Delirium Flashcards
1
Q
Cognition
A
brains ability to process, retain, and use information
2
Q
Cognitive Abilities
A
reasoning, judgment, perception, attention, comprehension, and memory
-essential for making decisions, solving problems, interpreting the environment, and learning new information
3
Q
Cognitive Disorder
A
disruption or impairment in these higher level functions of the brain
-disruption of cognitive abilities
4
Q
Delirium
A
a syndrome that involves an acute disturbance of consciousness accompanied by a change in cognition
- develops over a short period
- have difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations
5
Q
Examples of Illusion
A
an electrical cord on the ground may appear to them as a snake
6
Q
Example of Misinterpretation
A
may mistake the banging of a laundry cart in the hallway for a gunshot
7
Q
Example of Hallucination
A
may see “angels” hovering above them when nothing is there
8
Q
Onset of Delirium
A
rapid
9
Q
Duration of Delirium
A
brief
-1 week; rarely more than 1 month
10
Q
Delirium: State of Awareness
A
- impaired
- fluctuates from heightened awareness to environmental stimuli, vivid dreams, and nightmares
11
Q
Delirium: Memory
A
-short-term memory impaired
12
Q
Delirium: Speech
A
may be slurred, rambling, pressured, or irrelevant
13
Q
Delirium: Thought Process
A
temporarily disorganized
14
Q
Delirium: Perception
A
visual or tactile hallucinations
15
Q
Delirium: Emotions
A
anxious, irritable, crying, apathy (lack of interest)
16
Q
Delirium: Psychomotor Activity
A
agitated, restless, hyperactive, striking out
17
Q
Predisposing Factors ( at risk of developing a problem)
A
- systemic infections
- febrile illness
- electrolyte imbalance
- hypoxia (absence of enough oxygen)
- hepatic or renal failure
- head trauma
- seizures
- migraine headaches
- brain abscess or brain neoplasms
- stroke
- nutritional deficiencies
- uncontrolled pain
- heat stroke
- burns
- cardiac issues
18
Q
Etiology
A
almost always results from an identifiable physiological, metabolic, or cerebral disturbance or disease from drug intoxication or withdrawal
19
Q
Risk Factors
A
- increased severity of physical illness
- older age
- hearing impairment
- decreased food and fluid intake
- medications
- baseline cognitive impairment such as that seen in dementia
20
Q
Causes of Delirium: Physiological or Metabolic
A
- hypoxemia (low level of oxygen in the blood)
- electrolyte disturbances
- renal or hepatic failure
- thyroid or glucocorticoid disturbances
- thiamine or vitamin B12 deficiency
- vitamin C, niacin, or protein deficiency
- cardiovascular shock
- brain tumor
- head injury
- exposure to gas, paint solvents, insecticides, ad related substances
21
Q
Causes of Delirium
A
multiple stressors
- trauma to CNS
- drug toxicity or withdrawal
- metabolic disturbances related to organ failure
- requires a careful and thorough physical examination and laboratory tests for identification
22
Q
Cause of Delirium: Infection
A
- Systemic: sepsis, urinary tract infection, pneumonia
- Cerebral: meningitis, encephalitis, HIV, syphilis
23
Q
Cause of Delirium: Drug Related
A
- Intoxication: anti-cholinergic, lithium, alcohol, sedatives, and hypnotics
- Withdrawal: alcohol, sedatives, and hypnotics
- reactions to anesthesia, prescription medication or illicit (street) drugs
24
Q
Treatment and Prognosis
A
- identify and treat any causal or contributing medical conditions
- a transient condition that clears with successful treatment of the underlying cause
- some causes such as head injury or encephalitis may leave clients with cognitive, behavioral, or emotional impairments even when the underlying cause is resolved
25
Psychopharmacology
- clients with quiet, hypoactive delirium need no specific pharmacologic treatment aside from that indicated for causative condition
- agitation can interfere with safety and effective treatment; sedation to prevent inadvertent self-injury may be indicated
- anti-psychotic medicine, such as Haloperidol, may be used
- sedatives and benzodiazepines are avoided because they worsen delirium
26
Haloperidol
- anti-psychotic
- in doses of 0.5mg to 1 mg to decrease agitation and psychotic symptoms, as well as to facilitate sleep
- administered orally, IM, or IV
27
Other Medical Treatment
- adequate nutritious food and fluid intake speed recovery
- IV fluids or even total parenteral nutrition may be necessary if a clients physical condition has deteriorated and he/she cannot drink
- if client becomes agitated and threatens to dislodge IV or catheters, physical restraints may be necessary so needed medical treatments can continue; restraints can make a client agitated
28
Application of The Nursing Process Focuses On?
