Delirium

Delirium

1. Delirium...

2. Introduction Delirium   is a common clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course. It usually develops over 1–2 days.

3. Definition Delirium is an acute organic mental disorder characterized by impairment of consciousness, disorientation and disturbances in perception and restlessness.

4. 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. This percentage is higher in post-operative patients.

5. ETIOLOGY Vascular: hypertensive encephalopathy, cerebral arteriosclerosis , intracranial hemorrhage . Infections: encephalitis, meningitis Neoplastic : space occupying lesions Intoxication: chronic intoxication or with d rawal effect of sedative-hypnotic drugs Traumatic : subdural and epidural hematoma,contusion, laceration, post-operative, hea r tstroke Vitamin deficiency, e.g. thiamine

6. Clinical features Impairment of consciousness Impairment of attention Perceptual disturbances Disturbances of cognition Disturbances of a sleep-awake cycle Emotional disturbance.

7. Diagnostic criteria History collection Mental status examination Neurological examination Haematological investigation Urine examination Radiological examination Test for memory X- ray,Ct - scan,MRI for skull Brain biopsy.

8. COURSE And prognosis The onset is usually abrupt. The duration of an episode is usually brief , lasting for about a w eek .

9. MANAGEMENT

10. Medical management The delirium management includes Supportive therapy and Pharmacological management. Supportive therapy A) Fluid and nutrition= These should be given carefully, because the patient maybe unwilling or physically unable to maintain a balance intake. The patient suspected to having alcohol toxicity or alcohol withdrawal, therapy should include multivitamins, especially thiamine.

11. B) Environmental modification= The environment should be stable, quite and well lighted and also support from a familiar nurse and family should be encourage. Physical restrains should be avoided.

12. Medication Neuroleptics ; *Haloperidol 0.5-5mg,BD/TDS *Risperidone 0.5-2mg,PO,BD Short acting sedative : Lorazepam0.5-2 mg,IV/IM. Vitamins : *Thiamine hydrochloride 100mg,IV . * Cynocobalamine 1000mcg,IM monthly.

13. Nursing management 1. Providing safe environment: restrict environmental stimuli, keep unit calm and well-illuminated there should always be somebody at the patient’s bedside reassuring and supporting

14. 2. Alleviating patient's fear and anxiety: remove any object in the room that seems to be a source of misinterpreted perception A s much as possible have the same person all the time by the patient’s bedside.

15. 3.Meeting the physical needs of the patient: appropriate care should be provided after physical assessment use appropriate nursing measure to reduce high fever, if present maintain intake and output chart mouth and skin should be taken care monitor vital sign

16. 4. Facilitate orientation : repeatedly explain to the patient where he is and what date, day and time it is

17. Conclusion Delirium  leads to increased mortality and morbidity and longer hospital stays. In addition, many patients with delirium  will not return to their pre-hospitalized functional status and will require long-term care.