1. Delirium Patients Experiencing Delirium

2. Delirium Also known as an “acute state of confusion” It is considered a serious acute medical problem Indicates there may be a serious medical problem Patients describe delirium as: –The twigh light zone –Fog bank –A state of constant terror

3. Delirium can be described as: Starting and stopping suddenly Lasting a few hours, a few days or a few weeks Patient’s alertness fluctuates Patient knows person but not time and place Their attention is distracted easily, can not stay on one subject for very long They have NO short term memory Their thinking is disorganized and they ramble They have delusions and visual hallucinations

4. 4 Key Features 1.Difficulty concentrating 2.No short term memory, disorientated, seeing things 3.Sudden onset, can go from very active to very sleepy 4.Delirium is caused by a medical problem such as a new medication or alcohol withdrawal

5. 3 Types of Delirium Hyperactive Agitated state with increase activity and increased verbal behaviors Hypoactive More comment in elderly. Quietly confused with some anxiety. Tired and withdrawn Mixed Patients move from hyperactive to hypoactive states

6. What Causes Delirium Outside hospital Illness –Pneumonia, UTI’s Depression New medications Alcohol and drug withdrawal Post operative Previous delirium Inside hospital Dehydration, malnutrition Surgery Infections Not sleeping Not mobilizing Unfamiliar environment Sensory overload Isolation and no windows

7. What to Do Communication: Eye contact at eye level Identify self Call patient by preferred name Be calm and speak slowly Validate fears and concerns Use short and simple sentences Re orientate frequently Environment: Minimize noise and staff changes Provide food and fluids Ask family for familiar objects Music Promote sleep Use clocks and calendars to re orientate Limit visitors Have family sit with patient

8. What to Do Physiological: Look for signs of pain Check for constipation Check for urinary retention Toileting routines Mobilize lots Safety: Use bed and chair alarms Move patient closer to nursing station Remove sharp objects Have patient wear clean glasses and working hearing aides

9. Other Interventions to Consider No restraints, they only increase agitation Read the paper or your magazine to the patient. Let them read as well Elder Friendly Program has a TV for DVD’s and Videos

10. QUESTIONS?