Neuro Disorders ; delirium

Question 1

What does delirium mean?

Answer 1

State of confusion that develops over days to hours

Question 2

Notes
Epidemiology and etiology
Common complication of hospital
22% of general medical patients
11-35% of surgical patients
80% of ICU

It’s important to early recognize and prevent !!

Question 3

What is the clinical picture we’ll see with patients of delirium?

Answer 3

Distributance in attention
Abrupt onset with periods of lucidity
Disorganized thinking
Poor executive functioning
Disorientation
Anxiety and agitation
Poor recall
Delusions & hallucinations

Question 4

Precipitating factors
Demographic
Age ?
Gender?
Cognitive status (4)?

Answer 4

65
Male

Dementia, cognitive impairment, depression, history of delirium

Question 5

Delirium
Precipitating factors
Environmental (4)
Prolonged sleep deprivation!
Functional status? (3)

Answer 5

Admission to ICU
Use of physical restraints
Pain
Emotional stress

Functional dependence
Immobility
history of falls

Question 6

Delirium
Precipitation factors
Sensory (3)

Decreased oral intake (2)

Answer 6

Sensory deprivation
Sensory overload
Visual or hearing impairment

Dehydration
Malnutrition

Question 7

Delirium
NOTES !!
Drugs
Sedative-hypnotics
Opioids
Anticholinergic drugs
Aminohkycosides
Treatment with multiple drugs
Alcohol or drug abuse

Coexisting medical conditions
Fractures
Sepsis
History of stroke
Acute or terminal illness

Question 8

Delirium surgery precipitating factors are ? (4)

Answer 8

Orthopedic surgery
Cardiac surgery
Prolonged cardiopulmonary bypass
Noncardiac surgery

Question 9

What is the delirium mnemonic for causes?

Answer 9

Delirium

Question 10

D (2)
E (2)
L (5)
I (2)
R (1)
I (2)
U (2)
M (1)
STAND FOR?

Answer 10

Dementia, dehydration
Electrolyte imbalance, emotional stress
Lung, liver, heart, kidney, brain
Infection, ICU
Rx Drugs
Injury, immobility
Untreated pain, unfamiliar environment
Metabolic disorder

Question 11

What’s early manifestations for delirium? (7)

Answer 11

Inability to concentrate
Disorganized thinking
Irritability
Insomnia
Loss of appetite
Restlessness
Confusion

Question 12

What are later manifestations ? (4)

Answer 12

Agitation
Misperception
Misinterpretation
Hallucinations

Question 13

Delirium clinical manifestations can last from how many days ?
Can some manifestation persist?
Can some patients recover yes or no?

Answer 13

1-7 days
Yes for months or years
Yes and some don’t

Question 14

What are the 3 key distinctions of delirium rather than dementia ?

Answer 14

Sudden cognitive impairment
Disorientation
Clouded sensorium

Question 15

What are the 4 cardinal features of delirum

Overall assessment and application of the nursing process

Answer 15

Acute onset and fluctuating course

Reduced ability to direct; focus, shift and sustain attention

Disorganized thinking

Disturbance of consciousness

Question 16

Delirium patients
What will they experience cognitively ?
What will they experience physically? (3)
What will they feel or what is altered? (3)

Answer 16

Hallucinations & illusions

Tachycardia, hypertension, sweating

Sleep, wake up, hypervigilance

Question 17

Notes
Nursing diagnosis
Risk for injury
Acute confusion
Risk for deficient fluid volume
Disturbed sleep pattern
Impaired verbal communication
Dear
Self care deficits
Impaired social interaction

Question 18

What is the outcomes criteria/evaluation? (2)

Answer 18

Patients will remain safe and free from injury

Orientated

Question 19

What is planning for delirium? (3)

Answer 19

Ensure necessary aids and support home
Visual cues in the environment for orientation

Continuity of care providers

Question 20

Notes for implementation

Precent physical harm due to confusion, aggression, or fluid and electrolyte imbalance

Minimize use of restraints

Perform comphrensive nursing assessments

Assist with proper health management to eradicate underlying cause

Use support measures to relieve distress