American Journal of Critical Care. 2008;17: 576
Copyright © 2008 by the American Association of Critical-Care Nurses.
The AJCC Patient Care Page is a service of the American Journal of Critical Care and the American Association of Critical-Care Nurses. Designed to elaborate AACN practice guidelines based on content in select articles, this page may be photocopied noncommercially for use by readers in their work-place, in continuing education programs, or for distribution to colleagues, patients, or patients’ families. To purchase bulk reprints, call (800) 899-1712.
Patient Care and Delirium Assessment
By
Laura McNamara, RN, MSN, CCNS, CCRN.
Delirium is a commonly occurring cognitive disorder in seriously ill patients that is characterized by an acutely changing or fluctuating mental status. It is thought to be caused by an imbalance of the neurotransmitters dopamine, acetylcholine, and gamma aminobutyric acid.
The condition is underdiagnosed in 60% of critical care patients and is associated with increased morbidity and mortality. Significant risk factors for the occurrence of delirium that nurses can identify at the time of admission include vision impairment, severe illness, dehydration, and preexisting cognitive impairments.
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Here’s what you can do:
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- Incorporate delirium assessment into your regular assessment and monitor frequently for at-risk patients.
- Limit the use of restraints.
- Allow family to visit, as the presence and reassurance of familiar people may help calm the patient.
- Provide comfort, reassurance, and a calm environment. Reorient the patient as often as needed. Ask the family to provide small items, such as familiar pictures or the patient’s favorite music.
- Allow for normal sleep/wake cycles. When possible, group assessments and care activities to allow for uninterrupted sleep at night.
- Look for underlying causes such as diminished senses, environmental factors, devices, and restraints.
- Identify other etiologies such as drugs, depression, dehydration, loss of mobility, liver disease, infection, ischemia, renal failure, impaction, urinary retention, malignancies, and metabolic disorders.
- Advocate for delirium assessment education in your unit and hospital.
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Other helpful resources:
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Published as a supplement to the articles by Devlin and colleagues, "Assessment of Delirium in the Intensive Care Unit: Nursing Practices and Perceptions," and Chang and colleagues, "Prevalence and Risk Factors for Postoperative Delirium in a Cardiovascular Intensive Care Unit" (
American Journal of Critical Care. 2008;17:555–566, 567–575[Abstract/Free Full Text]
).
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