Delirium

  • Delirium Definition

    Delirium is a serious disturbance in a person’s mental abilities. It causes a decreased awareness of one’s surroundings and confused thinking. The onset of delirium is usually sudden, often within hours or a few days. (Source: Mayo Clinic)

    Delirium Characteristics

    Reduced awareness of surroundings resulting in:
    • An inability to stay focused on a topic or to change topics
    • Wandering attention
    • Getting stuck on an idea rather than responding to questions or conversation
    • Being easily distracted by unimportant things
    • Being withdrawn, with little or no activity or little response to the environment

    Poor thinking skills that may appear as:
    •  Poor memory, particularly of recent events
    •  Not knowing where one is, who one is or what time of day it is
    •  Difficulty speaking or recalling words
    •  Rambling or nonsense speech
    •  Difficulty understanding speech
    •  Difficulty reading or writing

    Behavior changes:
    •  Seeing things that don’t exist (hallucinations)
    •  Restlessness, agitation, irritability or combative behavior
    •  Disturbed sleep habits
    •  Extreme emotions, such as fear, anxiety, anger or depression

    (Source: Mayo Clinic)

  • Sundowning

    Sundowning describes behavioral problems such as confusion and agitation that show up at the end of the day and often continue into the night. Sundowning is often associated with delirium.

    Symptoms of sundowning may include:
    • Hallucinations
    • Confusion
    • Agitation
    • Loss of inhibitions
    • Paranoia

    The cause of sundowning is unknown. A patient’s body clock and sleep pattern may cause sundowning. Other factors, like fatigue, low lighting and shadows may cause sundowning. Noisy activity in a care facility may also have a sundowning effect.

    Remedies for sundowning may include:
    • Lighting fitting the time of day and sleep needs
    • Window shades that may be open or closed
    • Regular meal times
    • Visitors and visiting hours
    • Regular morning and bedtime routines
    • Mid-afternoon nap or quiet time
    • Limited noise before bedtime
    • Familiar items like photographs to help reduce agitation and confusion

  • Elopement

    Elopement “is when a patient wanders away, walks away, runs away, escapes, or otherwise leaves a caregiving facility or environment unsupervised, unnoticed and/or prior to their scheduled discharge” (National Institute for Elopement Prevention and Resolution).

    The following are possible causes of elopement in older adult patients (GilbertGuide.org):
    • Memory loss
    • Physical needs (e.g. toileting)
    • Social needs
    • Insomnia
    • Side effects from medication
    • Confusion

  • Mittens

    Mittens may be considered restraints, depending on their use. Mittens are a type of soft restraint designed to restrict hand movement without damaging the skin. Mittens are sometimes used to prevent the confused, disoriented or combative patient from injuring himself/herself or others, or from removing equipment such as IV lines, catheters and tubes. They are considered to be less restrictive than other methods of restraint.

    Restraints, including hand mitts, should be used only as a last resort. Restraints cannot substitute for adequate nurse staffing or monitoring.

  • Delirium Risk Assessment

    Delirium risk assessment is a way of identifying preventable and treatable risk factors of delirium such as pain, dehydration, medical illness and multiple medications. Delirium in older adults is often under recognized and under diagnosed. Therefore, routine screening and use of an assessment tool should be part of comprehensive nursing care of older adults.

  • Mini Cog

    The Mini Cog is a quick test used by doctors and nurses to assess someone who seems to have the signs and symptoms of a dementia. The Mini Cog only takes a few minutes to administer and can show that further tests are required. The test consists of a three-item recall and a clock drawing test:
    1. The patient is asked to repeat three unrelated words.
    2. The patient is then asked to draw a clock.
    3. The patient is then asked to recall the three words.

    If the patient is unable to recall any of the three words then they are categorized as “probably demented.”

    If the patient draws a clock that is in any way wrong they are considered as “probably demented.” If the clock is normal then they are considered “probably not demented.”

  • Delirium Therapeutic Activity Kits

    Links to things, people and events can help older adult patients with delirium. Activity Kits provide this link through the use of items that involve touch, hearing and vision. The kits can also help the patient connect with his or her caregivers.

    The activity kit may include:
    • Games
    • Audiotapes
    • Art supplies
    • Textured fabric
    • Cloth to fold
    • Tools
    • Key and lock boards

Links:

Delirium Link:

NICHE Delirium Need to Know

Delirium Definition Link:

Mayo Clinic

Delirium Characteristics Link:

Mayo Clinic

Sundowning Links:
Elopement Links:

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