Delirium for Nursing students

1. DELIRIUM

2. DELIRIUM (acute mental disorder)
Definition: It is a state of temporary but acute mental confusion is common.
Life threatening and possibly preventable syndrome in older adults.
Precipitating factors:-
1. Demographic characteristics.
• Age of 65 years / older.
• Male gender.
2. Cognitive status.
• Dementia.
• Cognitive impairment.
• History of delirium.
• Depression.
3. Environmental.
• Admission to ICU.

3. • Use of physical restraints.
• Pain (especially untreated).
• Emotional stress.
• Prolonged sleep deprivation
4. Functional statuses.
• Functional dependence.
• Immobility
• History of falls.
5. Sensory.
• Sensory deprivation.
• Sensory overload.
6. Decreased oral intake.
• Dehydration.

4. • Malnutrition
7. Drugs.
• Sedative hypnotics.
• Opioids
• Anticholinergic drugs.
• Treatment with multiple drugs.
8. Coexisting medical conditions.
• Severe acute illness.
• Chronic renal / hepatic disease.
• History of stroke, Neurologic disease.
• Infection / sepsis
• Fracture / trauma.
• Terminal illness

5. • HIV infection.
9. Surgery. / Anaesthesia.
• Orthopaedic surgery.
• Cardiac surgery & non cardiac surgeries.
• Prolonged cardiopulmonary bypass
10. Physiologic insults
• Hypoxia
• Hypoglycaemia
• Dehydration
11. Health Problems
• Heart failure
• Cognitive Impairment
• Cancer

6. • Sensory Limitations
GLOBAL
DISTURBANCE
of
COGNITION
IMPAIRED
CONSCIOUSNESS
and
ATTENTION DELIRIUM
PSYCHOMOTOR
DISTURBANCE
DISTURBANCE
of
CIRCADIAN
RHYTHMS
EMOTIONAL
DYSREGULATION

9. Clinical characteristics
• Onset - Rapid often at night ,Course - Fluctuates, lucid intervals
• Progression - Abrupt, Duration - 2 hours to < 1 month
• Awareness - Reduced, Alertness - Fluctuates, lethargic, hypervigilant
• Orientation - Fluctuates in severely, generally impaired
• Thinking - Disorganized, distorted, fragmented, slow or accelerated
incoherent speech
• Perception - Distorted, illusions, delusions, hallucinations.
• Psychomotor behaviour - Variable, hypokinetic hyperkinetic or mixed
• Sleep- wake cycle - Disturbed cycle (severe)
• Mental Status testing - Distracted from the task, poor performance
improves when the patient recovers.

10. Clinical manifestations:-
o Inability to concentrate, Altered Consciousness. o Irritability,
Extreme Distractibility. o Insomnia o Agitation
o Misinterpretation, impaired reasoning. o Clouded sensorium,
impairment of recent memory. o Restlessness o Loss of appetite o
Confusion o Misperception o Hallucination
o Disorientation, incoherent speech o Impaired sleep wake cycle
o Automatic manifestations - tachycardia, sweating, flushed face,
dilated pupil, altered BP o Cognitive impairment occurs suddenly.

11. Diagnostic evaluations:-
• Medical & Psychological history
• Physical examination
• Mini - MSE
• CBC, Serum Electrolytes, BUN & Creatinine
• ECG
• Urinalysis
• Liver & thyroid function test
• O2 Saturation level
• LP - CSF analysis for glucose & protein /Base
• X rays, CT scan, MRI
• Thiamine and VitaminB12 level.
• S100B-Serum marker of Delirium.

12. Pharmacological management:-
Along with Fluid and Nutrition management.
Medical management of Delirium
Sl
no
Drug group Action Example Nurses responsibility
1 Clonidine
hydrochloride Antihypertensive,
Central analgesic,
sympatholytic control
blood pressure
Apo-Clonidine
Duracolan
Contra indicated for patient with pacemaker, pregnant and
lactating mother.
Monitor the blood pressure carefully as hypotension may
occur.
Perform sensitivity test before administering.
2 Dopamine
receptor
antagonist
Sedative and anti
psychotics, reduce the
agitation.
Dexmedetomidine Extra pyramidal symptoms must be noticed
3 Atypical
antipsychotics
Anxiolytic activity
reduce
aggression
Risperidone
Clonazepam
Advised only for short term use.
4 Benzodiazepine Reduces the
aggression
Lorazepam (Ativan),
Temazepam
(Restoril),
Oxazepam (Serax).
Monitor blood test and liver function test. Observe for
dependency,
Cardiac activities closely.
5 Non
benzodiazepine
Safe recovery from
sedation or anesthetic
Propofol Monitor for excitation symptoms like tremors and blood
pressure. Take seizure precautions earlier

15. Nursing Management for patients with Delirium.
l.Disturbed thought process related to delusional thinking
2. chronic confusion related to cognitive impairment
3. Risk for injury related to suicide at tendency, illusions, hallucinations
4.Impaired memory related to cognitive impairment