Signs And Symptoms Of Delirium Nursing Essay

Introduction

Delirium is a common and exhausting disorder that affects mainly the elderly in intense care settings (Aguirre, 2010). Burock (2012) describes delirium as an intense mental health syndrome described as a disturbance in level of attention impairments, cognitive impairments, consciousness, disorientation, occasionally severe behavioral problems, and perceptual disturbances. The number of delirium in patients who are elderly and ill, but cared for at home are much lower, than for the elderly treated in the hospital. Delirium is one of the most general syndromes older patients develop and one that clinicians miss at the reported rate of 32% to 66%. The occurrence of delirium upon arrival to medical units is between 10% and 31%, however most experts place the time closer to 30% in the elderly population (65 years of age and older).

Signs and symptoms of Delirium

Attard, Ranjith, and Taylor (2008) describes some of the symptoms of delirium as attention and impairment of consciousness; disturbance of the sleep-wake cycle; emotional disturbances; cognition (including delusions, disorientation, illusions and hallucinations); psychomotor disturbances. Aguirre (2010) was able to describe the of signs and symptoms of delirium as alcohol abuse, co morbidities, dehydration, dementia, depression, malnutrition, medication exposure, old age, severe illness, and sensory impairments. While, Markowitz and Narasimhan (2008) describes the features of delirium as: change in cognition like memory impairment, perceptual disturbance, consciousness, and tendency to move, proof from the history, laboratory findings, or physical examination that the signs and symptoms, are the direct physiological consequences of a medical condition or substance use.

Lorenzl, Füsgen, and Noachtar (2012) list the predisposing factors of delirium as: deafness cognitive impairment or partial or total blindness, prior episodes of delirium, dementia and depression. The electrolyte disturbances (particularly hyponatremia): alcoholism, dehydration, hypoxia, and malnutrition. The other factors include the functional state: constipation, dependency, few social contacts, frailty, immobility, pain, recurrent falls, and sleep deprivation. Peacock, Hopton, Featherstone, and Edwards (2012) research revealed that the important triggers included constipation, dehydration, falls, infection, medication, or moving to a new or different environment and a noisy environment. A noisy environment was recognized as a trigger for behavior changes in residents, for example, noise made by some residents upset and agitated others.

Delirium process

The delirium process consist of clinical evaluation of delirium involves taking a elaborate medical and psychiatric history of the patient, which includes a thorough medical, mental state examination, and neurological (Attard, Ranjith, & Taylor, 2008). Lorenzl et al. (2012) shows that, the diagnostic evaluation of delirium begins with its difference from other syndromes and the characteristics of a study of the cause of the disease. First, the contributing factors and importance of delirium are described by the past events and physical examination. Delirium is identified on clinical ground. The existence is characterized by its change of course, intense onset, and typical indication. The cause of the disease is then discovered. The prominent part of delirium in a patient is the patient’s formal medical history, the patient’s current cognitive impairment, and diagnostic testing may be indicated.

In the implications for practice the most significant part of treating delirium is the point of diagnose it. Delirium can be diagnosed in most patients who have an altered level of consciousness, an intense onset of confusion, inattention, and disorganized thinking/behavior, disturbances of perception, or disturbances of the sleep cycle. Other conditions that often pertain to the diagnosis of delirium include dementia, depression, mania, psychosis, and neurological conditions. The inclusion of an assessment for delirium by the clinician can bring more desirable patient care, no matter the instrument used. Regardless of the intervention, an educational program to give important knowledge to hospital staff, along with treatment guidelines (Popeo, 2011).

Wiesenfeld (2008) identifies that clinicians need to have: advocacy, diligence vigilance, integration, support, and education. In advocacy, a patient who becomes delirious cannot advocate for themselves. The clinician would need to advocate for the patient. The diligence of clinicians in the help with delirious patient requires a physician who can investigate the mental status of the patient. The diligence of the physician involves clarifying not just the medication list with the pharmacy, but also the medication in accordance of the patient before giving the same list of drugs, half of which the patient may not even be taking. In vigilance, the vigilant clinician will monitor for under- or overdosing of chemical or physical they may hold back the patient and clinicians need to communicate with new doctors or nurses as shifts and staff rotations change. The integration requires the clinician to use a bio-psychosocial approach to the delirious patient, using sufficient pharmacology but also not forgetting to advocate for sensory optimization, working with healthcare providers to apply a gentle approach to care, frequent orientation, interpretation services, and primary nursing.

