NUR643E A Patient Experiencing Delirium After Initiation Of New Medication
NUR643E A Patient Experiencing Delirium After Initiation Of New Medication
DQ1 A patient is experiencing delirium after the initiation of a new medication. What are questions you want answered as well as physical findings would you be looking for?
DQ2 Choose a special population and detail the approach to history taking and physical examination with the patient and/or family member.
Delirium happens when a person has sudden confusion or a sudden change in mental status. The person may have trouble paying attention or thinking clearly. They may act disoriented or distracted.
Delirium is more severe than having a “senior moment” — the minor problems people have with memory and understanding as they get older. It requires treatment and often hospitalization.
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Is delirium a disease?
No, delirium is not a disease. It’s a changed mental state.
Is delirium the same as dementia?
Delirium and (which includes conditions such as ) have some similarities, but they are not the same.
- Delirium mostly affects a person’s attention. Dementia affects memory.
- Delirium is a temporary state that begins suddenly. Dementia is chronic (long-term) confusion that usually begins gradually and worsens over time.
However, someone can have both delirium and dementia. Seek care quickly if a person, especially one with dementia, begins to show symptoms of delirium.
What are the types of delirium?
The two types of delirium are:
- Hyperactive delirium: The person becomes overactive (agitated or restless).
- Hypoactive delirium: The person is underactive (sleepy and slow to respond).
Hypoactive delirium is more common, occurring in up to 75% of people with delirium. But many people, including healthcare providers, may incorrectly assume the person is depressed.
People can experience both types of delirium together. They can be extremely alert one minute and drowsy the next.
Who is at risk for developing delirium?
Delirium happens more often in older people and hospitalized patients. “Hospital delirium” can affect 10% to 30% of those patients.
People in these high-risk populations may develop delirium:
- People who have had surgery.
- 80% of people who are at the end of life.
- 70% of people in intensive care units (ICUs).
- 60% of people over age 75 in nursing homes.
- 30% to 40% of people who have human immunodeficiency virus ().
- 25% of people with .
People may also be at higher risk for developing delirium if they:
- Are on .
- Can’t move because of catheters or restraints.
- Don’t get enough sleep or are .
- Have .
- Have more than one illness, have a chronic condition or take multiple medications.
- Have , chronic or had a .
- Have trouble hearing or seeing.
- Suddenly stop using alcohol or drugs (withdrawal).
How common is delirium?
Because delirium is temporary, it’s hard to know exactly how many people develop it. Researchers estimate that hospital delirium affects 15% to 50% of people.
SYMPTOMS AND CAUSES
What are the causes of delirium?
In some cases, providers can’t find a cause of delirium.
Known causes of delirium include:
- Alcohol or illegal drug toxicity, overdose or withdrawal.
- Overwhelming reaction to infections such as , and .
- Changes in the environment.
- Dehydration.
- Medications, such as those with anticholinergic effects (including ), psychoactive drugs and .
- Hormonal issues (such as or ).
- Hospitalization or surgery.
- Kidney or liver injury or failure.
- Lack of oxygen to your tissues.
- Lack of sleep.
- Pain.
What are the symptoms of delirium?
The different types of delirium produce different symptoms. Symptoms tend to start suddenly and get worse over the next few hours or days. A person with delirium may act like they’re intoxicated. The main symptom is being unable to pay attention. Symptoms tend to become worse in the evening, which is known as sundowning.
Symptoms of hyperactive delirium include:
- Acting disoriented.
- Anxiety.
- Hallucinations.
- Rambling.
- Rapid changes in emotion.
- Restlessness.
- Trouble concentrating.
Symptoms of hypoactive delirium include:
- Apathy.
- Decreased responsiveness.
- Flat affect.
- Laziness.
- Withdrawal.
DIAGNOSIS AND TESTS
How is delirium diagnosed?
Healthcare providers look for problems with attention, memory, orientation and visual ability. Providers may ask the person to perform a few simple tasks, such as spelling a short word backward or doing a basic math problem.
A provider may diagnose delirium if the person:
- Can’t focus or shift attention.
- Has changes in thinking.
- Has a rapid onset of thinking problems, which may change throughout the day.
What tests are used to diagnose delirium?
After asking about the person’s symptoms, healthcare providers do a . They may also use other tests to help identify a cause, including:
- Blood test.
- .
- Imaging tests, including , or scan.
MANAGEMENT AND TREATMENT
How will the provider decide what treatment is best?
Other medical conditions usually cause delirium. It’s important to treat those conditions to treat the delirium. The provider will review the person’s:
- Medical history.
- Physical exam results.
- Lab results.
- Drug use, including over-the-counter drugs, illicit drugs and alcohol.
The person may not be able to answer questions about themselves. So providers may ask the person’s family member or loved one:
- Did the confusion begin suddenly or gradually?
- How quickly did it progress?
- What was the person’s mental and physical state before this?
- Is the person taking any drugs or dietary supplements?
- Did the person stop or start any new medicines or drugs recently?
Does delirium require hospitalization?
In some cases, the person is in the hospital when they develop delirium. If they are not, they will most likely need hospitalization. In a hospital setting, providers can monitor them and keep them from injuring themselves or others.
Providers try to identify the cause of delirium quickly to get the patient treatment as fast as possible. Once providers identify and treat the reason, they can often reverse the delirium.
A team of multiple providers can help give the best care. It’s important to prevent related problems such as undernutrition and incontinence. A care team may include a:
- Physician, nurse practitioner and/or physician’s assistant.
- Physical therapist.
- Occupational therapist.
- Nurse.
- Social worker.
