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Dr.Balan Stephen

Delirium is an acutely disturbed state of mind characterized by restlessness, illusions, and incoherence, occurring in intoxication, fever, and other disorders.

Causes of Delirium
Brain based            ----- meningitis, encephalitis
Otherorgans ----------- UTI, respiratory infections, hepatitis, etc.
Systemic ---------------- viremia, septicaemia, malaria, sub-acute bacterial endocarditis.
Hidden ------------------ abscesses, dental infection, bedsores, osteomyelitis

Any psychoactive substance.

Acut Metabolic
The four failures-------- cardiac, respiratory, renal, liver failure
Electrolyte abnormalities.

To head    ------------          extradural, subdural, subarachnoid and intracerebral haemorrhage
To other organs --------   burns, heat stroke, hypothermia.

CNS Lesions
Structural ------------ ISOL, (tumour, brain abscess etc.)
Functional----------- epilepsy, Para neoplastic syndrome

             Shock            ----------------------   cardiogenic, haemorrhagic,etc.
Haematological --------- --------   altitude sickness, anaemia

General ------------------ starvation, cancer cachexia
Thiamine B1 ------------ korasakoffs syndrome, Wernicke's encephalopathy
Niacin --------------------  pellagra- 4 Ds- diarrhoea, dementia (reversible), dermatitis, depression.
Vitamin B12 & folate ----- due to anaemia, neurological signs

Thyroid---------- hyperthyroid, hypothyroid
Parathyroid -------- hypercalcemia
Adrenal -------------- Cushing's syndrome, Addison's disease.

Acute Vascular
Cerebro vascular accident,
Cardiac arrhythmias,
Hypertensive encephalopathy,

All CNS drugs

Heavy Metals
Lead, mercury.

Nursing strategies to manage patients with delirium
1.   Frequent observation. 4 hourly or more
2.   Efforts by staff to repeatedly orientate the patient to surroundings recognised as a specific part of the management plan
3.  Avoid excessive staff changes. special nurse [one to one care] or named, key nurse
4.   Patient nursed in a single room
5.   Uncluttered nursing environment. beds apart by an adequate distance, and no more than two objects in vicinity that are non-vital or non-orienting
6.   Use of individual night light
7.   Specific efforts made to minimise noise levels. radio, televisions
8.   Relatives or friends specifically requested to visit at regular times and asked to help with reorientation.
9.  Observation of sleeping pattern will inform prescription of hypnotic - if this is absolutely necessary

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