickly, Delirium is a serious
condition and is linked to severe problems if it isn’t treated.
■ can diagnose delirium on the basis of medical history, tests to assess mental status and
the identification of possible contributing factors.
■ As well as diagnosing the person’s delirium, healthcare professionals will do other tests
to work out what has caused the delirium.
For example, they may take blood samples or possibly a chest x-ray. This is important
because treating the cause of the delirium will usually help the person’s symptoms improve
or go away.
Who gets delirium and why?
■ Delirium is common, particularly among older people in hospital. It’s usually the
reaction of the brain to a separate medical problem (or several medical problems at
once).
Who gets delirium and why? (cont’d)
■ Problems that can cause delirium include:
■ pain
■ infection
■ poor nutrition
■ constipation (not pooing) or urinary retention (not peeing)
■ dehydration
■ low levels of blood oxygen
■ a change in medication
■ abnormal metabolism (for example, low salt or blood sugar levels)
■ an unfamiliar or disorientating environment.
Who gets delirium and why? (cont’d)

■ Anyone can get delirium, but the following factors put people at higher risk:
■ dementia – this is the biggest single risk factor for delirium
■ aged over 65
■ frailty
■ multiple medical conditions
■ poor hearing or vision
■ taking multiple medications (for example, antipsychotics, benzodiazepines and certain
antidepressants)
■ having already had delirium in the past.
What is treatment and support for
delirium?
■ Delirium is treated first by addressing the medical problem(s) that have caused it. For example, if the person
has low blood oxygen or low blood sugar levels these will be corrected quickly. If the person has an infection
they may be given antibiotics. If they are in pain, constipated or not passing urine then these will be treated.

■ Doctors will also review the person’s medication and stop any non-essential drugs that may be linked to
delirium. Staff will make sure the person is supported to eat and drink regularly.

■ Delirium will usually improve if its cause is found and treated.

■ A supportive and calm environment can also help someone recover from delirium.
What is treatment and support for
delirium?(cont’d)
■ Nursing staff, and visiting family and friends, can all help by:

■ talking calmly to the person in short clear sentences, reassuring them as to where they are and who
you are
■ supporting the person with familiar objects from home, such as photographs
■ making sure that any hearing aids and glasses are clean and working and that the person is wearing
them
■ setting up a 24-hour clock and calendar that the person can see clearly
■ helping the person develop a good sleep routine, including reducing noise and dimming lights at night
■ reassuring the person if they have delusions
What is treatment and support for
delirium?(cont’d)
■ supporting the person to be active – to sit up or to get out of bed – as soon as they safely
can
■ helping the person to eat and drink regularly
■ not moving the person unnecessarily – either within and between hospital wards, or into
hospital if delirium is being managed at home.
■ Doctors won’t normally give someone medication to treat delirium, because there is
very little evidence that drugs help. Drugs should be considered only if the person’s
behavior (for example, severe agitation in hyperactive delirium) poses a risk of harm to
themselves or others, or if hallucinations or delusions are causing the person severe
distress.
Nursing Management

A. Nursing Diagnosis:
- Risk for trauma related to impairment in cognitive and psychomotor function.
Nursing intervention:
- Store frequently use items within easy access.
- Keep the dim light on at night.
- Soft restraints may be required if client is very disoriented and hyperactive.
- Frequently orient the client to place, time, and situations.
Nursing Management (cont’d)

B. Nursing Diagnosis:
- Disturbed thought process related to cerebral degeneration as evidenced by disorientation,
confusion, and memory deficits.
Nursing intervention:
- Frequently orient to reality.
- Use clock and calendars with large number that are easy to read.
- Monitor for medication side effects.
- Keep simple explanation.
- Talk about real people and real events.
Nursing Management (cont’d)

C. Nursing Diagnosis:
- Self-care deficit related to disorientation, confusion, and memory deficits as evidence by
in ability to fulfil the need.
Nursing intervention:
- Provide guidance and assistance for independent action.
- Provide the structural schedule of activities that does not change from day to day.
- Involve the family members in the care of the patients.
Summary

■ Delirium is a common problem among older adults, especially those frail and
compromised
■ Nursing care for individual with delirium is aimed at discovering and treating
underlying causes
 End sentence

Delirium is not a disease, It’s a changed mental state.

Reference

■ https://www.alzheimers.org.uk/get-support/daily-living/delirium
■ https://www.mayoclinic.org/diseases-conditions/delirium/diagnosis-treatment/drc-20371
391
■ https://my.clevelandclinic.org/health/diseases/15252-delirium
■ https://ar.wikipedia.org/wiki/‫هذيان‬
■ https://www.osmosis.org/learn/Delirium
■ https://www.healthline.com/health/delirium
■ http://www.yhscn.nhs.uk/media/PDFs/mhdn/Dementia/Delirium/Delirium-Presentation-
%20mid%20yorks.pdf
Thank you