Delirium by manish Bijalwan
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Delirium by manish Bijalwan Delirium by manish Bijalwan Presentation Transcript

  • 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.
  • -Mr. Manish Bijalwan M.Sc Nursing 1st Year SCON
  • Delirium is sudden severe confusion and rapid changes in brain function that occur with physical or mental illness
  •      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.
  •  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.
  • Delirium is a serious disturbance in a person's mental abilities that results in a decreased awareness of one's environment and confused thinking.
  •      DELIRIUM DUE TO GENERAL MEDICAL CONDITION SUBSTANCE INDUCED DELIRIUM SUBSTANCE INTOXICATION DELIRIUM SUBSTANCE WITHDRAWAL DELIRIUM DELIRIUM DUE TO MULTIPLE ETIOLOGIES
  • 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  
  •  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.
  • 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
  • Reduced awareness of the environment 1.  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
  • Poor thinking skills (cognitive impairment) 2.       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
  • 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
  •      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.
  • Differences 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.
  •  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.
  • 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
  •   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
  •  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.
  •  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
  • 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 
  •     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
  • 1. 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
  • ▪ 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
  • 2. 3. 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. 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
  • 4. 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
  • 5. 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
  • 6. 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.
  • Townsend M C. Psychiatric Mental Health Nursingconcepts 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. 1.
  •  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/diseasesconditions/delirium/basics/prevention/con-20033982