Signs and Symptoms of Delirium

Delirium is a condition in which an individual presents with sudden onset of disorientation, confusion and unusual behavior. A patient in the acute care unit presented with these symptoms as he was confused, uncooperative, and combative to the point that he assaulted a nurse. The patient needed to be restrained as he attempted to leave the facility by pulling out his IV’s. While the restraints protected the patient it did create some paranoia in the patient. The patient began to state that the nursing staff was attempting to kill him and that he had a bomb strapped to his chest. 

Due to the unusual and sudden onset of the symptoms present in the condition individuals will often find themselves in a hospital or acute care settings. Delirium also most likely occurs in individuals in their later years of life as deteriorating health, cognitive ability, and decline in the parent-child relationship can combine to increase the chances of getting the condition. Providers who work in acute care settings should follow standards of care in treating these individuals. However, treatment of the condition can be complicated. “Clinicians have three potential approaches when it comes to the management of delirium: (1) managing delirium... (2) treatment of delirium....; or (3) prevention of delirium” (Maldonado, 2008, p. 683). Providers must be aware of what approach they are taking in the treatment of the condition.

The ICU nurse can be critical to making the decision regarding what stage a patient ready for whether it is management, treatment or prevention of the symptoms. The nurse can also play a vital role in the management of the condition by managing the behaviors that occur with delirium. This could be in the form of administering medication or utilizing restraints to secure the patient if they are violent. The nurse can then assist the doctor in providing treatment of the condition by finding out what caused the delirium by way of an accurate interview. The underlying causes of the delirium would prescribe a course of treatment for the condition. The nurse could then provide psychoeducation to the patient regarding how they could avoid the condition occurring again. 

Delirium is a condition which is very upsetting for both the patient and the family. They may request a bedside sitter; however, there are ways to reduce the need. Providing reassurance and knowledge surrounding the condition is essential in assisting the family gets through an episode of the condition. Due to the distress and trauma that occurs after the condition, nurses must play a role in helping to ensure that the condition does not occur again. The nurse must be able to collaborate with everyone on the team to determine a treatment plan which would be followed by the patient or their family. As delirium is prevalent in the hospital setting a nurse must familiarize herself with the condition in order to be able to diagnose it right away and begin providing treatment. Early detection could be lifesaving for the patient's mental state and the chances of the disorder occurring again. A nurse must not minimize her ability to play a crucial role in the patients' treatment and recovery.

Reference

Maldonado, J. R. (2008). Delirium in the acute care setting: Characteristics, diagnosis, and treatment. Critical Care Clinics, 24(4), 657-722