The patient is restless and agitated.

Also they are disoriented and pulling at the IV.

As you intervene and try to calm the situation, the patient becomes combative and aggressive.

It is not a good start to the shift.

Delirium is a well- recognised and preventable condition.

It is commonly seen in the older person and is life-threatening.

The highest rates of delirium occurs in intensive care units, postoperatively and in end-of-life situations.

The common thread is the hospital environment.

Approximately 30 per cent of some patients experience delirium at some point in their hospitalization.

The acute nature of the condition presents with aggression, agitation, drowsiness and withdrawal.

Because it is acute in nature, that distinguishes the condition from dementia.

It is often undiagnosed and untreated.

In fact there are four sub types of delirium, 

  1. hyperactive, 
  2. hypoactive, 
  3. mixed and 
  4. unclassifiable.

The contributing factors are

  • infection,
  • electrolyte disturbances and 
  • drug toxicity.

The prevention and treatment of delirium occurs with early identification of existing predisposing and/or precipitating factors in conjunction with early detection.

So crucial to the detection of delirium is the nurses’ knowledge and awareness of the signs and symptoms.

Having insufficient knowledge of cognitive deficits will lead yo unrecognised delirium.

In fact, nurses can talk about delirium but often are unable to recognise the behaviours in the clinical setting.

A formal delirium assessment is laborious and arduous and nurses rely upon their experience to make a diagnosis.

Nurses who are able to distinguish delirium and act on it will reduce the behaviours associated with delirium.

The consequences of reducing delirium is improved patient care and safety.

But delirium assessment tools are used inconsistently, if at all.

Nurses spend the most time with patients and are best placed to detect and manage delirium.

They are best placed to ask significant others about the premorbid status of the patient.

But the focus of delirium care loses out to coping with the behaviours.

To learn more about delirium:

Nurses’ knowledge of delirium: A survey of theoretical knowing;dn=434165307512915;res=IELHEA

Future Directions of Delirium Research and Management