A woman in her early 50s was admitted to a hospital because of increasingly odd behavior. Her family

reported that she had been showing memory problems and strong feelings of jealousy. She also had become disoriented at home and was hiding

objects. During a doctor's examination, the woman was unable to remember her husband's name, the

year, or how long she had been at the hospital. She could read but did not seem to understand what she read, and she stressed the words in an

unusual way. She sometimes became agitated and seemed to have hallucinations and irrational fears.

DELIRIUM

-Mr. Manish Bijalwan M.Sc Nursing 1st Year SCON

DELIRIUM

Delirium is sudden severe confusion and rapid changes in brain function that occur

with physical or mental illness

Delirium

ICD 10 F05 Delirium itself is not a disease, but

rather a clinical syndrome. acute confusional state Present with severe confusion and

disorientation, developing with relatively rapid onset and fluctuating in intensity.

decline from a previously attained baseline level of cognitive function.

Delirium

Involve cognitive deficits changes in arousal (hyperactive, hypoactive, or

mixed) perceptual deficits altered sleep-wake cycle psychotic features such as hallucinations and

delusions more frequently in people in their

later years. onset is usually sudden, often within

hours or a few days.

Definition

Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's

environment and confused thinking.

CATEGORIES OF DELIRIUM

DELIRIUM DUE TO GENERAL MEDICAL CONDITION

SUBSTANCE INDUCED DELIRIUM SUBSTANCE INTOXICATION DELIRIUM SUBSTANCE WITHDRAWAL DELIRIUM DELIRIUM DUE TO MULTIPLE

ETIOLOGIES

ETIOLOGY Dehydration Infections, such as urinary tract infection,

pneumonia, and skin and abdominal infections. Dementia Older age Fever and acute infection, particularly in children Previous delirium episodes Visual or hearing impairment Poor nutrition or dehydration Severe, chronic or terminal illness Multiple medical problems or procedures Treatment with multiple drugs Alcohol or drug abuse or withdrawal

ETIOLOGY A number of medications or combinations of

medications can trigger delirium, including some types of: Pain medications Sleep medications Allergy medications (antihistamines) Medications for mood disorders, such as anxiety and

depression Parkinson's disease medications Drugs for treating spasms or convulsions Asthma medications

Delirium may have more than one cause, such as a medical condition and medication toxicity.

Psychophysiology

combination of factors

make the brain vulnerable and trigger a malfunction in brain activity

normal sending and receiving of signals in the brain becomes

impaired

Delirium

SIGN & SYMPTOMS

1. Reduced awareness of the environment

An inability to stay focused on a topic or to change topics

Wandering attention Getting stuck on an idea rather than

responding to questions or conversation Being easily distracted by unimportant things Being withdrawn, with little or no activity or

little response to the environment

SIGN & SYMPTOMS

2. Poor thinking skills (cognitive impairment)

Poor memory, particularly of recent events Disorientation, or not knowing where one

is, who one is or what time of day it is Difficulty speaking or recalling words Rambling or nonsense speech Difficulty understanding speech Difficulty reading or writing

SIGN & SYMPTOMS

3. Behavior changes Seeing things that don't exist

(hallucinations) Restlessness, agitation, irritability or

combative behavior Disturbed sleep habits Extreme emotions, such as fear, anxiety,

anger or depression

DELIRIUM vs DEMENTIA

Dementia is the progressive decline of memory and other thinking skills due to the gradual dysfunction and loss of brain cells.

The most common cause of dementia is Alzheimer's disease.

difficult to distinguish a person may have both In fact, frequently delirium occurs in

people with dementia.

DELIRIUM vs DEMENTIADifferences are based on:

Onset Delirium occurs within a short time dementia usually begins with relatively minor

symptoms that gradually worsen over time.

Attention The inability to stay focused or maintain

attention is significantly impaired with delirium. A person in the early stages of dementia

remains generally alert.

DELIRIUM vs DEMENTIA Fluctuation

The appearance of delirium symptoms can fluctuate significantly and often throughout the day.

While people with dementia have better and worse times of day, their memory and thinking skills stay at a fairly constant level during the course of a day.

Complications Delirium may last only a few hours or as long as

several weeks or months. If factors contributing to delirium are addressed,

the recovery time is often shorter. The degree of recovery depends to some extent on

the health and mental status before the onset of delirium.

Delirium people is also more likely to lead to: General decline in health Poor recovery from surgery Need for institutional care Increased risk of death

DIAGNOSTIC EVALUATION

History Mental status assessment

awareness, attention and thinking. mental state, perception and memory.

Physical and neurological exams checking for signs of dehydration, infection, alcohol

withdrawal and other problems. Delirium may be the first or only sign of a serious condition,

such as respiratory failure or heart failure. A neurological exam — checking vision, balance, coordination

and reflexes — can help determine if a stroke or another neurological disease is causing the delirium.

Other possible tests.  blood, urine and other diagnostic tests. Brain-imaging tests

MANAGEMENT

The first goal of treatment for delirium is to address any underlying causes or triggers — by stopping use of a particular medication, for example, or treating an infection.

