Delirium is an acute organic brain syndrome characterized by a rapid onset of cognitive dysfunction and disruption in consciousness. It can also be referred to as as intensive care unit psychosis, acute brain disorder syndrome, acute confusional state or acute psychosis. It is temporary and a potentially reversible condition.
Causes
Delirium can be induced by any process, disorder or agent that disrupts the integrity of the central Nervous system and diffusely impair it’s functioning at a cellular level. The specific causes of delirium are;
1. Primary brain disease
- head injury; concussion, contusion, hemorrhage
- tumor
2. Systemic disease secondarily disrupting brain homeostasis
- electrolyte imbalance
- dehydration
- endocrine disorder ( hypoglycemia, hypo or hyper thyroidism)
- epilepsy
- uremia
- Vitamin deficiency such as vitamin B1 and B6
- infection
- Hypo perfusion of the brain
3. Brain Toxic Exogenous Disturbance
- all drugs over dosages
- non-compatibility or poor interactions
- Poisoning
- Drug side effects
Clinical Features of Delirium
1. Reduce Level or Clouding Consciousness
client’s awareness of ongoings of his/her environment is reduced/ diminished, showing a wide fluctuation between day and night. consciousness level also fluctuates between alertness(hyperactivity) and somnolence(hypoactivity)
hyperactivity manifest as agitation, loud speech, euphora, climbing out of bed, removing IV liners or tubes, elevated pulse. Hypoactivity client exhibit activity, appears to be stupor, slow in response to request and depressed.
2. Disordered Cognition
disorganized thinking, confused appearance and minimal problem solving abilities. Speech may be bizzare and incoherent, has difficulty distinguishing reality fromimagery, fails to connect new information with prior knowledge.
3. Attention Deficit
Have difficulty directing/focusing their attention
4. Disorientation in time, person or place
this may be coupled with Dejavu or in more serious cases to de-personalization.
5. Perceptual Disturbances
hallucinations and illusions are also experienced. This can make the client assume a fight or flight stance to elude unfounded perceptions.
He/she may become very combative with whomever or whatever is seen thwarting his/her effort to escape such as horrible situation.
6. Anxiety/fear
this may accompany terrifying hallucinations and may be seen as patient cries out.
Management
Most cases of delirium are reported in general medical hospitals, because of their sudden nature and urgent need for attention. The goals of management are to correct underlying cause, check or control acute confusion to maximize cognitive functioning and prevent further decline/injury.
1. Environmental Care
- patient is admitted and nursed in a separate room, preferably with regular attendants, whom patient will recognize as friend and protector.
- his belongings should be kept at specific areas to lessen confusion
- lights should neither be too bright nor too dim at night
- side rails or temporary seclusion may be necessary if patient is too confused.
- televisions are not as benefiting as soft music
- clocks and calendars are necessary for continuous re-orientation.
2. Medical Interventions
This include treatment of the underlying cause
- oxygen will be administered if hypoxia is the cause of delirium
- dextrose can also be given if hypoglycemia is the cause
- Antibiotics can also be given in case of infection
3. Psychological Care
- support tolerance, reassurance are constantly required from both the nurses and patient’s relations.
- Regular visitors should be maintained to avoid confusion
- some personal effects from patient’s home should be brought by relations to improve orientation.
- Maintenance of daily routine is very important by both staff and relations.
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