Which intervention would the nurse include when planning care for a patient with delirium?

Diagnosis

A doctor can diagnose delirium on the basis of medical history, tests to assess mental status and the identification of possible contributing factors. An examination may include:

• Mental status assessment. A doctor starts by assessing awareness, attention and thinking. This may be done informally through conversation, or with tests or screenings that assess mental state, confusion, perception and memory. Additional information from family members or caregivers can be helpful.
• Physical and neurological exams. The doctor performs a physical exam, checking for signs of health problems or underlying disease. A neurological exam — checking vision, balance, coordination and reflexes — can help determine if a stroke or another neurological disease is causing the delirium.
• Other tests. The doctor may order blood, urine and other diagnostic tests. Brain-imaging tests may be used when a diagnosis can't be made with other available information.

Treatment

The first goal of treatment for delirium is to address any underlying causes or triggers — for example, by stopping use of a particular medication, addressing metabolic imbalances or treating an infection. Treatment then focuses on creating the best environment for healing the body and calming the brain.

Supportive care

Supportive care aims to prevent complications by:

• Protecting the airway
• Providing fluids and nutrition
• Assisting with movement
• Treating pain
• Addressing incontinence
• Avoiding use of physical restraints and bladder tubes
• Avoiding changes in surroundings and caregivers when possible
• Encouraging the involvement of family members or familiar people

Medications

If you're a family member or caregiver of someone who experiences delirium, talk with the doctor about avoiding or minimizing the use of drugs that may trigger delirium. Certain medications may be needed to control pain that's causing delirium.

Other types of medications may help calm a person who has severe agitation or confusion or who misinterprets the environment in a way that leads to severe paranoia, fear or hallucinations. These medications may be needed when certain behaviors:

• Prevent the performance of a medical exam or treatment
• Endanger the person or threaten the safety of others
• Don't lessen with nondrug treatments

These medications are usually reduced in dose or discontinued when the delirium resolves.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Coping and support

If you're a relative or caregiver of someone at risk of or recovering from delirium, you can take steps to help improve the person's health, prevent a recurrence and manage responsibilities.

Promote good sleep habits

To promote good sleep habits:

• Provide a calm, quiet environment
• Keep inside lighting appropriate for the time of day
• Plan for uninterrupted periods of sleep at night
• Help the person keep a regular daytime schedule
• Encourage self-care and activity during the day

Promote calmness and orientation

To help the person remain calm and well-oriented:

• Provide a clock and calendar and refer to them regularly throughout the day
• Communicate simply about any change in activity, such as time for lunch or time for bed
• Keep familiar and favorite objects and pictures around, but avoid a cluttered environment
• Approach the person calmly
• Identify yourself or other people regularly
• Avoid arguments
• Use comfort measures, such as reassuring touch, when appropriate
• Minimize noise levels and other distractions
• Provide and maintain eyeglasses and hearing aids

Prevent complicating problems

Help prevent medical problems by:

• Giving the person the proper medication on a regular schedule
• Providing plenty of fluids and a healthy diet
• Encouraging regular physical activity
• Getting prompt treatment for potential problems, such as infections or metabolic imbalances

Caring for the caregiver

Providing regular care for a person with delirium can be scary and exhausting. Take care of yourself, too.

• Consider joining a support group for caregivers.
• Learn more about the condition.
• Ask for educational materials or other resources from a health care provider, nonprofit organizations, community health services or government agencies.
• Share caregiving with family and friends who are familiar to the person so you get a break.

Examples of organizations that may provide helpful information include the Caregiver Action Network and the National Institute on Aging.

Preparing for your appointment

If you're the relative or primary caregiver of a person with delirium, you'll likely play a role in making an appointment or providing information to the doctor. Here's some information to help you get ready for the appointment and know what to expect from the doctor.

What you can do

Before the appointment, make a list of:

• All medications, including all prescriptions, over-the-counter medications and supplements the person takes, and the dosages — noting any recent medication changes
• Names and contact information of any health care providers, therapists or other clinicians who provide care for the person
• The symptoms and when they started, describing all signs and symptoms and minor changes in behaviors that preceded the delirium symptoms, such as pain, fever or coughing
• Questions you want to ask the doctor

What to expect from the doctor

The doctor is likely to ask a number of questions about the person with delirium. These may include:

• What are the symptoms and when did they begin?
• Is there or was there a recent fever, cough, urinary tract infection or sign of pain?
• Is there or was there a recent fever, cough or urinary tract infection?
• Was there a recent head injury or other trauma?
• What were the person's memory and other thinking skills like before the symptoms started?
• How well did the person perform everyday activities before the onset of symptoms?
• Can he or she usually function independently?
• What other medical conditions have been diagnosed?
• Are prescription medications taken as directed? When did the person take the most recent dose of each?
• Are there any new medications?
• Do you know if the person recently used drugs or alcohol? Does the person have a history of alcohol or drug misuse? Is there any change in the pattern of use, such as increasing or stopping use?
• Has the person recently appeared depressed, extremely sad or withdrawn?
• Has the person indicated that he or she does not feel safe?
• Are there any signs of paranoia?
• Has the person seen or heard things that no one else does?
• Are there any new physical symptoms — for example, chest or abdominal pain?

The doctor will ask additional questions based on your responses and the person's symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.

Sept. 01, 2020

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