Please enable JavaScript.
Coggle requires JavaScript to display documents.
CONFUSION - Coggle Diagram
CONFUSION
PATHOPHYSIOLOGY
-
Delirium is a type of confusional state which develops suddenly and causes rapid changes in brain function.
-
Certain diseases and strokes cause confusion. There is evidence to support a sub cortical mechanism for confusion.
Certain drugs have anticholinergic properties which can impair brain function in elderly people and when used in high doses.
In certain conditions, post surgical recovery states can induce cytokine activation, which may be the cause for confusion.
Certain metabolic states like hypoglycemia, electrolyte abnormalities, and hypoxia cause global brain dysfunction leading to confusion.
MEDICATION
Delirium - may be hyperactive, hypoactive or mixed state (Benzodiazepines alone do not improve cognition in delirium, and may worsen it)
use haloperidol:- stat+ PRN; 1.25-5mg, SC or 0.5-5mg, oral maintenance ; 2.5-10mg/ 24hrs, SC via a syringe driver or 0.5-3mg b.d, oral
Acute on chronic confusion example in dementia, cerebrovascular disease
-
chronic confusion risperidone 0.25-1mg nocte, increasing gradually to 1mg bd, oral
-
-
-
NURSING INTERVENTIONS
When patients are confused and frightened and are having a difficult time interpreting reality, they might be prone to accidents. Therefore, safety is a high priority.
Delirium is transitory when interventions are instituted and if delirium does not last a prolonged period of time. Therefore, immediate intervention for the underlying cause of the delirium is needed to prevent irreversible damage to the brain. Medical interventions are the first priority.
Delirium is a terrifying experience for many patients. When some individuals recover to their premorbid cognitive function, they are left with frightening memories and images. Preventive counseling and education after recovery from acute delirium is helpful.
Avoid the use of restraints. Encourage one or two significant others to stay with the patient to provide orientation and comfort.
PATIENT EDUCATION
Orient patient to surroundings, staff, necessary activities as needed. Present reality concisely and briefly. Avoid challenging illogical thinking and defensive reactions may result.
Encourage family to participate in reorientation as well as providing ongoing input such as current news and family happenings.
-
Teach or assist the family and significant others in developing coping strategies that are helpful to the patient
-
BEHAVIORAL INTERVENTIONS
-
-
Provide for safety needs such as supervision, siderails, seizure precautions, placing call bell within reach, positioning needed items within reach/clearing traffic paths, ambulating with devices.
-
Communicate patient’s status, cognition, and behavioral manifestations to all necessary providers.
Manipulate the situation to make it as close to the patient as possible. Use a large clock and calendar. Encourage visits by family and friends. Place familiar objects in sight.
-