Delirium is an acute organic mental disorder characterized by impaired consciousness, disorientation, and disturbances in perception and cognition. It develops rapidly over 1-2 days and fluctuates in severity. Delirium is common in medical-surgical inpatients, with around 10-25% of patients and 20-40% of geriatric patients experiencing it during hospitalization. Causes include vascular issues, infections, tumors, intoxication, trauma, and vitamin deficiencies. Symptoms include impaired attention, perceptual disturbances, cognitive impairment, sleep-wake cycle disturbances, and emotional issues. Diagnosis involves history, exam, tests, and ruling out other conditions. Episodes typically last around a week. Management focuses on supportive care, environmental modification

1. Delirium...

2. Introduction
Delirium is a common clinical syndrome
characterised by disturbed consciousness, cognitive
function or perception, which has an acute onset
and fluctuating course. It usually develops over 1–2
days.

3. Definition
Delirium is an acute organic mental disorder
characterized by impairment of consciousness,
disorientation and disturbances in perception
and restlessness.

4. Incidence
Delirium has the highest incidence among
organic mental disorders. About 10 to 25%
of medical-surgical inpatients, and about 20 to
40% of geriatric patients meet the criteria for
delirium during hospitalization. This percentage
is higher in post-operative patients.

6. ETIOLOGY
• Vascular: hypertensive encephalopathy, cerebral arteriosclerosis, intracranial
hemorrhage.
• Infections: encephalitis, meningitis
• Neoplastic: space occupying lesions
• Intoxication: chronic intoxication or withdrawal effect of sedative-hypnotic drugs
• Traumatic: subdural and epidural hematoma,contusion, laceration, post-operative,
heartstroke
• Vitamin deficiency, e.g. thiamine

7. Clinical features
• Impairment of consciousness
• Impairment of attention
• Perceptual disturbances
• Disturbances of cognition
• Disturbances of a sleep-awake cycle
• Emotional disturbance.

8. Diagnostic criteria
• History collection
• Mental status examination
• Neurological examination
• Haematological investigation
• Urine examination
• Radiological examination
• Test for memory
• X-ray,Ct-scan,MRI for skull
• Brain biopsy.

9. COURSE And prognosis
The onset is usually abrupt. The duration of
an episode is usually brief , lasting for about a
week.

10. MANAGEMENT

11. Medical management
The delirium management includes Supportive therapy and Pharmacological
management.
Supportive therapy
A) Fluid and nutrition=
• These should be given carefully, because the patient maybe unwilling or
physically unable to maintain a balance intake.
• The patient suspected to having alcohol toxicity or alcohol withdrawal,
therapy should include multivitamins, especially thiamine.

12. B) Environmental modification=
• The environment should be stable, quite and well lighted and
also support from a familiar nurse and family should be
encourage.
• Physical restrains should be avoided.

13. Medication
• Neuroleptics ; *Haloperidol 0.5-5mg,BD/TDS
*Risperidone 0.5-2mg,PO,BD
• Short acting sedative : Lorazepam0.5-2 mg,IV/IM.
Vitamins : *Thiamine hydrochloride 100mg,IV
. * Cynocobalamine 1000mcg,IM monthly.

14. Nursing management
1.Providing safe environment:
• restrict environmental stimuli, keep unit calm and
well-illuminated there should always be somebody
at the patient’s bedside reassuring and supporting

15. 2. Alleviating patient's fear and anxiety:
• remove any object in the room that seems to be a source of misinterpreted
perception
• As much as possible have the same person all the time by the patient’s
bedside.

16. 3.Meeting the physical needs of the patient:
• appropriate care should be provided after physical assessment
• use appropriate nursing measure to reduce high fever, if present
• maintain intake and output chart
• mouth and skin should be taken care
• monitor vital sign

17. 4.Facilitate orientation:
• repeatedly explain to the patient where he
is and what date, day and time it is

18. Conclusion
Delirium leads to increased mortality and morbidity
and longer hospital stays. In addition, many
patients with delirium will not return to their pre-
hospitalized functional status and will require long-
term care.