الهذيان

Definition

Delirium is an acute disturbance of attention, awareness and thinking that develops over hours to days, fluctuates during the day and has a medical cause.

Types

• Hyperactive: agitation, hallucinations, pulling at lines
• Hypoactive: lethargy and withdrawal, most often missed
• Mixed

Risk factors

Older age, dementia, severe illness, surgery, sensory impairment and polypharmacy.

Common causes

Infection, drugs (sedatives, opioids, anticholinergics), dehydration, electrolyte disturbance, hypoxia, pain, urinary retention and constipation, and alcohol withdrawal.

Assessment

Tools such as CAM and CAM-ICU, and a search for the cause.

Treatment

• Treating the cause is central
• Frequent reorientation, glasses and hearing aids, appropriate lighting
• Night sleep, early mobility, fluids and family presence
• Reduce causative drugs
• Low-dose antipsychotics only when the client endangers himself or others

Nursing care

• Safety and fall prevention
• Avoid restraints where possible
• Reassure and inform the family

Exam point

Delirium is acute and fluctuating with inattention; dementia is gradual and persistent. Sudden change in a person with dementia is usually delirium.