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Tip of the Week– Assessment and Nursing Care of Delirium

Delirium is characterized as a progressive decline in memory and rapid changes in brain function that occur with physical or mental illness. Its symptoms arise from various underlying causes such as heart or renal failure, or withdrawal from medication.

Most common causes and risk factors for delirium can best be remembered through the following mnemonic.

D- Dementia

E- Electrolyte disorders

L- Lung,liver,heart,kidney, brain

I- infection

R- Rx drugs

I- Injury, pain, stress

U- Unfamiliar environment

M- Metabolic

Since symptoms of delirium may often overlap with symptoms of dementia, especially in the elderly, nurses should be familiar with the clinical manifestations of both to be able to differentiate them. Symptoms of delirium involves a quick change in mental state and appear suddenly in a short time, usually hours or days. It includes alteration in mental status, inability to concentrate, alternating periods of agitation or restlessness and lethargy. Patients suffering from delirium also exhibits altered perceptions like visual illusions or hallucinations.

Preventing delirium can be done through treatment of the underlying cause that triggers the event. Reducing stimulation like avoiding psychoactive drugs, providing a calm and quiet environment especially at night can be done to reduce the occurrence of delirium. Other preventive measures include providing daytime activity, use of visual and hearing assistive devices, orientation devices and avoidance of the use of restraints.

Treatment of delirium is aimed at resolving the medical or mental disorder that causes it. Medications given are used to control aggressive or agitated behaviors and start at low doses which gradually increases depending on the need.

Medications include:

  • Dopamine blockers (haloperidol, olanzapine, risperidone, clozapine)
  • Mood stabilizers (fluoxetine, imipramine, citalopram)
  • Sedating medications (clonazepam or diazepam)
  • Serotonin-affecting drugs (trazodone, buspirone)
  • Thiamine

Other treatments like behavior modification to control unacceptable or dangerous behavior and reality orientation to reduce disorientation may also be helpful.

Delirium from MedlinePlus medical Encyclopedia

Dementia And Delirium

Sorting out Delirium, Dementia, and Depression


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