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delirium(di-lir'e-um) [L. delirium, madness, insanity]
Common causes include drug and alcohol withdrawal; medication side effects; infections (esp. sepsis); pain; surgery or trauma; hypoxia; electrolyte and acid-base imbalances; sensory deprivation and sensory overload; dementia; hospitalization and/or depression, esp. but not exclusively in people 65 years or older.
Treatment involves determining the cause of the delirium and removing or resolving it if possible.
Preventive measures may sometimes reduce the risk of delirium in hospitalized patients. Such measures include providing glasses and hearing aids to patients with known sensory defects; mobilizing patients or providing range-of-motion (R.O.M) activities several times each day; avoiding multiple new medications; maintaining hydration by encouraging oral fluid intake; using holistic measures to promote relaxation; inducing sleep and reducing anxiety; and engaging family members or people familiar to delirious patients in their care.
The health care professional should consider delirium whenever an acute change in mental status occurs. Supportive care consists of minimizing unanticipated, frightening, or invasive procedures; integrating orienting statements into normal conversation; and providing confused patients with a calm supportive presence. When patients express deluded thoughts, it is important not to try to convince them that their perceptions are distorted. Speaking in a calm, clear voice, talking directly to the patient and using only simple statements and questions, and maintaining eye contact may be helpful. Maintaining caregiver consistency and encouraging family visiting are especially beneficial. Delirious patients should be roomed close to nursing stations so that they can be frequently observed. Physical protection from self-injury should be provided by bed alarms, wander guards, or mattresses placed on the floor to decrease the likelihood of patients' falling. Delirious patients should be permitted to sleep without interruption. Pain that they experience should be treated with analgesic drugs that do not affect mental status. Large calendars and clocks should be provided to aid orientation. Natural light should be used to delineate day and night. Other useful preventive interventions include limiting interfacility transfers and room changes as much as possible and providing complementary therapies to decrease agitation and aggression (e.g., music therapy, massage, and shared activities). Antipsychotic drugs and benzodiazepines may be used cautiously when other nonpharmacological interventions have failed.
alcoholic deliriumDelirium tremens.
delirium cordisAtrial fibrillation.
delirium of negation
delirium of persecution
delirium tremensAbbreviation: DT
Sedation with benzodiazepines is the chief therapy. Other supportive care includes airway protection (and intubation when indicated); fluid and electrolyte resuscitation; hemodynamic support; protection of the patient from injury; and precautions against seizure. Comorbid conditions resulting from chronic alcoholism (e.g., pancreatitis, esophagitis, hepatitis, or malnutrition) may complicate therapy.
The patient and those nearby need to be protected from harm while prescribed treatment is carried out to relieve withdrawal symptoms. The patient's mental status, cardiopulmonary and hepatic functions, and vital signs (including body temperature) are monitored in anticipation of complicating hyperthermia or circulatory collapse. Prescribed drug and fluid therapy, titrated to the patient's symptoms and blood pressure response, are administered as prescribed, or by symptom-triggered algorithms. A calm, evenly illuminated environment is provided to reduce visual hallucinations. The patient is addressed by name; surroundings are validated frequently to orient the patient to reality, and all procedures are explained. The patient is observed closely and left alone as little as possible. Physical restraints should be reserved for patients who are combative or who have attempted to injure themselves. Patience, tact, understanding, and support are imperative throughout the acute withdrawal period. Once the acute withdrawal has subsided, the patient is advised of the need for further treatment and supportive counseling.