Patients Experiencing DeliriumDelirium

Delirium

• Also known as an “acute state of confusion”• It is considered a serious acute medical problem• Indicates there may be a serious medical

problem• Patients describe delirium as:

– The twigh light zone– Fog bank– A state of constant terror

Delirium can be described as:

• Starting and stopping suddenly

• Lasting a few hours, a few days or a few weeks

• Patient’s alertness fluctuates

• Patient knows person but not time and place

• Their attention is distracted easily, can not stay on one subject for very long

• They have NO short term memory

• Their thinking is disorganized and they ramble

• They have delusions and visual hallucinations

4 Key Features

1. Difficulty concentrating

2. No short term memory, disorientated, seeing things

3. Sudden onset, can go from very active to very sleepy

4. Delirium is caused by a medical problem such as a new medication or alcohol withdrawal

3 Types of DeliriumHyperactive• Agitated state with increase

activity and increased verbal behaviors

Hypoactive• More comment in elderly.

Quietly confused with some anxiety. Tired and withdrawn

Mixed• Patients move from

hyperactive to hypoactive states

What Causes Delirium

Outside hospital• Illness

– Pneumonia, UTI’s

• Depression• New medications• Alcohol and drug

withdrawal• Post operative• Previous delirium

Inside hospital• Dehydration, malnutrition• Surgery• Infections• Not sleeping• Not mobilizing• Unfamiliar environment• Sensory overload• Isolation and no windows

What to Do

Communication:• Eye contact at eye level• Identify self• Call patient by preferred

name• Be calm and speak slowly• Validate fears and

concerns• Use short and simple

sentences• Re orientate frequently

Environment:• Minimize noise and staff

changes• Provide food and fluids• Ask family for familiar

objects• Music• Promote sleep• Use clocks and calendars

to re orientate• Limit visitors• Have family sit with

patient

What to Do

Physiological:• Look for signs of pain• Check for

constipation• Check for urinary

retention• Toileting routines• Mobilize lots

Safety:• Use bed and chair

alarms• Move patient closer to

nursing station• Remove sharp

objects• Have patient wear

clean glasses and working hearing aides

Other Interventions to Consider

• No restraints, they only increase agitation

• Read the paper or your magazine to the patient. Let them read as well

• Elder Friendly Program has a TV for DVD’s and Videos

QUESTIONS?