Symptoms And Treatment Of Delirium

Excited delirium syndrome is a rare but dangerous disease generally recognized by agitation, aggression, disorientation, and sometimes sudden death. Often associated with drug usage. There has been some documentation as early as the 1800s, but it manly started to come back around in the 1980s. These patients will often need to be restrained, usually by law enforcement, and pose a great danger to the crew’s safety until restrained and sedated. Excited deliriums cause is somewhat unknown. There is much conflict from researcher’s on the why and how.

While there was a policy in place for conscious sedation, even good policies rely on the vigilance of staff to adhere to them. Often times, working conditions allow for distractions, and even the best of practitioners, with the best of intentions, make errors. There were several areas presented in this scenario that require examination and improvement.

Lauren Oliver once said, “Find the things that matter, and hold on to them, and fight for them, and refuse to let them go.” Despite the fact that Lena is taught that love is a disease and is forbidden, she falls in love anyhow. She comes to realize love is all that matters; that love is something you hold onto, fight for, and never let go of. Delirium is a story that teaches a valuable life lesson that holds true even for today’s teenager: following your heart can set you free.

Unintentional errors, near-misses, and adverse patient outcomes occurring in the intensive care unit can range from significant to fatal. These errors have

Yuma Regional Medical Center (YRMC) does not currently have a standardized delirium prevention protocol or policy in place. Although there is no current protocol in place, YRMC does utilize the Confusion

Delirium is a serious condition that can affect patients in and outside the hospital. With its presence being unknown to many nurses and providers, delirium has significant long term complications that can last well beyond discharge. Noise, medication, and infection are significant in the development and progression of delirium and these are more than abundant within intensive care patients. The importance of nurse’s knowledge cannot be stressed enough regarding the assessment, symptoms, and interventions of delirium, in an effort to decrease its occurrence

The investigation of how anesthesia effects cognitive functioning has had a long history. Overtime, it has been suggested that there is an association between anesthesia, surgery, delirium, dementia and postoperative cognitive dysfunction (Inan & Ozkose Satirlar, 2015). The theory of anesthesia’s impact on cognitive functioning was derived in 1887, by Savage, who began to observe the “insanity” that follows the use of anesthesia. He suggested that “Any cause which will give rise to delirium may set up a more chronic form of mental disorder quite apart from any febrile disturbance” (Savage, 1887, p. 1199). Delirium can be defined as an altered level of consciousness that may cause a sudden decline in attention and focus perception (Isik, 2015). Postoperative delirium was reevaluated in 1955 when Bedford used a series of case studies collected over a 50 year span to describe a connection between anesthesia and dementia. The results suggest that 10% of the patients had postoperative cognitive dysfunction (Bedford, 1955). Since these initial studies, research has persisted using a variety of methods, in an attempt to determine: both long- and short-term effects of anesthesia on cognitive functioning and memory; whether the anesthesia administration technique will change the outcome of postoperative cognitive dysfunction; and other risk factors that may be associated to AD.

Clinicians recognize risk factors assess, better diagnose and manage patients and reduce mortality rates. (Trenary, 2007)Describes how Banner Health Care System uses a system called eICU where patients are cared for by intensivists, experienced critical care nurses and health unit secretaries working from a remote location on the campus of Banner Desert Medical Centre. From this location care clinicians can see and hear six different units in five different hospitals .Their aim is to increase this added support to all ICU patients within their Banner Health Care System across the seven states in twenty different facilities. .Using the eICU system the ICU rooms are fitted with a camera, microphone and a speaker .The camera is activated when initiated by the bedside team when there is an alert received from the eICU system .There is no recording availability so the system is HIPAA compliant .This system adds an additional support to the nurse patient ration at bedside. A similar system is used in the Ob department to support the nurses and help to reduce complications during childbirth

Every year, up to 249,000 BSIs occur within hospitals in the US. Apparently, 32.2% of these BSIs do occur in the ICUs (Chopra, Krein, Olmsted, Safdar & Saint, 2013)The apparent bias in prevalence of BSIs within the ICUs is associated with the increased utilization of the CVCs within these units since they deal with a majority of critical care situations.