In support, the supportive clinician must play a role for psychotherapeutic support to patients who may be frightened or embarrassed during and after being diagnosed with delirium. The education, the clinician dealing with delirium will use every chance to educate patients, families, and colleagues about the implications, purpose, and risks of the delirium by giving advice and education about how to reduce the symptoms of delirium in the future (Wiesenfeld, 2008). According to Peacock et al. (2012), the implications for practice include: training in delirium prevention can broaden care workers’ repertoire in managing confusion in residents; Unqualified staff should understand the rationale behind actions such as constipation and monitoring dehydration ; Care home managers should encourage staff to reflect on underlying causes of behavior change in residents; and communication of concerns in usual systems such as handover and key worker systems is essential.

Delirium affects on activities of daily living

The delirium affects on activities of daily include predisposing factors which include altered blood urea, cognitive impairment, severe medical illness, and visual impairment. These can help to locate factors that need to be brought to the attention of hospital staff, family, and friends or to identify high-risk patients. Other identified predisposing factors include increasing age, functional impairments joined with the main physical illness, lower educational attainment, male gender, and other neurological disorders, presence of dementia depression, and the severity, burden of co-morbidity. Other symptoms include change in emotions, memory, reading, and writing. The number of alertness and activity of the patient permits for the division of delirium, into three different subtypes which are mixed, hyperactive, and hypoactive (Attard, Ranjith, & Taylor, 2008).

Common treatments for Delirium

According to Juliebø, Krogseth, Neerland, Watne, and Wyller (2012) the treatment of delirium is focusing on management of the precipitating factors, as well as avoiding hypoxia, hyperthermia, and electrolyte disturbances. Antipsychotics and anxiolytics are widely used in the treatment of delirium, but except for a couple of studies indicating a prophylactic effect of haloperidol and risperdal on the incidence, duration and accuracy of delirium, no study has so far shown a considerable benefit on the end result after delirium. While Burock (2012) reported that the single most effective treatment of delirium is to diagnose and treat the underlying cause. The research also revealed that there is no FDA proving effective medications for the treatment of delirium. The most generally used drug for behavioral problems in delirium is still haloperidol. Haloperidol is a generally used antipsychotic and has been shown to improve delirium severity. While Lorenzl et al. (2012) focus on the non-pharmacological treatment of delirium include: creating a quiet, getting help from the patient’s family, the best level of functional activity with a set day/night rhythm, advancement of mobility, calming music and smells (aromatherapy), safe environment, and a feel by persons with whom the patient feels comfortable around.

Common risks and benefits of treatment

The common risk of treatment of delirium include medications, especially polypharmacy, are a well-known cause of delirium in the elderly. Medications such as, benzodiazepines, and narcotics are known for the incident and harshness of delirium. Medications with anticholinergic properties are more known to be associated with delirium than any other drug. Delirium with mania may occur in patients who come in contact with steroids and even oral steroid doses (Burock, 2012). According to Juliebø et al. (2012), hip fracture is considered to be a harmful insult, and delirium may occur as result of a hip fracture also in patients without known hip problems. Pre morbid cognitive damage is the most known risk factor for delirium showed across several studies. Other risk factors, including age, co morbidity, male sex, medications, and preoperative risk factors, are inconsistently reported, and the risk factors may differ in patients with and without pre fracture cognitive impairment. In medical, surgical, and ICU settings, different types of infections (pneumonia, sepsis, and urinary tract infection) are shown to be risk factors for delirium.

The common benefits of treatment of delirium include haloperidol, a known antipsychotic, is the most often used and the highest studied quality medication treatment for delirium is antipsychotic medication due to its small side effects, little active metabolites, and less likelihood of resulting in sedation (Markowitz & Narasimhan, 2008). Neufeld et al (2011) suggested that delirium is a significant syndrome happening to patients in numerous hospital settings. The article’s focal point was on interdepartmental and multidisciplinary working with advance efforts in delirium research and clinical. Vidán et al (2009) concluded that a multi component, non pharmacological intervention combining routine practice decreases delirium during hospitalization in older patients, increases value in quality of care, and can be utilized without supplementary resources in a public healthcare system.

Economic issues

Aguirre (2010) describes that decrease evaluation and recognition of delirium is a part of increased case, difficulties, mortality, and morbidity. Lorenzl et al (2012) concluded that patients with delirium are the reason for the health-care system having a rather large expense. In hospitalized patients diagnosed with delirium have, a $295 in supplementary expenses per day unlike those without delirium. If one gathers the rough amount that 20% of hospitalized patients over age 65 who have delirium, then the yearly additional expense for the United States is in the scope of 143 to 152 million dollars. Patients diagnosed with delirium that have specific medical care at a particular time have 39% higher costs in the intensive care unit. The same patient has 31% higher illness costs unlike patients without delirium. Patients with delirium account for the noticeable exceeding costs over a three-year period. Popeo (2011) delirium patients stay in the hospital longer, which results in a greater pharmacy and professional costs. The delirium patients often take more medications and require more meetings with physician than non delirium individuals. In decreasing the length of stay of a delirium patient in the hospital can account for $1 billion to $2 billion in cost savings annually.