DELIRIUM

ACUTE CARE SETTING

WHAT IS IT?
Acute syndrome characterized by a sudden onset
impaired attention that fluctuates together with
altered consciousness and impaired cognition.
Types of Delirium:
THERAPIES
Hyper- inactivity or reduced motor activity, sluggishness,
abnormal drowsiness or seeming to be in a daze. ROLE:
Orientation-
Hypo- typically characterized by psychomotor agitation and - Encourage communication and reorient patient
repetitively
hypervigilance (least common), hallucinations - Staff and family members should reassure
patients of time and place at every opportunity
Mixed-patients fluctuate between hyper and hypo; see this - Procedures should be explained before they are
type most commonly in acute care patients
done
- Validate the patient- never argue or contradict
thoughts
RISK FACOTRS - Daily news paper (current events)
- Daily schedules/ Orientation board
Non modifiable Potentially Modifiable - Find out from family what person's normal daily
schedule is and try to mimic
Over the age of 65 Polypharmacy
Pre-existing cognitive impairment Immobility Environment-
(dementia) Sensory impairment - Well lit during the day-time, blinds open
Gender (males) Urinary catheterization
Length of hospital stay - Ambulate or mobilize patient early and often
Comorbidities (hypertension, (walk to windows)
depression, alcohol use) Inadequately controlled pain
Sleep deprivation or disturbance - Have familiar objects from patients home in the
Severity of illness Anemia room
Infection Hypoxia or hypercarbia Ex. pillow, blanket (touch, smell), pictures (visual)
Hearing and/or visual impairment Poor nutrition
Recent coma - Music/ TV show interests (getting idea of what
Dehydration their normal is)
Prior institutionalization Electrolyte abnormalities
Mechanical Ventilation - Clocks, calendars (where Pt can easily see)
- Remove clutter
- Low stim
Pathophysiology
Mechanisms are not fully understood but may involve: Early Mobilization!!!!!
Reversible impairment of cerebral oxidative metabolism
Multiple neurotransmitter abnormalities Meet sensory needs-
Generation of cytokines - Visual and hearing aids
*Stress of any kind upregulates sympathetic tone and - Weighted blankets if agitated
downregulates parasympathetic tone, impairing cholinergic function
and thus contributing to delirium. The elderly are particularly Cognitive therapy-
vulnerable to reduced cholinergic transmission, increasing their risk - Mind working games
of delirium. Ex: cross words, card games, hang man
*Regardless of the cause, the cerebral hemispheres or arousal - Weighted seek and find pads
mechanisms of the thalamus and brain stem reticular activating
system become impaired.
Sleep hygiene-
- Lights off at night, on during the day
- Control excess noise at night (ear plugs)
- Eye masks
Clinical parameters-
- Maintain systolic BP > 90 mmHG
- Maintain O2 saturdayions > 90%- education of
spirometer
- Managing nutrition/hyrdation
- Preventing constipation

Created by: Gabrielle Beauchamp

 CONFUSION
ASESSMENT
METHOD (CAM)

RASS SCALE