Enhanced assessment and nursing implementations to better prevent and detect ICU delirium will bring improved outcomes for this particular patient population. There are many ways to assess for ICU delirium. Two of the most reliable and easiest methods are basic observations from the bedside nurse and The Confusion Assessment Method (CAM). The CAM includes nine different criteria for delirium (1) acute onset and fluctuation, (2) inattention, (3) disorganized thinking, (4) altered level of consciousness, (5) disorientation, (6) memory impairment, (7) perceptual disturbances, (8) psychomotor agitation or retardation, and (9) altered sleep-wake cycle. A delirium diagnosis is given when criteria one and two and either three or four are present. The second assessment tool for delirium detection is made from nursing observations. The nurse observes the patient throughout their

Yuma Regional Medical Center (YRMC) does not currently have a standardized delirium prevention protocol or policy

Delirium is all too common in the intensive care unit (ICU) and should not be taken lightly. A 2009 observational cohort study performed in post-acute care facilities found that the one-year mortality rate for patients with delirium was 39% and that “subjects with persistent delirium were 2.9 times more likely to die during the one-year follow-up compared to subjects who resolved their delirium” (Kiely, et al., 2010, p. 55). Unfortunately, the change in mentation caused by delirium is often overlooked as a side-effect of sedative and analgesic medications often administered in the critical care setting or as symptoms of dementia or depression (Girard, Pandharipande, & Ely, 2008). Girard states, “The prevalence of delirium reported in medical and surgical ICU cohort studies has varied from 20% to 80%, depending upon severity of illness observed and diagnostic methods used” (Girard, Pandharipande, & Ely, 2008, p. S3). This variance is most likely due to the complications in defining the pathophysiology of delirium, as well as the difficulty in categorizing its signs and symptoms, which can range from mild confusion to full-blown hallucinations. Despite new scoring tools intended to identify delirium early in their hospital stay, many

Clinical reasoning can be defined as, ‘the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding of a patient’s problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from the process’ (Levett-Jones & Hoffman 2013, p.4). It requires health professionals to be able to think critically and ensures better engagement and results for the patient (Tanner 2006, p.209). The Quality in Australian Healthcare Study (Wilson 1995, p.460) discovered that ‘cognitive failure’ resulted in approximately 57% of unfavourable clinical events involving the failure to produce and act correctly on clinical information. It also recognises that often nurse’s preconceptions and assumptions can greatly affect patient care and by going through such a process, one can take into account the holistic nature of the patient and provide the best, most appropriate care.

I’ve known delirium as being acutely confused and disoriented and unalert to person, place, or time, or even having some decline in cognitive function. However, in Geriatric Nursing, delirium is defined as “an acute decline in cognition and attention and disturbance of consciousness and perception” Delirium can be acute or chronic. Delirium can occur post-surgery, in an ICU due to room change, lights, etcetera.This would be considered acute delirium. Chronic delirium is typically associated with disease processes. Delirium develops over a short period of time and can fluctuate. Delirium is a topic that most people aren’t aware of. If people were aware of delirium, we’d be more likely to talk about it and why it happens. Delirium is a condition

Delirium is a condition that is often treated by identifying and correcting the underlying etiology (Townsend & Morgan, 2017). This includes the healthcare team addressing if the patient was hypoxic, took certain medications, or had a fluid and electrolyte imbalance that lead to the delirium (Townsend & Morgan, 2017). Medical treatment modalities for delirium involve select pharmacological therapy for specific symptoms, but are not recommended (Townsend & Morgan, 2017). Common pharmacological interventions include reducing symptoms of psychosis or substance withdrawal (Townsend & Morgan, 2017). Physicians prescribe anti-psychotics such as Haloperidol at a low dose to reduce the agitation associated with delirium (Townsend & Morgan, 2017). Other medical treatment modalities for delirium include the use of anxiolytic agents such as Benzodiazepines to reduce the occurrence of delirium associated with substance withdrawal (Townsend & Morgan, 2017). Lastly, as the delirious client becomes increasingly confused and aggressive, other mechanical or chemical restraints may be implicated for overall safety measures (Townsend & Morgan, 2017).