What is Delirium?
Posted in Psychiatric Nursing Review by admin On November 8, 2009. No comments
- Delirium is characterized by a disturbed consciousness and change in cognition that develops over a short period of time; onset is acute and symptoms occur rapidly.
- Delirium is an acute and debilitating decline in attention-focus, perception, and cognition that produces an altered form of semi-consciousness.
- It is a systemic syndrome caused by a chemical or disease-process which is disrupting the neurons of the cerebral cortex.
- Though hallucinations and delusions are often present, the symptoms of delirium are clinically distinct from those induced by psychosis or hallucinogens.
- Delirium itself is not a disease, but rather a clinical syndrome (a set of symptoms), which result from an underlying disease or new problem with mentation
- Evidence from the client’s history, physical examination, or diagnostic testing indicates that the delirium is a direct physiologic consequence of a general medical condition, substance intoxication or withdrawal, use of medication, or toxin exposure or a combination of these factors.
B. Common Symptoms of Delirium:
- Impaired consciousness and attention, disorientation
- Disorganized thinking and rambling speech
- Disturbance in the sleep-wake cycle, such as daytime sleepiness and nighttime agitation
- Psychomotor changes (hyperactivity and agitation, or hypoactivity and somnolence)
- Misinterpretation of situations and reality, illusions, and hallucinations
- Labile mood (rapid, unpredictable shifts from one emotional state to another).
C. Types of Delirium:
- In delirium due to a general medical condition, multiple medical conditions can be associated with delirium; acute or chronic illnesses, hormonal and nutritional factors, sensory impairments, and various medication as well as surgical procedures can all contribute.
- In substance-induced delirium and substance withdrawal delirium, the client’s history, physical examination and diagnostic study findings indicate the delirium is associated with substance use.
- In delirium due to multiple etiologies, several medical conditions or a combination of substance use and medical conditions is evident.
- Delirium not otherwise specified is the DSM-IV TR classification applied when insufficient evidence exists to establish a definitive etiology.
D. Causes of Delirium:
- Delirium is complex and usually multifactored.
- Delirium may be caused by severe physical illness, or any process which interferes with the normal metabolism or function of the brain.
- The following risk factors are associated with delirium:
- Advanced age
- Preexisting illness
- Infection and/or electrolyte and metabolic imbalance
- Bone fractures
- Brain damage or dementia.
E. Delirium Treatment:
- Treatment of delirium is achieved by treating the underlying dysfunction cause, or in many cases, the causes (plural), as delirium is often multi-factorial.
- Treatment usually occurs in an acute care medical-surgical setting.
- The client typically undergoes a comprehensive diagnostic assessment, and physiologic symptoms are readily treated.
- Objectives of treatment include:
- Identification of the immediate cause
- Correction of the underlying cause
- Symptoms management
- Supportive and safety measures.
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