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.
Delirium is an outcome of a general medical condition, head injury and drug intoxication or withdrawal.
2. INTRODUCTION
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.
3. Delirium is the common clinical syndrome characterized
by the inattention and acute cognitive dysfunction.
Delirium is an outcome of a general medical condition,
head injury and drug intoxication or withdrawal.
The delirius patient may have visual hallucinations eg-
seeing the multicolor rats or have tactile hallucination,
during which he patient may feel bugs under the skin.
4. DEFINITION:
Delirium is the most common organic mental disorder
characterized by impairment of consciousness.
Delirium is the acute organic disorder characterized by
impairment of consciousness, disorientation and
disturbance in the perception and restlessness.
5. 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.
6. This percentage is higher in post-operative patients.
Although delirium may occur in any age group, it is
most common among the elderly
7. ETIOLOGY:
Vascular: Hypertensive encephalopathy, intracranial
hemorrhage.
Infections: Encephalitis, meningitis.
Neoplastic: Space occupying lesions.
Intoxication: chronic intoxication or withdrawal effect
of sedative hypnotic drugs.
8. 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.
9. 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.
10. Impairment of consciousness: clouding of
consciousness ranging from drowsiness to stupor and
coma.
Impairment of attention: difficulty in shifting, focusing
and sustaining attention.
Perceptual disturbances: illusions and hallucinations,
most often visual.
11. Disturbance of cognition: impairment of abstract
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.
12. Disturbance of sleep wake cycle: insomnia or in severe
cases total sleep loss, daytime drowsiness, disturbing
dreams or nightmares.
Emotional disturbances: depression, anxiety, fear,
irritability, etc.
13. DIAGNOSTIC CRITERIA:
1. History collection: any history of head injury,
meningitis etc.
2. Mental status examination
15. 4. Tests for memory: i.e. immediate, recent and remote
5. Radiological examination
CT scan of skull
MRI of skull
Electroencephalography
Brain biopsy
16. 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.
17. 2. Symptomatic measures:
Benzodiazepines (10mg diazepam or 2 mg lorazepam
IV)
Antipsychotics (5 mg haloperidol or 50 mg
chlorpromazine IM) may be given.
18. MANAGEMENT:
1. MEDICAL MANAGEMENT:
The delirium management includes supportive therapy
and pharmacological management;
19. 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 or
alcohol withdrawal, therapy should include
multivitamins, especially thiamine.
20. 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 well-
lighted, and also support from a familiar nurse and
family should be encourage.
• Physical restrains should be avoided.
• These patients should never live alone.
21. 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 IV,
followed by 50-100mg/d, IV/IM, and
cynocobalamine 1000mcg IM monthly or
500mcg/wk. intranasally or 100mcg/d, PO.
23. A. Nursing Diagnosis:
- Risk for trauma related to impairment in cognitive
and psychomotor function.
24. 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.
25. B. Nursing Diagnosis:
- Disturbed thought process related to cerebral
degeneration as evidenced by disorientation, confusion,
and memory deficits.
26. Nursing intervention:
- Frequently orient to reality.
- Use clock and calendars with large number that are
easy to read.
- Monitor for medication side effects.
- Keep simple explanation.
- Talk about real people and real events.
27. C. Nursing Diagnosis:
- Self-care deficit related to disorientation, confusion,
and memory deficits as evidence by in ability to fulfil
the need.
28. 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 the
patients.
31. Delirium tremens is a psychotic condition caused by the
complications from alcohol withdrawal. It involves
tremors, hallucination, anxiety, and disorientation.
• Delirium tremens typically occurs in people with a
high intake of alcohol for more than a month.
• When it occurs, it often lies for three days into the
withdrawal syndromes and last for two to three days.
32. SIGNS AND SYMPTOMS:
The main symptoms of delirium tremens are;
- Nightmares,
- Disorientation,
- Hallucinations,
- Fever,
- Confusion,
- High blood pressure
33. CAUSES:
- Delirium tremens is mainly caused by the long
period of drinking alcohol and stopped suddenly.
- Head injury,
- Infections,
- Illness in the people with a history of having use of
alcohol.
34. CHARACTERISTIC FEATURES:
- Clouding of consciousness with disorientation.
- Poor attention span with distractibility.
- Visual, tactile also hallucination and illusion.
- Disturbance with tachycardia, fever, sweating,
hypertension.
- Shouting and evidence fear.
35. - Insomnia.
- Will have disorientation related to time and place.
- Death may occur due to cardiovascular collapse,
infection, hypertension, or self-inflicted injury.
36. MANAGEMENT OF DELIRIUM
TREMENS:
1. Keep the patients in a quiet and safe environment.
2. Sedation is usually given with diazepam 10mg, or
lorazepam 4mg, IV or followed by oral administration.
3. Maintain fluid and electrolyte balance.
4. Reassure patient and family
37. CONCLUSION:
Delirium is the acute organic disorder characterized by
impairment of consciousness, disorientation and
disturbance in the perception and restlessness. Delirium
has the highest incidence among organic mental
disorders.
38. About 10 to 25% of medical-surgical inpatients, and
about 20 to 40% of geriatric patients meet the criteria
for delirium during hospitalization. A delirium is
characterized by a disturbance of consciousness. So the
client may have impairment of consciousness,
impairment of attention, and also emotional disturbance
such as depression, fear, irritability.
39. Delirium tremens is a psychotic condition caused by the
complications from alcohol withdrawal. It involves
tremors, hallucination, anxiety, and disorientation.
41. BIBLIOGRAPHY:
1. R. Sreevani, A guide to Mental Health & Psychiatric
Nursing, JAYPEE BROTHERS, 3rd Edition 2010; page
No – 249-251.
2. Anbu.T; Text book of Psychiatric Nursing;
EMMESS., 1st Edition 2010; Page No- 188-190.
3. R.K.Gupta, New Approach To Mental Health
Nursing, 2011 Edition, Page No- 220-224.