Nursing Care for Delirium

Delirium is an acute condition characterized by an abrupt decline in mental function, including memory, orientation, judgment, and reasoning.

It is reversible and can fluctuate from day-to-day, and can last for hours, days, or weeks. Okay, now, delirium is usually related to an underlying condition, such as fluid and electrolyte imbalance, glucose dysregulation, malnutrition, or systemic infections.

Certain medications, like benzodiazepines, opioids, and anticholinergics, can also contribute to delirium. Other risk factors include advanced age, untreated pain, sleep deprivation, immobility, and sensory deprivation or sensory overload; as well as being hospitalized and being in intensive care.

Dementia is another risk factor for delirium; and likewise, delirium can increase the risk of developing dementia. Now, although the exact cause of delirium is unclear, it likely involves an interaction between one or more risk factors and a vulnerable patient that ultimately results in alterations in neuronal function in the brain.

Clinical manifestations include disorientation, meaning the patient doesn’t know where they are or what day it is; difficulty concentrating; and altered speech, that might be rambling and difficult to understand.

Their emotional state can range from being irritable and agitated to being withdrawn and depressed. Also, they may experience hallucinations, which means they see, hear, or even smell things that are not actually real but feel very real to them; as well as illusions, or misinterpretations of reality; and delusions, or beliefs that are objectively false.

Alright, now the diagnosis of delirium is typically based on the patient’s history as well as a physical and psychological assessment.

In addition, certain tools, like the Confusion Assessment Method, or CAM, can be used to gather information. After the diagnosis is confirmed, laboratory tests, as well as imaging tests, like CT or MRI scans are performed to identify the underlying cause.

Moving on to treatment, delirium is a medical emergency that must be recognized and treated promptly. The good news is that delirium is often reversible when the underlying condition is resolved.

Okay, when caring for a patient with delirium, your primary responsibilities include prevention, early recognition, and working with the health care team to identify and treat the underlying cause.

Begin by recognizing when your patient is at risk for delirium, such as elderly patients, patients who are immobile, or those who have underlying health conditions like dementia or an infection.

Then, take steps to reduce your patient’s risk of delirium. Keep your patient’s pain managed with pharmacological and nonpharmacological interventions; monitor your patient’s oxygenation closely and initiate supplemental oxygen, as needed, to prevent hypoxia; and ensure your patient has adequate rest and sleep by clustering your nursing care and reducing noise and distractions.

If your patient uses sensory aids, like hearing aids or glasses, ensure they are wearing them to prevent sensory deprivation; and be sure to encourage social interaction with family or friends to prevent feelings of isolation.

Also remember to speak to your patient in a calm, reassuring tone, and provide simple explanations about the nursing care you’re providing.

Next, review your patient’s medications to identify those that could potentially contribute to delirium, and collaborate with the registered nurse, pharmacist, and prescriber to consider possible alternative medications or changes in dosage.

To promote mobility, work with the physical therapist to provide range of motion exercises and assist with mobilizing the patient, as appropriate.

Keep a close eye on your patient’s hydration status, and work together with the registered nurse to identify and correct fluid or electrolyte imbalances if they occur.

Also, collaborate with the dietitian to ensure your patient is receiving adequate calories and nutrients. Finally, support your patient’s orientation to their surroundings by using clocks and calendars to provide cues to date and time; place familiar items and photos in your patient’s room; and remember to orient them often.

Alright, as a quick recap… Delirium is an abrupt decline in mental function, including memory, orientation, judgment, and reasoning.

It is acute, reversible, can fluctuate from day-to-day, and can last for hours, days, or weeks. Delirium is usually related to an underlying condition, and is characterized by manifestations like disorientation, altered speech, hallucinations, illusions, or delusions.

Nursing considerations are focused on prevention, early recognition, and working with the health care team to identify and treat the underlying cause.