"Delirium is a common clinical syndrome characterized by inattention and acute cognitive dysfunction.”

1. By-
Mr. Kishor Supet
MSc. (N), PSN (SMHS)

3. INTRODUCTION-
• Acute confusional state
• Present in hypoactive,
hyperactive or mixed forms.
• Delirium itself is not a disease,
but rather a clinical syndrome
(a set of symptoms).

4. DEFINITION-
• Acc. to “Ramkumar Gupta”-
“Delirium is a common clinical
syndrome characterized by inattention
and acute cognitive dysfunction.”
• Acc. to “K.P. Neerja”-
“an acute organic mental disorder
characterized by impairment in
attention, concentration and
conciousness added by disturbance in
thinking and perception.”

5. INCIDENC E-
• 20-40 % of genetic clients, in
hospitalization.
• In post operative cases highest
incidence was notice.

6. DELIRIUM BY OTHER NAMES -
• Intensive care unit psychosis
• Acute confusional state
• Acute brain failure
• Encephalitis
• Encephalopathy
• Toxic metabolic state
• Central nervous system toxicity
• Sun downing

7. CLASSIFICATION OF DELIRIUM-
• General medical condition ( infection)
• Substance induced (cocaine, opioid)
• Substance withdrawal
• Multiple causes (head trauma & kidney
disease)
• Delirium not otherwise specified.

8. MAJOR CAUSES OF DELIRIUM -
• Central nervous system disease (eg.-
epilepsy),
• Systematic disease (eg. Cardiac failure)
and
• Either intoxication or withdrawal from
pharmacological or toxic agents.

9. Predisposing factors-
• Older age
• Physical comorbidity (biventricular failure,
cancer, cerebrovascular disease)
• Psychiatric comorbidity (e.g. depression)
• Sensory impairment (vision, hearing)

10. Precipitating factors-
• Metabolic
– Malnutrition
– Dehydration, electrolyte imbalance
• Infection
– Especially respiratory and urinary tract
infections.
• Other
- Substance withdrawal, esp. alcohol.

11. PSYCHOPATHOLOGY-
Due to any etiological factor
Impair metabolism of neuron cells
Over activation of the brain
Brain tissue dysfunction
Mental confusion, hallucination (Delirium)

12. DIAGNOSTIC -
 Patient History
 Physical Examination
 Laboratory Test
 Complete Blood Count
 Urine Analysis Test
 Blood Glucose Test

13. DIAGNOSTIC CRITERIA -
A. Reduced ability to maintain attention to external
stimuli and to appropriately shift attention to new
external stimuli.
B. Thinking is disorganized. Indicators include
rambling, irrelevant, or incoherent speech.

14. CONT.. -
C. At least two of the following :
1. Reduced Level Of Consciousness (Eg. Difficulty
Keeping Awake During Examination)
2. Perceptual Disturbances ; Misinterpretations,
Illusions, Or Hallucinations.
3. Disturbance Of Sleep-wake Cycle With Insomnia Or
Daytime Sleepiness
4. Increased Or Decreased Psychomotor Activity
5. Disorientation To Time, Place, Or Person
6. Memory Impairment

15. Cont. . .
D. Clinical features develop over a short period
of time .

16. CLINICAL FEATURES-
 Disorientation
 Mental confusion
 Thinking is disturbed
 MOOD
- apathy, depression and euphoria.
 Perception
-Hallucination
(auditory, visual)
 Language and cognitiion

17. Neurological symptoms
• including –
dysphasia,
tremor,
in coordination and
urinary incontinence

18. TREATMENT
• To treat underlying condition that is
causing the delirium.
• When the condition is anti-cholinergic
toxicity . The use of physostigmine
salicylate 1 to 2mg IV or IM with
repeated dose in 15-30 minutes .
• Physical support .

19. MANAGEMENT -
PHARMACOLOGICAL TREATMENT-
 two major symptoms of delirium that
may require pharmacological
treatment are psychosis and
insomnia .
 Drug of choice for psychosis is
Haloperidol, a butyrophenone
 Environmental Modification –
re-orientation techniques such as
Calendar, Clocks, and family
photos may be helpful.

20. NURSING MANAGEMENT-
• To provide calm & quite
environment.
• To minimize the risk of injury.
• Communicate clearly and give
explaination in simple language.
• Administer medications at proper
time .
• Observe the patient activity .

21. • Diet
• Medication
• Exercise
• Rest and sleep
• Personnel hygiene
• Follow up