2. DEFINITION:
Delirium is the most common organic
mental disordercharacterized by impairment
of consciousness.
Serious disturbance in mental abilities that
results in confused thinking and reduced
awareness of surroundings.
3. INCIDENCE
highest incidence among organic
Delirium has
the
mental disorders.
About 10 to 25% of medical-surgical inpatients, a
n
dabout 20 to
40% of geriatric patients meet the criteria for delirium during
hospitalization.
4. ETIOLOGY:
Vascular: Hypertensive encephalopathy, intracranial
hemorrhage.
Infections: Encephalitis, meningitis.
Neoplastic: Space occupying lesions.
Intoxication: chronic intoxication or
withdrawal effect of sedative
hypnotic drugs.
5. Traumatic:Subdural and epidural hematoma,
contusion, laceration, postoperative, heatstroke.
Vitamin deficiency: For example, thiamine
Endocrine and metabolic: Diabetic
coma and shock,
hyperthyroidism, hepatic failure
Metals: Heavy metals (lead, manganese,
mercury), carbon monoxide and toxins.
6. CLINICAL FEATURES
A delirium is characterized by a disturbance of
consciousness and a change in cognition that develop
rapidly over a short period, emotional instability may be
manifested by fear, anxiety, depression, irritability,
anger, euphoria, or apathy. These emotions may be
evidenced by crying.
7. Impairment of consciousness: clouding of
consciousness ranging from drowsiness to stupor and
coma.
Impairment of attention: difficulty in shifting, f
o
c
u
s
i
n
g
and sustaining attention.
Perceptual disturbances: illusions and hallucinations,
most often visual.
8. Disturbance of cognition: impairment of thinking
and Comprehension, impairment of recent and
immediate memory, increased reaction time.
Psychomotor disturbances: hypo or hyper-activity,
aimless groping or picking at the bed clothes
(flocculation), enhanced startle reaction.
9. Disturbance of sleep wake cycle: insomnia or in s
e
v
e
r
e
cases total sleep loss, daytime drowsiness, disturbing
dreams or nightmares.
Emotional disturbances: depression, anxiety,
irritability, etc.
12. 4. Tests for memory: i.e. immediate, recent and remote
5. Radiological examination
CT scan of skull
MRI of skull
Electroencephalography
Brain biopsy
13. TREATMENT:
1. Identification of cause and its immediate correction, for,
example,
50 mg of 50% dextrose IV for hypoglycaemia,
O2 for hypoxia,
100mg of B1 IV for thiamine deficiency,
IV fluids for fluid and electrolyte imbalance.
16. a) Fluid and nutrition:
• These should be given carefully, because
the patients may be unwilling or physically
unable to maintain a balance intake.
• The patients suspected of having alcohol
toxicity o
ralcohol withdrawal, therapy should
include multivitamins, especially thiamine.
17. b) Environmental modification:
• Reorientation techniques or memory cues
such as calendar, clocks, and family photos may be
helpful.
• The environment should be stable, quiet and w
e
l
l
-
lighted, and also support from a familiar nurse and
family should be encourage.
• Physical restrains should be avoided.
• These patients should never live alone.
18. c) Medication:
Neuroleptics: Haloperidol 0.5-5mg, PO, BD/ TDS.
Risperidone 0.5-2mg, PO, QID or BD.
Short-acting sedative: lorazepam 0.5-2mg,
PO/IM/IV
Vitamins: thiamine hydrochloride 100mg I
V
,
followed by 50-100mg/d, IV/IM, and
cynocobalamine 1000mcg IM monthly or
500mcg/wk. intranasally or 100mcg/d, PO.
20. A. Nursing Diagnosis:
- Risk for trauma related to impairment in
cognitive and psychomotor function.
21. Nursing intervention:
- Store frequently use items within easy
access.
- Keep the dim light on at night.
- Soft restraints may be required if client
is very disoriented and hyperactive.
- Frequently orient the client to
place, time, and situations.
22. B. NursingDiagnosis:
- Disturbed thought process related to cerebral
degeneration as evidenced by disorientation, confusion,
and memory deficits.
23. Nursing intervention:
- Frequently orient to reality.
- Use clock and calendars with large number
that areeasy to read.
- Monitor for medication side effects.
- Keep simple explanation.
- Talk about real people and real events.
24. C. NursingDiagnosis:
- Self-care deficit related to disorientation,
confusion, and memory deficits as evidence by in
ability to fulfil the need.
25. Nursing intervention:
- Provide guidance and assistance for
independent action.
- Provide the structural schedule of
activities that does not change from day to day.
- Involve the family members in the care
of thepatients.
