518 Unit 4 NURSINGPRACTICE FORPSYCHIATRICDISORDERS
understand what health care practices are necessary
to avoid a recurrence. This may involve monitoring a
chronic health condition, careful use of medications,
or abstaining from alcohol or other drugs.COMMUNITY-BASED CARE
Even when the cause of delirium is identified and
treated, clients may not regain all cognitive functions,
or problems with confusion may persist. Because
delirium and dementia frequently occur together,
clients may have dementia. A thorough medical eval-
uation can confirm dementia, and appropriate treat-
ment and care can be initiated (see the following
section).
When delirium has cleared and any other diag-
noses have been eliminated, it may be necessary for
the nurse or other health care professionals to initi-
ate referrals to home health, visiting nurses, or a re-
habilitation program if clients continue to experience
cognitive problems. Various community programs pro-
vide such care including adult day care or residential
care. Clients who have ongoing cognitive deficits after
an episode of delirium may have difficulties similar to
those of clients with head injuries or mild dementia.
Clients and family members or caregivers might ben-
efit from support groups to help them deal with the
changes in personality and remaining cognitive or
motor deficits.◗ CLIENT/FAMILYEDUCATION: DELIRIUM
Monitor chronic health conditions carefully.
Visit physician regularly.
Tell all physicians and health care providers what
medications are taken including over-the-
counter medications, dietary supplements, and
herbal preparations
Check with physician before taking any non-
prescription medication.
Avoid alcohol and recreational drugs.
Maintain a nutritious diet.
Get adequate sleep.
Use safety precautions when working with paint
solvents, insecticides, and similar products.◗ SUMMARY OFNURSINGINTERVENTIONS FORDELIRIUM
- Promoting client’s safety
Teach client to request assistance for activities (getting out of bed, going to bathroom).
Provide close supervision to ensure safety during these activities.
Promptly respond to client’s call for assistance. - Managing client’s confusion
Speak to client in a calm manner in a clear low voice; use simple sentences.
Allow adequate time for client to comprehend and respond.
Allow client to make decisions as much as able.
Provide orienting verbal cues when talking with client.
Use supportive touch if appropriate. - Controlling environment to reduce sensory overload
Keep environmental noise to minimum (television, radio).
Monitor client’s response to visitors; explain to family and friends that client may need to visit quietly
one on one.
Validate client’s anxiety and fears, but do not reinforce misperceptions. - Promoting sleep and proper nutrition
Monitor sleep and elimination patterns.
Monitor food and fluid intake; provide prompts or assistance to eat and drink adequate amounts of flood
and fluids.
Provide periodic assistance to bathroom if client does not make requests.
Discourage daytime napping to help sleep at night.
Encourage some exercise during day like sitting in a chair, walking in hall, or other activities client
can manage.
improve ability to sleep at night. It is also important
for clients to have some exercise during the day to
promote nighttime sleep. Activities could include
sitting in a chair, walking in the hall, or engaging in
diversional activities (as possible).
Evaluation
Usually successful treatment of the underlying causes
of delirium returns clients to their previous level of
functioning. Clients and caregivers or family must