Delirium

Mental Health Nursing

1. delirium R.RUPPAMERCY M.Sc NURSING II YEAR MENTAL HEALTH NURSING

2. WHAT IS ORGANIC MENTAL DISORDER????

3. INTRODUCTION An organic mental disorder (OMD), also known as organic brain syndrome , decreased mental function due to a medical or physical disease of the brain. The brain cells could be damaged due to a physical injury (a severe blow to the head, stroke, chemical and toxic exposures, organic brain disease, substance abuse, etc.) or due to psycho-social factors like severe deprivation, physical or mental abuse, and severe psychological trauma

4. CLASSIFICATION OF ORGANIC MENTAL DISORDERS – ICD 10 F00 : Dementia in Alzheimer’s disease. F01 : vascular dementia. F02: Dementia in other diseases classified elsewhere F03: Unspecified dementia F04 : Organic amnestic syndrome. F05: Delirium. F06 : Mental disorders due to brain damage, dysfunction and physical disease F07 : Personality and behavioral disorders due to brain disease, damage and dysfunction .

5. TYPES OF ORGANIC BRAIN DISORDER Delirium (Acute brain syndrome) Dementia (chronic brain syndrome) Amnestic (due to - may or may not organic or non – organic ) WHAT IS THE DIFFERENCE ?

6. DELIRIUM INTRODUCTION de (away from, out of) + Lira (the earth thrown up between two furrows) means out of tract Acute organic brain syndrome Delirium is a syndrome, not a disease. Once the acute episode has remitted, the premorbid level of functioning is reached again, with personality reappearing intact .

7. DEFINITION Serious disturbance in mental abilities that results in confused thinking and reduced awareness of surrounding . It is also known as acute confusional state . THREE C’S Rapid onset of impairment and fluctuation in CONCENTRATION. Altered CONSCIOUSNESS. Impaired COGNITION .

8. TYPES OF DELIRIUM Hypoactive delirium . This may include inactivity or reduced motor activity, sluggishness, abnormal drowsiness. Hyperactive delirium. This may include restlessness , agitation, rapid mood changes or hallucinations. Mixed delirium. This includes both hyperactive and hypoactive symptoms. The person may quickly switch back from hyperactive to hypoactive states.

9. Risk factors 1 . Predisposing risk factors Age > 70 yrs Sex : male > women Brain disorders such as Dementia, Stroke or parkinson's disease Previous delirium episodes Visual or hearing impairment Having multiple medical problems

10. Risk factors 2. Precipitating factors Use of Physical restraint Use of indwelling catheter Adding three or more medications pain Surgery Anaesthesia and hypoxia Malnutrition and dehydration

11. CAUSES????

12. SIGNS & SYMPTOMS The clinical hallmarks of delirium are decreased awareness, a change in baseline cognition and behavior. It begins over a few hours or a few days.

13. REDUCED AWARENESS OF THE ENVIRONMENT An inability to stay focused on a topic or to switch topics. Getting stuck on an idea rather than responding to question or conversation. Being easily destructed Being withdrawn

14. POOR THINKING SKILLS (COGNITIVE IMPAIRMENTS) Poor memory , particularly of recent events. Disorientation . (E.g.) not knowing where you are or who you are. Difficulty speaking or recalling words. Trouble understanding speech Difficulty reading or writing

15. BEHAVIOR CHANGES This may include Hallucinations Restlessness , agitation Calling out, making other sounds Being quiet and withdrawn — especially in older adults Slowed movement or lethargy Disturbed sleep habits Reversal of night-day sleep-wake cycle

16. EMOTIONAL DISTURBANCES This may appear as: Anxiety , fear or paranoia Depression Irritability or anger A sense of feeling elated ( euphoria) Apathy Rapid and unpredictable mood shifts Personality changes

17. DIAGNOSIS Mental status Examination. To assess orientation, attention and thinking. Physical and neurological Examination: Physical Examination: To check for signs of health problems and underlying disease. Neurological Examination: Check for vision, balance Co-ordination and reflexes. Other test: Blood and urine to check for electrolyte imbalance. Brain Imaging. Rating scale

18. MANAGEMENT Treat the underlying causes or triggers. ( Eg .) Stopping use of particular medication. Care for metabolic imbalance Treating Infection. Vitamins- Patient with alcoholism & malnutrition prone for thiamine, B12 deficiency which can cause delirium. Medication Antipsychotic-To treat agitation, hallucination and to improve sensory problem. ( Eg ) Haloperidol, Risperidone , Olanzapine, quetiapine Benzodiazepines

19. NURSING MANAGEMENT Assess the level of anxiety to intervene before violence occurs. Provide an appropriate environment. Promote patients safety. Ask assistance from others when needed. Stay calm and reassure patients . Medicate or restrain patients as prescribed. Observe suicide precautions. Teach relaxation exercises.

20. CONTD… Medications Talk with the doctor about avoiding or minimizing the use of drugs that may trigger delirium. Certain medications may be needed to control pain that's causing delirium. Fluid and nutrition should be given carefully because the patient may be unwilling or physically unable to maintain a balanced intake . For the patient suspected of having alcohol toxicity or alcohol withdrawal, therapy should include multivitamins, especially thiamine

21. SUPPORTIVE THERAPY To Prevent Complications by Protecting the Airway . Providing adequate Nutrition . Assisting with movement . Treating pain . Addressing Incontinence Avoiding use of physical restraints Avoiding changes in surrounding . Encouraging the family members to involve in the care.

22. PREVENTION Having a clock and calendar nearby Having lots of lighting during the day Limiting medicines that may cause delirium, or any extra medicines that are not needed Drinking plenty of water and other fluids Trying to walk or at least sit in a chair daily Reporting to doctors any symptoms of an infection (cough, fever, pain, shortness for breath) Family involvement in the patient’s treatment

23. RECAPITULATE…..

24. THANK YOU….