514 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
Cultural Considerations
People from different cultural backgrounds may not
be familiar with the information requested to assess
memory such as the name of former U.S. presidents.
Other cultures may consider orientation to placement
and location differently. Also some cultures and reli-
gions, such as Jehovah’s Witnesses, do not celebrate
birthdays, so clients may have difficulty stating their
date of birth. The nurse should not mistake failure to
know such information for disorientation (APA, 2000).
Treatment and Prognosis
The primary treatment for delirium is to identify and
to treat any causal or contributing medical conditions.
Delirium is almost always a transient condition that
clears with successful treatment of the underlying
cause. Nevertheless some causes, such as head injury
or encephalitis, may leave clients with cognitive,
behavioral, or emotional impairments even after the
underlying cause resolves.
PSYCHOPHARMACOLOGY
Clients with quiet, hypoactive delirium need no spe-
cific pharmacologic treatment aside from that indi-
cated for the causative condition. Many clients with
delirium, however, show persistent or intermittent
psychomotor agitation that can interfere with effec-
tive treatment or pose a risk to safety. Sedation to pre-
ventinadvertent self-injury may be indicated. An
antipsychotic medication such as haloperidol (Haldol)
may be used in doses of 0.5 to 1 mg to decrease agi-
tation. Sedatives and benzodiazepines are avoided
because they may worsen delirium (Caine & Lyness,
2000). Clients with impaired liver or kidney function
could have difficulty metabolizing or excreting seda-
tives. The exception is delirium induced by alcohol
withdrawal, which usually is treated with benzo-
diazepines (see Chap. 17).OTHER MEDICAL TREATMENT
While the underlying causes of delirium are being
treated, clients also may need other supportive phys-
ical measures. Adequate, nutritious food and fluid
intake will speed recovery. Intravenous fluids or even
total parenteral nutrition may be necessary if a client’s
physical condition has deteriorated and he or she
cannot eat and drink.
If a client becomes agitated and threatens to
dislodge intravenous tubing or catheters, physical
restraints may be necessary so that needed medical
treatments can continue. Restraints are used only
when necessary and stay in place no longer than
warranted because they may increase the client’s
agitation.Box 21-1
➤ MOSTCOMMONCAUSES OFDELIRIUM
Physiologic or metabolic Hypoxemia, electrolyte disturbances, renal or hepatic failure, hypo- or hyperglycemia,
dehydration, sleep deprivation, thyroid or glucocorticoid disturbances, thiamine or vi-
tamin B 12 deficiency, vitamin C, niacin, or protein deficiency, cardiovascular shock,
brain tumor, head injury, and exposure to gasoline, paint solvents, insecticides, and
related substances
Infection Systemic: sepsis, urinary tract infection, pneumonia
Cerebral: meningitis, encephalitis, HIV, syphilis
Drug-related Intoxication: anticholinergics, lithium, alcohol, sedatives, and hypnotics
Withdrawal: alcohol, sedatives, and hypnotics
Reactions to anesthesia, prescription medication or illicit (street) drugsCompiled from Caine, E. D., & Lyness, J. M. (2000). Delirium, dementia, and amnestic and other cognitive disorders. In B. J.
Sadock & V. A. Sadock (Eds.). Comprehensive textbook of psychiatry, Vol. 1 (7th ed., pp. 854–923). Philadelphia: Lippincott
Williams & Wilkins, and Ribby, K. J., & Cox, K. R. (1996). Development, implementation, and evaluation of a confusion protocol.
Clinical Nurse Specialist, 10(5), 241–247.◗ SYMPTOMS OFDELIRIUM
- Difficulty with attention
- Easily distractible
- Disoriented
- May have sensory disturbances such as illusions,
misinterpretations, or hallucinations - Can have sleep—wake cycle disturbances
- Changes in psychomotor activity
- May experience anxiety, fear, irritability, eupho-
ria, or apathy