DELIRIUM
DELIRIUM
DELIRIUM
Code: 9071
Submitted by:
Submitted to:
February 2022
DEFINITION
MEDICAL MANAGEMENT
• Fluid and nutrition. Fluid and nutrition should be given carefully because the patient
may be unwilling or physically unable to maintain a balanced intake; for the patient
suspected of having alcohol toxicity or alcohol withdrawal, therapy should include
multivitamins, especially thiamine.
• Reorientation techniques. Reorientation techniques or memory cues such as a
calendar, clicks, and family photos may be helpful.
• Supportive therapy. The environment should be stable, quiet, and well-lighted;
sensory deficits should be corrected, if necessary, with eyeglasses or hearing aids;
family members and staff should explain proceedings at every opportunity, reinforce
orientation, and reassure the patient.
Pharmacotherapy
Delirium that causes injury to the patient or others should be treated with medications.
• Antipsychotics. This class of drugs is the medication of choice in the treatment of
psychotic symptoms of delirium.
• Benzodiazepines. Reserved for delirium resulting from seizures or withdrawal
from alcohol or sedative hypnotics.
• Vitamins. Patients with alcoholism and patients with malnutrition are prone to
thiamine and vitamin B12 deficiency, which can cause delirium.
• Hypnotic, miscellaneous. Agents in this class may be useful in the prevention and
management of delirium (e.g. melatonin, ramelteon).
NURSING MANAGEMENT
Nursing management for a patient with delirium include the following:
✓ Psychiatric interview. The psychiatric interview must contain a description of the
client’s mental status with a thorough description of behavior, flow of thought and
speech, affect, thought processes and mental content, sensorium and intellectual
resources, cognitive status, insight, and judgment.
✓ Serial assessment. Serial assessment of psychiatric status is necessary for determining
fluctuating course and acute changes in mental status.
✓ Providing a safe and supportive environment. For example, prevent excessive noise,
provide consistent caregivers and a consistent care routine, use simple phrases,
provide feeding assistance, encourage early mobilization, decrease or avoid
medication administration after the patient's bedtime, eliminate unnecessary stimuli,
and provide supportive aids such as glasses and hearing aids.
✓ Avoiding use of physical restraints, which are indicated only if medically necessary
and all other alternatives have failed. Restraints can worsen confusion and cause
additional medical problems, such as pressure injuries and other complications of
immobility.
✓ Closely monitoring vital signs Delirium may cause hypertension and tachycardia;
hypoxemia can contribute to delirium.
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
OBJECTIVES: Disturbed thought That within my 8 1. Assess client’s level of 1. Recognizing these behaviors, GOAL MET
processes related to hours span of care, anxiety and behaviors that nurse may be able to intervene
delusional thinking. client will be able to: indicate the anxiety is before violence occurs. After my 8 hours
increasing. span of care, client
a. Maintain agitation was able to:
at a manageable level 2. Maintain a low level of 2. Because anxiety increases in a
so as not to become stimuli in client’s environment highly stimulating environment. a. Maintain agitation
violent. (low lighting, few people, at a manageable
b. will not harm self or simple decor, low noise level). level so as not to
others. become violent.
3. Have sufficient staff 3. Assistance may be required
available to execute a physical from others to provide for b. No harm to self
confrontation, if necessary. physical safety of client or and others.
primary nurse or both.