Delirium resident survival guide: Difference between revisions
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❑ Treatment of underlying etiology is important in management of delirium. <br> | ❑ Treatment of underlying etiology is important in management of delirium. <br> | ||
❑ '''Non-pharmacological treatments''' <br> | ❑ '''Non-pharmacological treatments''' <br> | ||
* Avoid unnecessary movement of the patient <br> | * Avoid unnecessary movement of the patient <br> | ||
* Maintain continuity of care from caring staff <br> | * Maintain continuity of care from caring staff <br> | ||
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* Having a means of orientation available (such as a clock and a calendar) may be sufficient in stabilizing the situation<br> | * Having a means of orientation available (such as a clock and a calendar) may be sufficient in stabilizing the situation<br> | ||
* Reassurance and explanation to the patient and carer of any procedures or treatment, using short simple sentences<br> | * Reassurance and explanation to the patient and carer of any procedures or treatment, using short simple sentences<br> | ||
* Verbal and non-verbal de-escalation techniques to calm the patient. <br>❑ ' | * Verbal and non-verbal de-escalation techniques to calm the patient. <br> | ||
❑ T-A-DA Method (Tolerate, Anticipate, Don't Agitate)<br> | |||
:* Tolerate patient behavior, as long as the patient or other people are not in danger<br> | |||
:* Provide greater mobility by removing unnecessary attachments like catheter <br> | |||
:* Reduce agitation, do not reorient if reorientation causes agitation<br> | |||
:* Provide supervision, anticipate behavior to keep the patient safe.<br> | |||
❑Wandering and Rambling Speech<br> | |||
* Closely observe wandering patients<br> | |||
* Distract agitated wandering patient, if required, seek help from relatives<br> | |||
* Rule out common stressors causing agitation, such as pain, thirst, need for toilet<br> | |||
* Do not agree with rambling talk, acknowledge the feelings expressed and ignore the content, or change the subject, tactfully disagree, if the topic is not sensitive.<br> | |||
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Revision as of 00:13, 16 March 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]
Overview
It is commonly associated with a disturbance of consciousness (e.g., reduced clarity of awareness of the environment). The change in cognition (memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance, must be one that is not better accounted by a preexisting, established, or evolving dementia. Usually the rapidly fluctuating time course of delirium is used to help in the latter distinction.
Distressing symptoms of delirium are sometimes treated with antipsychotic, preferably those with minimal anticholinergic activity, such as haloperidol or risperidone, or else with benzodiazepine, which decrease the anxiety felt by a person who may also be disoriented, and has difficulty completing tasks. However, since these drug treatments do not address the underlying cause of delirium, and may mask changes in delirium which themselves may be helpful in assessing the patient's underlying changes in health, their use is difficult. Because delirium is a mere symptom of another problem that may be very subtle, the wisdom of treatment of the delirious patient with drugs must overcome natural skepticism, and requires a high degree of skill.
Definition
Delirium is an acute and relatively sudden (developing over hours to days), fluctuating decline in attention-focus, perception, and cognition.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
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Management
Diagnosis
Characterize the symptoms: ❑ Impairment of sleep awake cycle | |||||||||||||||||
Obtain detailed history: ❑ Collateral history from relatives, out patient care providers, case managers etc. is crucial in confused mental states. Identify if patient is at high risk to develop delirium: | |||||||||||||||||
Diagnosis is made by DSM V criteria or CAM-ICU scale ❑ DSM V Diagnostic Criteria
Specify if,
Specify if delirium is,
Specify if delirium is,
Or,
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If delirium is diagnosed, do focused examination to find out underlying etiology: Vital signs
Respiratory rate
Raised temperature
Skin Appearance Nurological examination Cardiovascular examination Pulmonary examination Abdominal examination | If delirium is not diagnosed, ❑ Re-access patient multiple times a day, diagnosis of delirium may be missed because of it's fluctuating course
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Investigations ❑ Delirium is a clinical diagnosis, investigations are aimed to reveal underlying etiology.
If indicated
| Primary Prevention ❑ Targeted symptomatic intervention can help prevent the emergence of delirium
❑ Prediction of Delirium in ICU can be done by [PREDELIRIC] model | ||||||||||||||||
Treatment: ❑ Treatment of underlying etiology is important in management of delirium.
❑ T-A-DA Method (Tolerate, Anticipate, Don't Agitate)
❑Wandering and Rambling Speech
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Discharge and follow up: | |||||||||||||||||
Do's
Dont's
References
- ↑ "http://psychiatryonline.org/content.aspx?bookID=28§ionID=1663978". External link in
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(help) - ↑ "Matching the Environment to Patients with Delirium: Lessons Learned from the Delirium Room, a Restraint‐Free Environment for Older Hospitalized Adults with Delirium - Flaherty-2011 - Journal of the American Geriatrics Society - Wiley Online Library".