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Nursing Care Plan for Delirium

Delirium or acute confusional state is a transient global disorder of cognition. The condition is a medical emergency associated with increased morbidity and mortality rates. Early diagnosis and resolution of symptoms are correlated with the most favorable outcomes. Therefore, it must be treated as a medical emergency.

Delirium is not a disease but a syndrome with multiple causes that result in a similar constellation of symptoms. Delirium is defined as a transient, usually reversible, cause of cerebral dysfunction and manifests clinically with a wide range of neuropsychiatric abnormalities. The clinical hallmarks are decreased attention span and a waxing and waning type of confusion.

Delirium often is unrecognized or misdiagnosed and commonly is mistaken for dementia, depression, mania, an acute schizophrenic reaction, or part of old age (patients who are elderly are expected to become confused in the hospital).

The word delirium is derived from the Latin term meaning "off the track." This syndrome was reported during Hippocrates' time, and, in 1813, Sutton described delirium tremens. Later, Wernicke described the encephalopathy that bears his name.

Epidemiology

Frequency

United States

Delirium is common in the United States. It has been found in 14-56% of elderly patients who are hospitalized. Delirium is present in 10-22% of elderly patients at the time of admission, with an additional 10-30% of cases developing after admission. Delirium has been found in 40% of patients admitted to intensive care units. Prevalence of postoperative delirium following general surgery is 5-10% and as high as 42% following orthopedic surgery. As many as 80% of patients develop delirium near death. Delirium is extremely common among nursing home residents.

Mortality/Morbidity
In patients who are admitted with delirium, mortality rates are 10-26%.
Patients who develop delirium during hospitalization have a mortality rate of 22-76% and a high rate of death during the months following discharge.
In patients who are elderly and patients in the postoperative period, delirium may result in a prolonged hospital stay, increased complications, increased cost, and long-term disability.

Age
Delirium can occur at any age, but it occurs more commonly in patients who are elderly and have compromised mental status. Delirium can occur on top of an underlying dementia. This diagnosis here requires not only a careful mental status but also a thorough history from the patient's family and the staff as well as a comprehensive chart review.


Assessment Nursing Care Plan for Delirium
  1. Identity

  2. The main complaint

  3. Predisposing factors

  4. Physical examination

  5. Psychosocial
    • Genogram
    • The self concept
    • Social relationships
    • Spiritual

  6. Mental status
    • Appearance
    • Talk loud, fast and incoherent.
    • Motor activity
    • Natural feelings
    • Affect and emotion
    • Interaction during the interview
    • Perception
    • The process of thinking
    • Level of consciousness
    • Memory
    • Levels of concentration
    • Capability assessment

  7. Day-to-day needs of clients
    • Sleep
    • Appetite
    • Elimination

  8. Coping mechanisms

  9. Impact of problem

Nursing Diagnosis Nursing Care Plan for Delirium
  1. Risk for torturing themselves, others and the environment related to the response in mind delusions and hallucinations.
  2. Ineffective individual coping related to the inability to express in a constructive way.
  3. Change the thought process related to the inability to trust people
  4. Risk for Imbalanced Nutrition : Less Than Body Requirements related to intake is less, the status emoosional increased.
  5. Impaired Verbal Communication related to communication pattern that is not logical or inkohern and side effects of drugs, the pressure to talk and hyperactivity.
  6. Lack of social interaction (social isolation) are related to inadequate support systems.
  7. Lack of self-care related to a decreased willingness

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