delirium Flashcards
definition
disturbance in attention and awareness, disorganized thinking, disturbance of consciousness
attention = decreased ability to focus, sustain, shift
awareness = orientation
acute onset (hrs - days), fluctuate with periods of lucidly over 24 hr day, change from baseline
may have 1 of following
mem deficit (short term), disorientation (location, time, usually oriented to person), language change (pressured, mute, ramble, incoherent, bizzare), visuospatial (wont recognize people), delusions (persecutory), hallucinations (anx, visual), sleep wake disturbance, agitation
direct phys cause
meds: new, stop, polypharm
infection: fever, encephalitis/meningitis, F+E, hypoxia/ischemia, sx
brain alterations: decreased cerebral functioning or brain met, increased plasma cortisol, NT imbalance, damage to enzyme systems, BBB, or cell membranes, hypoxia
illusions
something there just misinterpreting what it is
4 cardinal features
acute onset and fluctuating course, decreased ability to direct, focus, shift, sustain attention
disorganized thinking, disturbance of consciousness
nc
orient: express fear and discomfort, comfort measures (trust), freq verbal orient, freq brief interactions, consistent staff, TV during day with news, non verbal music, approach slowly from front and address by name
env: adequate lighting, calendar, clock (easy to read, large), decrease stim (esp at night), sleep hygiene, safety (bed low and locked), symptomatic and supportive care
pharm
small dose antipsych or benzo -> watch for agitation, use if hepatic dysF
sleep aid -> mirtazapine
pain -> objective assess, intermittent narcotics
drug - drug interacitons
treat cause
communication tips
short and simple, slow and clear, low pitch, identify self, call by their name, repeat Q, allow time, point or demonstrate, tell what you want done, listen and observe (behaviors), educate client and fam, express fear and discomfort, freq brief orientation
