Delirium

• Transient & Reversible

• Acute change in consciousness & cognition

• Decreased ability to maintain or shift detention

Delirium “PINCH ME”

• P = pain

• IN = Infection

• C = constipation & urinary retention

• H = hydration

• M = medication & substance

• E = environmental triggers

Main Cause of Delirium “ I WATCH DEATH”

I : infection ( uti, pneumonia)

W: withdrawal ( alcohol, benzodiazepines)

A: acute metabolic (alcohol, benzodiazepines)

T: Toxins

C: CNS Patho ( stroke, tumor, hemorrhage)

H: Hypoxia (anemia, pulmonary/cardiac failure)

D: deficiency ( thiamine, ETOH abuse)

E: Endocrine: (thyroid, hypo/hyperglycemia)

A: Acute (vascular shock, hypertensive)

T: Trauma ( head injury, fall)

H: Heavy metals (lead, mercury)

Delirium impact on overall health

Delirium is acute and reversible if treated properly

Delirium: Clinical Presentation (ACUTE Acronym)

•A: Acute – sudden, behavior changed in past few days or less (Agitated, Anxious).


•C: Confusion – marked by periods of confusion, usually fluctuates(Combative)

• U: Unusual – not typical behavior for this client (Unorganized thoughts, Unaware of surroundings).

• T: Temporary, Transient – TREATABLE once underlying cause is corrected

• E: Etiology – physiologic cause (Electrolyte imbalance).

Role of Nurse (delirium)

•Maintain client safety (environment, medications).


•Identify and treat the underlying cause (individual risk factors, environmental risk factors, medications

Hypoactive Delirium

Motor Activity : Decreased, Lethargy

Behavior: Quiet, Withdrawn, apathetic

Diagnosis Ease: Often mistaken for depression

Risk: HIGH risk of aspiration, immobility, pressure Injuries

Hyperactive Delirium

Motor Activity: Increased, restless, pacing

Behavior: Loud, rapid shouting, disorganized speech

Diagnosis Ease: Usually diagnosed easily

Risk: Falls, pulling out lines, self harm

Dementia

Onset: Gradual month-years

Course: Progressive decline

Attention: Worsens in late stages

Memory: Impaired late on

Reversibility: Irreversible

Speech: Word finding/ aphasia

Treatment: support

Delirium

Onset: Acute, hours/days

Course: Fluctuating throughout days

Attention: Impaired cannot focus

Memory: Short term

Reversibility: usually reversible

Speech: slow, incoherent or rapid

Treatment: treat underlying issues