meeting physiological and psychological needs
29
Nursing Process: History
- thorough history of medical illness, alcohol, or other drugs
- may need to gather from family if ability to provide accurate data is impaired
30
General Appearance and Motor Behavior
- disturbance of psychomotor behavior
- restless or hyperactive, frequently picking at bed or clothes, or making sudden, uncoordinated attempts to get out of bed
- could have slow motor behavior, appearing sluggish and lethargic with little movement
- speech can be affected as delirium worsens
- rambling, difficult to follow, pressured speech
- may call out or scream; especially at night
31
Mood and Affect
- rapid and unpredictable mood shifts
- wide range of emotional responses
- nothing to do with clients environment
- when fearful and feel threatened; they may become combative to defend themselves
32
Thought Processes and Content
- disorganized and makes no sense
- difficult for the nurse to assess
- thoughts may be fragmented
- unrelated to situation
- speech is illogical and difficult to understand
33
Sensorium and Intellectual Processes
- primary and initial sign of delirium is an altered level of consciousness that is seldom stable and usually fluctuates throughout the day
- oriented to people but disoriented to time and place
- decreased awareness of environment or situation; focus on irrelevant stimuli such as color of bedspread or room
- noises, people, sensory misperceptions distracts them
- experience illusions, misinterpretations, and hallucinations
34
Primary and Initial Sign of Delirium
altered level of consciousness that is seldom stable and usually fluctuates throughout the day
35
Judgment and Insight
- judgment is impaired
- cannot perceive potentially harmful situations or act in their own best interest
- insight depends on severity of delirium
36
Roles and Relationships
- unlikely to fulfill their roles during course of delirium
| - most regain previous level of functioning; no long-standing problems with roles or relationships
37
Self-Concept
- no direct effect
- often feel frightened or threatened
- those with some awareness may feel helpless or powerless to do anything to change it
- may feel guilt, shame, and humiliation if delirium resulted from substance abuse
38
Physiological and Self-care Considerations
- experience disturbed sleep-wake cycles; difficulty falling asleep, daytime sleepiness, nighttime agitation, or complete reversal of usual daytime waking/ nighttime sleep pattern
- ignore or fail to perceive internal body cues such as hunger, thirst, or urge to urinate or defacate
39
Nursing Diagnosis
- risk for injury
- acute confusion
- disturbed sensory perception
- disturbed thought process
- disturbed sleep pattern
- risk for deficient fluid volume
- risk for imbalanced nutrition: less than body requirements
40
Nursing Interventions
- promoting client's safety
- managing clients confusion
- controlling environment to reduce sensory overload
- promoting sleep and proper nutrition
41
Nursing Interventions: Promoting Client Safety
- teach patient to request assistance for activities (getting out of bed, going to the bathroom)
- provide close supervision to ensure safety during these activities
- promptly respond to the patients call for assistance
42
Nursing Interventions: Managing Clients Confusion
- speak to client in a calm manner in a clear low voice
- use simple sentences
- allow adequate time for the client to comprehend and respond
- allow client to make decisions as much as he/she is able to
- provide orienting verbal cues when talking with the client (facing them, using their name, calendars)
- use supportive touch if appropriate
- correct them matter-of-factly
43
Nursing Interventions: Controlling Environment to Reduce Sensory Overload
- keep environmental noise to a minimum (television/ radio)
- monitor clients response to visitors; explain to family and friends that the client may need to visit quietly one at a time
- validate the clients anxiety and fear, but do not reinforce misperceptions
ex: "I know things are upsetting and confusing right now, but your confusion should clear as you get better"
44
Nursing Interventions: Promoting Sleep and Proper Nutrition
- monitor sleep and elimination pattern
- monitor food and fluid intake; provide prompts or assistance to eat and drink adequate amounts of food and fluids; may be helpful to sit with the patient at meals
- provide periodic assistance to the bathroom if client does not make requests
- discourage daytime napping to help sleep at night
- encourage some exercise during the day, such as sitting in a chair, walking in the hall, or activities the client can manage
45
Client and Family Education
- monitor chronic health conditions carefully
- visit physician regularly
- tell health care providers what medications are taking, OTC, dietary supplements, and herbal preparations
- check with physician before taking nonprescription meds
- avoid alcohol and recreational drugs
- get adequate sleep
- use safety precautions when working with paint solvent, insecticides, and similar products
46
Community Based Care
- medical evaluation--> can confirm dementia and appropriate treatment and care plan can be initiated if cognitive function is impaired after delirium
- initiate referrals to home health aide, visiting nurse, or rehab if continue to experience cognitive problems
- support groups
