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10/24/23, 3:13 PM Realizeit for Student Delirium Delirium, often called acute confusional state, begins with disorientation and if not recognized and treated can progress to changes in LOC, irreversible brain damage, and sometimes death. In fact, up to 80% of patients in intensive care units are a...

10/24/23, 3:13 PM Realizeit for Student Delirium Delirium, often called acute confusional state, begins with disorientation and if not recognized and treated can progress to changes in LOC, irreversible brain damage, and sometimes death. In fact, up to 80% of patients in intensive care units are affected, and the presence of delirium triples in-hospital mortality rates (Mulkey, Hardin, Munro, et al., 2019). Delirium is disturbing for the affected patient and their family, associated with worse outcomes, and a significant increase in medical care costs (Devlin, Skrobik, Gelinas, et al., 2018; Mulkey et al., 2019). Risk Factors Careful clinical assessment is essential because delirium is sometimes mistaken for dementia and the two conditions may overlap. Table 61-4 compares dementia and delirium. It helps to know an individual patient’s usual mental status and whether the changes noted are long term, which probably represents dementia, or are abrupt in onset, which is more likely delirium. There are numerous risk factors for delirium. Risk factors that are modifiable include the use of medications such as benzodiazepines and the administration of blood transfusions (Devlin et al., 2018). Nonmodifiable risk factors include age, presence of dementia, prior coma, as well as recent emergency surgery or trauma (Devlin et al., 2018). Older adults are particularly vulnerable to acute confusion if they are in a debilitated health state or take multiple medications. Symptoms Nurses must recognize the symptoms of delirium and report them immediately. The Confusion Assessment Method (CAM) is a commonly used screening tool (Devlin et al., 2018; Inouye, van Dyck, Alessi, et al., 1990). Because of the acute and unexpected onset of symptoms, it is recommended that all patients who are critically ill receive routine screening for delirium at prescribed intervals (Devlin et al., 2018). If the delirium goes unrecognized and the underlying cause is not treated, permanent, irreversible brain damage or death can follow. Prevention The most effective approach is prevention. Strategies include providing therapeutic activities for cognitive impairment, reorienting the patient as needed, ensuring early mobilization, controlling pain, minimizing the use of psychoactive drugs, preventing sleep deprivation, enhancing communication methods (particularly eyeglasses and hearing aids) for vision and hearing impairment, maintaining oxygen levels and fluid and electrolyte balance, and preventing surgical complications (Eliopoulos, 2018). https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 1/2 10/24/23, 3:13 PM Realizeit for Student Including the family in therapeutic activities, as appropriate, is encouraged but more research is needed to validate the effect of families (Devlin et al., 2018). There is some research evidence for the use of bright light therapy to reduce delirium in patients who are critically ill (Devlin et al., 2018). Treatment Once delirium occurs, treatment of the underlying cause is most important. Therapeutic interventions vary depending on the cause. Delirium increases the risk of falls; therefore, management of patient safety and behavioral problems is essential. Because medication interactions and toxicity are often implicated, the nurse should alert the prescriber about any nonessential medications that could be discontinued. Nutritional and fluid intake should be supervised and monitored. The environment should be quiet and calm. To increase function and comfort, the nurse provides familiar environmental cues and encourages family members or friends to touch and talk to the patient (see Fig. 61-9 ). The nurse should provide for sleep hygiene measures in addition to assessing for and managing pain (Bennett, 2019). Ongoing mental status assessments using prior mental cognitive status as a baseline are helpful in evaluating responses to treatment and upon admission to a hospital or extended care facility. If the underlying problem is adequately treated, the patient often returns to baseline within several days. Dementia The cognitive, functional, and behavioral changes that characterize dementia eventually destroy a person’s ability to function. The symptoms are usually subtle in onset and often progress slowly until they are obvious and devastating. Dementia in older adults is typically caused by some degree of neurodegeneration (Gale, Acar, & Daffner, 2018). The most common type of dementia is Alzheimer’s disease (AD). AD alone or in conjunction with other dementing disorders accounts for up to 75% of older adults with dementia (Hickey & Strayer, 2020). Other non-Alzheimer’s dementias include degenerative, vascular, neoplastic, demyelinating, infectious, inflammatory, toxic, metabolic, and psychiatric disorders. It is important to identify reversible dementia, which occurs when pathologic conditions masquerade as dementia. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=0Dn26kXyU%2f6F5gOCz4%2f2IUFUzXhwrkmByRPKGm7XOkO3V8uhfXYXOmPZGy%2b… 2/2