Mr. Pawas Netawat is an assistant professor specializing in medical surgical nursing (cardio) who will discuss the topic of delirium. Delirium involves dramatic behavioral changes and symptoms like hallucinations that represent brain failure due to various medical conditions, injuries, or intoxication/withdrawal. It is characterized by inattention, acute cognitive dysfunction, impairment of consciousness and orientation, and perceptual disturbances. Delirium has various causes including intoxication, withdrawal, infections, vascular issues, metals, and endocrine/metabolic problems. It involves neurotransmitter abnormalities and cytokine increases that can influence neurotransmitter activity. Nursing care for delirium involves treating underlying causes, monitoring for safety issues, and managing symptoms.

1.  NAME-Mr.Pawas Netawat
 DESIGNATION-Assistant professor
 QULIFICATION-Msc.Nursing
 SPECILIZATION-medical surgical nursing
(cardio)
 TOPIC- delirium

2. The word delirium means “out of one’s furrow”
which refers to the dramatic behavior changes that
the person may experience. Some have called
delirium "brain failure” because it may represent a
variety of caused such as heart failure does in cardiac
health. The delirium patient may have visual
hallucinations eg- seeing the multicolor rats or have
tactile hallucination, during which he patient may
feel bugs under the skin.Delirium is an outcome of a
general medical condition, head injury and drug
intoxication or withdrawal. Delirium is the common
clinical syndrome characterized by the inattention
and acute cognitive dysfunction.

3.  Delirium is the acute organic disorder
characterized by impairment of
consciousness, disorientation and disturbance
in the perception and restlessness. Delirium
is the most common organic mental disorder
characterized by impairment of
consciousness.

4.  Intoxication: chronic intoxication
 withdrawal effect of sedative hypnotic
drugs Neoplastic Space occupying lesions
 Infections Encephalitis meningitis
 Vascular Hypertensive encephalopathy,
intracranial hemorrhage
 Metals Heavy metals (lead, manganese,
mercury), carbon monoxide and toxins
 Endocrine and metabolic: Diabetic coma
and shock, hyperthyroidism, hepatic
failure

5. due to etiological factor
neurotransmitter hypothesis, decreased oxidative metabolism in the brain causes cerebral
dysfunction due to abnormalities of various neurotransmitter systems.
Reduced cholinergic function, excess release of dopamine, norepinephrine, and glutamate, and
both decreased and increased serotonergic and gamma-aminobutyric acid activity.
increased cerebral secretion of cytokines due to a wide range of physically stressful events
cytokines can influence the activity of various neurotransmitter systems, these mechanisms may
interact.
fundamental processes like intraneuronal signal transduction, second messenger systems that at
the same time use neurotransmitters as first messengers and play an important role in their
synthesis and release, may be disturbed.
delirium.

6.  fear,
 anxiety,
 depression,
 irritability,
 anger,
 euphoria
 apathy.
 Impairment of attention
 difficulty in shifting
 focusing and sustaining attention
 Impairment of consciousness
 clouding of consciousness ranging from drowsiness to
stupor and coma.
 Psychomotor disturbances: hypo or hyper-activity,
aimless

7.  Mental status examination
 History collection: any history of head injury,
meningitis etc
 Urine examination
 CBC ESR Blood glucose Blood “Rh” type (blood
grouping)
 Haematological investigation
 Brain biopsy
 Electroencephalography
 MRI of skull
 CT scan of skull
 Tests for memory: i.e. immediate, recent and remote
 Radiological examination

8.  IV fluids for fluid and electrolyte imbalance
100mg of B1 IV for thiamine deficiency, O2 for
hypoxia, 50 mg of 50% dextrose IV for
hypoglycaemia,
 Antipsychotics (5 mg haloperidol or 50 mg
chlorpromazine IM) may be given.
Benzodiazepines (10mg diazepam or 2 mg
lorazepam IV) Symptomatic measures:
 Vitamins: thiamine hydrochloride 100mg IV,
followed by 50-100mg/d, IV/IM, and
cynocobalamine 1000mcg IM monthly or
500mcg/wk. intranasally or 100mcg/d, PO.Short-
acting sedative: lorazepam 0.5-2mg, PO/IM/IV
Neuroleptics: Haloperidol 0.5-5mg, PO, BD/ TDS.
Risperidone 0.5-2mg, PO, QID or BD

9.  Risk for torturing themselves, others and the environment
related to the response in mind delusions and
hallucinations.
 Ineffective individual coping related to the inability to
express in a constructive way
 Change the thought process related to the inability to trust
people
 Risk for Imbalanced Nutrition : Less Than Body
Requirements related to intake is less, the status
emotional increased.
 Impaired Verbal Communication related to communication
pattern that is not logical or inkohern and side effects of
drugs, the pressure to talk and hyperactivity.
 Lack of social interaction (social isolation) are related to
inadequate support systems.
 Lack of self-care related to a decreased willingness

10. THANKYOU