Nursing Management: Delirium

Delirium is an abrupt decline in mental function, including memory, orientation, perception, behavior, language, and personality, which can fluctuate from day-to-day and can last for hours, days, or weeks. In contrast, dementia has a gradual onset, lasts for months to years, and progressively worsens over time.

Okay, now, delirium usually occurs as a consequence of an underlying condition. Health problems like heart failure, cognitive impairment, or visual and hearing impairment can make patients more vulnerable to the impact of stress, pain, sleep deprivation, immobility, dehydration, or malnutrition, which can lead to delirium. Other risk factors include advanced age, infections, electrolyte imbalances, as well as being hospitalized, being in intensive care, the use of mechanical ventilation, and sensory deprivation. Some medications, such as benzodiazepines, opioids, and anticholinergics, can also contribute to delirium. Notably, dementia is a leading risk factor for delirium, and delirium increases the risk of developing dementia.

Now, although the exact cause of delirium is unclear, it's likely not due to a single factor. One theory is that impaired oxidative metabolism can lead to low oxygen levels in the brain. Another theory is that abnormal levels of neurotransmitters in the brain, like decreased acetylcholine, increased dopamine, and either increased or decreased serotonin, can promote the development of delirium. It is also thought that in delirium, neuronal membranes may not be able to depolarize properly, and therefore, the action potential cannot be efficiently transmitted from one neuron to another. Alternatively, delirium might be related to inflammatory cytokines that are released during infection or trauma, which interfere with neuronal function.

Okay, so clinical manifestations include disorientation, meaning the patient doesn’t know where they are or what day it is; or they might have difficulty concentrating. Based on the level of activity, delirium can be classified as hypoactive, hyperactive, or mixed, where their activity fluctuates. The patient’s emotional state can also range from being irritable and agitated to being withdrawn and depressed. Their speech might be rambling and hard to understand, and they could experience hallucinations, which means they see, hear, or even smell things that are not actually real but feel very real to them.

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 assess delirium. Now, after the diagnosis is confirmed, the specific cause can be identified based on laboratory tests and imaging tests, like CT and MRI scans.

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.