Treatment then focuses on creating the best environment for healing the body and calming the brain.

PREVENTIVE MANAGEMENT Most successful approach is to prevent

triggering factor Hospital environments: frequent room

changes, invasive procedures, loud noises, poor lighting and lack of natural light can worsen confusion.

Provide adequate fluids

PREVENTIVE MANAGEMENT Provide stimulating activities and familiar

objects Encourage the use of eyeglasses and hearing

aids, if applicable Use simple and regular communication about

people, current place and time Provide mobility and range-of-motion exercises Reduce noise and avoid sleep interruptions Provide appropriate pain management and

offer nondrug treatment for sleep problems or anxiety

MEDICAL MANAGMENT

ANTIDEPRESSANTS (fluoxitine, citalopram), if depression is present

DOPAMINE BLOCKERS (haloperidol, quetiapine, or risperidone are most commonly used)

SEDATIVES (clonazepam or diazepam) in cases of delirium due to alcohol or sedative withdrawal

THIAMINE SUPPLEMENTS

HOSPITALIZED LIFE PROGRAM

NURSING MANAGEMENT1. Supportive care

to prevent complications by protecting the airway, providing fluids and nutrition, assisting with movement, treating pain, addressing incontinence and keeping people with delirium oriented to their surroundings.

A number of simple, nondrug approaches may be of some help:▪ Clocks and calendars to help a person stay

oriented▪ A calm, comfortable environment that includes

familiar objects from home▪ Regular verbal reminders of current location and

what's happening▪ Involvement of family members

NURSING MANAGEMENT▪ Avoidance of change in surroundings and

caregivers▪ Uninterrupted periods of sleep at night, with low

levels of noise and minimal light▪ Open blinds during the day to promote daytime

alertness and a regular sleep-wake cycle▪ Avoidance of physical restraints and bladder

tubes▪ Adequate nutrition and fluid▪ Use of adequate light, music, massage and

relaxation techniques to ease agitation▪ Opportunities to get out of bed, walk and perform

self-care activities▪ Provision of eyeglasses, hearing aids and other

adaptive equipment as needed

NURSING MANAGEMENT

2. Coping and support If you're a relative or caregiver of someone at risk

of or recovering from delirium, you can take steps to improve the person's health, prevent a recurrence and help manage responsibilities.

3. Promote good sleep habits To promote good sleep habits: Keep inside lighting appropriate for the time of

day Encourage exercise and activity during the day Offer warm, soothing, non caffeinated beverages

before bedtime

NURSING MANAGEMENT4. Promote calmness and orientation

Provide a clock and calendar and refer to them regularly throughout the day

Communicate simply about any change in activity, such as time for lunch or time for bed

Keep familiar and favorite objects around, but avoid a cluttered environment

Approach the person calmly Identify yourself or other people regularly Avoid arguments Keep noise levels and other distractions to a

minimum Help the person keep a regular daytime

schedule Maintain and provide eyeglasses and hearing

aids

NURSING MANAGEMENT5. Prevent complicating problems

Help prevent medical problems by: Giving the person his or her medication

on a regular schedule Providing plenty of fluids and a healthy

diet Encouraging regular exercise and

activity

NURSING MANAGEMENT6. Caring for the caregiver

If you're providing regular care for a person with or at risk of delirium, consider ▪ support groups▪ educational materials▪ other resources offered by the person's health

care provider, nonprofit organizations, community health services and government agencies.▪ E.g. National Family Caregivers Association

and the National Institute on Aging.

References

1. Townsend M C. Psychiatric Mental Health Nursing-concepts of care. (3 rd edition). F.H Davis Publishers; Philadelphia: 2000. Pg.No. 158-160.

2. Kapoor B. Text book of psychiatric nursing. Publishers of medical and nursing books; Delhi: 2006.Pg.No. 997-998.

3. Sreevani R.A guide to mental health and psychiatric nursing. Jaypee Brothers Medical Publishers; New Delhi: (2006). Pg.No. 159-163.

4. Stuart gail.w. principles & practices of Psychiatric Nursing. (9th edition). Elsevier publishers: 2011. Pg. No. 115-120.

References Gleason OC (March 2003). "Delirium". Am Fam

Physician67 (5): 1027–34.  American Psychiatric Association (2000). Diagnostic and

statistical manual of mental disorders (4th ed., text revision). Washington DC: American Psychiatric Association.

de Rooij, SE; Schuurmans, MJ; van der Mast, RC; Levi, M (July 2005). "Clinical subtypes of delirium and their relevance for daily clinical practice: a systematic review.". International journal of geriatric psychiatry 20 (7): 609–15.

Hopkins, RO; Jackson, JC (September 2006). "Long-term neurocognitive function after critical illness.". Chest 130 (3): 869–78. 

http://www.mayoclinic.org/diseases-conditions/delirium/basics/prevention/con-20033982

ANY DOUBT??