Module 1: Delirium

Question 1

how to diagnose delirium

Answer 1

BOTH: 1. acute onset & fluctuating course 2. inattention

and either: 1. disorganized thinking 2. altered level of consciousness

Question 2

causes to consider if confused

Answer 2

Central nervous system
Organ dysfunction
Nutrition
Fever
Fluid & Electrolytes
Urine infection/retention
Sensory over or under stimulation
Endocrine disorders
Drugs - including withdrawal

Question 3

drugs commonly causing delirium

Answer 3

alcohol, other sedative/hypnotics
anticholinergics (diphenhydramine, tricyclics, cimetidine, theophylline)
opioid analgesics (especially meperidine)
corticosteroids
antihypertensives/cardiac drugs
antiparkinson drugs
psychoactive drugs (anxiolytics, hypnotics)

Question 4

what is a good delirium evaluation

Answer 4

1. confused
2. target labs (CBC, CMP, phosphate)
3. search of occult infection: CXR, UA
4. consider ABG, EKG, LP, CT/MRI, Mg, B12, drug levels, tox screen, EEG

Question 5

treatment of delirium

Answer 5

• treat underlying medical problem: stop offending medications; identify & address other precipitants
• use environmental interventions: reduce isolation & provide reassurance, re-estabolish normal stimulation & activities, promote rest periods & night time sleep, maximize safety
• retrain or use low dose antipsychotics only when absolutely necessary

Question 6

behavioral restraint standards?

Answer 6

• where the behavior may be violent or aggressive
• because of an emotional or behavioral disorder
• to protect the patient from injury to self or others

Question 7

med surg restrain standards

Answer 7

• patient with behavior classified as irrational or uncooperative
• attempting to seriously interfere w/ a physical treatment or device necessary for the patients healing
• less restrictive approaches don’t work to prevent this interferences
• used to improve medical care

Question 8

antipsychotic drugs of choice for delirium

Answer 8

Haldol, Risperdal, Zyprexa

Question 9

alternatives to use of restraints and antipsychotics

Answer 9

• increase nursing surveillances
• involve family and friends
• modify medications if problematic
• reality orientation, explanation, reassurance
• improve hearing and vision
• modify environment to increase safety
• reconsider NG tubes, IVs, catheters