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
-Mr. Manish Bijalwan
M.Sc Nursing 1st Year
Delirium is sudden severe confusion and rapid changes
in brain function that occur with physical or mental
ICD 10 F05
Delirium itself is not a disease, but rather a
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.
changes in arousal (hyperactive, hypoactive, or mixed)
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
DELIRIUM DUE TO GENERAL MEDICAL
SUBSTANCE INDUCED DELIRIUM
SUBSTANCE INTOXICATION DELIRIUM
SUBSTANCE WITHDRAWAL DELIRIUM
DELIRIUM DUE TO MULTIPLE ETIOLOGIES
Infections, such as urinary tract infection, pneumonia,
and skin and abdominal infections.
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:
Allergy medications (antihistamines)
Medications for mood disorders, such as anxiety and depression
Parkinson's disease medications
Drugs for treating spasms or convulsions
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
Reduced awareness of the environment
An inability to stay focused on a topic or to
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)
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
Seeing things that don't exist (hallucinations)
Restlessness, agitation, irritability or combative
Disturbed sleep habits
Extreme emotions, such as fear, anxiety, anger or
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
difficult to distinguish
a person may have both
In fact, frequently delirium occurs in people
Differences are based on:
Delirium occurs within a short time
dementia usually begins with relatively minor symptoms
that gradually worsen over time.
The inability to stay focused or maintain attention is
significantly impaired with delirium.
A person in the early stages of dementia remains generally
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
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.
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
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,
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
(haloperidol, quetiapine, or risperidone are
most commonly used)
SEDATIVES (clonazepam or diazepam) in
cases of delirium due to alcohol or sedative
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
▪ 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
▪ 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
▪ Provision of eyeglasses, hearing aids and other adaptive
equipment as needed
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
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
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
Approach the person calmly
Identify yourself or other people regularly
Keep noise levels and other distractions to a minimum
Help the person keep a regular daytime schedule
Maintain and provide eyeglasses and hearing aids
Prevent complicating problems
Help prevent medical problems by:
Giving the person his or her medication on a
Providing plenty of fluids and a healthy diet
Encouraging regular exercise and activity
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.
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