Delirium

The nurse conducts the MMSE-2 on Mr. Mackey while his wife is present. The wife gets irritated and says, "Didn't he already do this? Why does he have to answer these questions again?" How should the nurse respond?

"This is a screening tool that is done periodically to assess if his cognitive performance is improving with treatment." This response demonstrates that the nurse understands that the MMSE-2 measures cognitive performance and should be done serially to assess cognitive changes over time.

A patient with delirium secondary to a urinary tract infection has been receiving pharmacologic treatment for 3 days, including the antibiotic doxycycline and the benzodiazepine lorazepam. The health care provider has ordered for the patient to be tapered off of lorazepam. The patient's husband is concerned about this decision and asks, "Why is lorazepam being decreased if it was helping her?" What would be the best response by the nurse?

"This medication needs to be lowered in order to know if your wife's cognitive function is improving." Medications, such as benzodiazepines, should be administered at the lowest effective dose, carefully monitored, and lowered or discontinued as soon as possible in order to assess for clinical improvement.

What is the difference in clinical presentation between delirium and amnestic disorders?

Amnestic disorders do not impair alertness. Individuals with amnestic disorders do not have an abnormal level of alertness.

Which conditions are patients with delirium at direct risk for if the underlying cause of delirium is not identified and treated?

Death If effective management of delirium is not successful, instead of returning to baseline functioning level, the patient is at risk of dying due to hypoxic injury. Seizures Seizure is an imminent risk for patients with untreated delirium due to fever and alcohol withdrawal. Irreversible brain damage If effective management of delirium is not successful, instead of returning to baseline functioning level, the patient is at risk for irreversible brain damage related to impaired oxygenation.

How should the nurse explain the key difference between delirium and dementia?

Delirium has a rapid onset, while dementia has a gradual onset. Delirium develops over hours to days, while dementia develops over months to years.

A nurse is orienting to a hospital unit as a new hire. Prior to going into the room of a patient with delirium, the preceptor tells the new nurse to introduce herself to the patient despite this being the third time the new nurse has seen the patient this shift. What importance does this serve for the nurse's patient with delirium?

Delirium impairs memory and orientation. Due to memory and orientation impairment, the nurse should make it a habit to re-introduce herself each time a new interaction with a patient takes place in order to prevent the patient from experiencing confusion and fear.

Which symptoms are supportive of the DSM-5 diagnosis of delirium?

Disorientation Disorientation is a hallmark feature of delirium included in its diagnostic criteria. Impaired memory Impaired memory is a symptom included in the diagnostic criteria of delirium. Disturbance in perception A disturbance in perception, such as illusions, is a feature of delirium.

Nursing's implementation of the Hospital Elder Life Program (HELP) program has been effective in directly reducing which adverse outcomes?

Functional decline The HELP prevention model has led to a 67% reduction in functional decline. Incidence of delirium The HELP prevention model has led to a 40% reduction in the incidence of delirium.

In which clinical setting is delirium most common?

Hospital Delirium is most common in the hospital setting with a prevalence of 14-56%.

Within the past 48 hours, Ms. Bader has developed symptoms of arousal, aggression, and hyperactivity. The nurse recognizes these symptoms as being associated with which disorder?

Hyperactive delirium Hyperactive delirium is characterized by arousal, aggression, increased strength, and hyperactivity.

A patient with delirium has been given the nursing diagnosis of Impaired verbal communication. The nurse should know that this is most related to which problem?

Hypoxic injury Impaired verbal communication is due to decreased oxygenation to the brain leading to hypoxic injury.

The charge nurse on a neurology unit is assigning patients to nurses for the next day. What should the charge nurse keep in mind when assigning a nurse to the patient diagnosed with delirium?

Keep the nurse assigned to the patient as consistently as possible. In order to avoid worsening disorientation, consistency in staffing is ideal for a patient with delirium.

How should the day shift nurse of a patient with delirium arrange the patient's room in order to promote recovery?

Limit wires and cords around the patient. By limiting wires and cords in the patient's environment, this prevents falls, limits stimuli, and promotes free movement in a safe manner. Make sure a calendar and clock are in view of the patient. The presence of a calendar and a clock helps to orient the patient to time.

Which medications are associated with the highest risk of developing delirium?

Narcotics Narcotics are highly associated with delirium. The CNS depression that occurs with narcotics is associated with symptoms of delirium. Benzodiazepines Benzodiazepines are highly associated with delirium and can have the same effect on the brain as delirium. Anticholinergic agents Anticholinergic agents are highly associated with delirium and can be the cause of delirium in some patients.

In which age group does delirium most commonly occur?

Older adults Delirium occurs most commonly in the older adult population.

Which assessment aspects are most important for a nurse to address in patients with delirium?

Pain level Pain control is necessary for prevention and treatment of delirium. Temperature Fever could indicate an infection is the underlying cause of delirium. Pulse oximetry Hypoxia could be the cause of the delirium; oxygenation is extremely important in order to prevent or alleviate delirium. Level of consciousness Proper neurological function is extremely important in order to prevent or alleviate delirium.

Which nursing goal is the priority outcome for a patient with delirium?

Patient will remain free from falls. Preventing falls and subsequent injury is of highest importance when caring for a patient with delirium.

Identify the specific risk associated with each type of delirium.

Pulmonary embolism Hypoactive Aggression Hyperactive Sudden shift in behavior Mixed

Which nursing diagnosis is the highest priority for Ms. Cocoschelli?

Risk for Injury The patient's safety is of utmost importance. Delirium presents a major risk to safety.

Which therapeutic communication strategies are important for the nurse to use when caring for patients with delirium?

Speak slowly and clearly. When the nurse speaks slowly and clearly, the patient will have time to absorb and interpret what is the nurse is saying, thereby easing communication. Allow ample time for the patient to respond. Giving the patient time to respond will allow the patient to collect his or her thoughts and carefully respond, thereby easing communication. Communicate the behavior that is desired from the patient. When interacting with a patient with delirium, the nurse should make an effort to verbalize desired behaviors from the patient, rather than telling the patient what not to do.

Which communication techniques would be most helpful for the nurse to use when speaking to Mr. Mackey during the dressing change?

Speak slowly in simple sentences to explain the next steps in the dressing change. When the nurse speaks slowly and in simple statements, the patient has an easier time processing the information provided. Explanation of a procedure before it is being done helps to alleviate the patient's fear or anxiety about being touched or about unexpected movements.

A patient with delirium has become acutely agitated and has started to pull out the urinary catheter. How should the nurse interpret this behavior?

The patient is struggling to communicate an unmet need. Erratic behavior should be interpreted as the patient trying to communicate that he or she is in need of something. The need itself is not necessarily related to the particular behavior the patient is exhibiting.

Which outcome would be indicative that Ms. Cocoschilli's delirium has not successfully been resolved?

The patient struggles to recall the date. Disorientation is a sign of delirium. This would need to be resolved for the patient to be considered recovered.