Delirium Management

An underlying medical condition, medication, toxin exposure, substance use, or withdrawal can be the cause or causes of delirium, which is an acute reversible condition that alters baseline cognition.  Courtney Bennet (2019) stated in the article Caring for Patients with Delirium, that delirium is considered a medical emergency and needs immediate intervention; it can develop over hours to days and typically is only a brief occurrence, lasting a maximum of one week (pg. 17).

Delirium affects the ability to sustain attention, disturbs orientation to one’s environment, thinking, behavior, and the sleep-wake cycle.  It can affect patients across all age groups but is most commonly seen in hospitalized older adults.  Delirium affects:

• 17% or more of patients presenting to the ER
• 10% to 70% of older adults postoperatively
• 50% of patients in the ICU
• 60% of residents in a long-term care facility or post-acute care
• Up to 80% of those receiving end-of-life-care

(Bennett, C, 2019, pg. 17)

Nurses play a critical role in identifying the symptoms of delirium in patients and may be the first to notice changes in patient’s cognitive status.  Because delirium symptoms can sometimes be mistaken for aging or disease processes such as dementia; the changes can be overlooked. A 2015 study found that signs of delirium were missed in 67% of patients referred to palliative care (Bennett, C, 2019, pg. 17).

Interventions for patients with delirium should be planned on a case-by-case basis but some interventions could include safety/fall precautions, frequent re-orientation to the environment or familiar objects, monitoring bowel and bladder, monitoring vital signs, monitoring lab results, assessing response to drug therapy, assessing and managing pain, sleep hygiene, music or pet therapy, education to family members ((Bennett, C, 2019, pg. 18).

To read more about caring for patients with delirium please read this article.

Bennet, C. (2019). Caring for patients with delirium. Behavioural Health (49), 9, pg. 17-20.  Retrieved from https://www.va.gov/covidtraining/docs/Caring_for_Patients_with_Delirium.pdf