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DYSPNEA
DELIRIUM
cognitive impairment with a
sudden onset and fluctuating
level of consciousness
DEMENTIA, DIFFERENCE
AND IMPORTANCE
gradual onset
persons LOC unimpaired and does not
fluctuate
chronic and irreversible
2. Hyperactive hypoalert
(mixed)
restless somnolent state
can fluctuate between
somnolence and agitation
3 MAIN TYPE OF DELIRIUM
3. Agitated or hyperactive hyperalert
agitated, restless state w/ sudden onset
and fluctuating LOC, may or may not
include
Hallucinations
Delusions
Disorientation
Memory impairment
Distractibility
Day/night reversal
CAUSES
D- Drugs (opioids, benzodiazepines, antidepressants,
NSAIDS, ACE inhibitors, digoxin, anticholinergics, diuretics)
E- ETOH or drug use, misuse or withdrawal
L- Liver impairment
I- Infection
R- Resp. impairment (hypoxemia)
I- Intracranial pathology (brain tumour/head injury)
U- Uremia (renal impairment)
M- Metabolic abnormalities (hypercalcemia/hyponatremia)
NURSING ALERT!
2. Physical
examination
s/sx of possible causes
(opioid toxicity, infection,
DHN, metabolic
ASSESSMENT
3. Investigation
CBC, blood culture, electrolytes, ca
and albumin, liver and renal fn tests,
metabolic screening, u/a, CT of head,
chest xray, 02 sat
Screening tool Molloy Standardized
Mini-Mental State Examination
INTERVENTIONS
Surround the person w/ familiar objects and
people including family members and
consistent caregivers if possible
Be calm and respectful
Provide structure and routine w/ simple
explanations
Provide a quiet, well-lit room, night light,
visible clock, and calendar
Do not try to re-orient agitated persons or
IDENTIFY AND TREAT REVERSIBLE
CAUSES INCLUDING
Infection (antibiotics)
Opioid neurotoxicity (hydration and opioid
rotation)
Cerebral tumor (steroids or radiation therapy)
Metabolic abn (correct imbalances)
Medications (change/discontinue as
indicated)
PHARMACOLOGICAL
INTERVENTIONS
Haloperidol (Haldol)
0.5-2mg PO/SQ x 4-6 hrs and every hour as
needed, titrate upward to max dose of 20mg in 24
hrs
Has antipsychotic properties effective for
controlling hallucinations, restlessness, agitation
drug of choice
Methotrimeprazine (Nozinan)
2.5mg to 25mg PO/SQ x 8-12 hrs and every hour
as needed, max dose 200mg in 24 hrs.
NURSING ALERT!
In rare instances of
agitated delirium
intractable to all
measures, consider
palliative sedation.
Lorazepam (Ativan)
Midozalam (Versed)
Quick acting benzodiazepine used to
produce sedation for cases of intractable
agitated delirium
Common starting dose is 1mg per hour via
continuous SQ/IV infusion
Titrate upward to achieve the desired level
of sedation that relieves the distress of
intractable delirium
Midazolam 2.3-5.0mg SQ loading dose
NURSING ALERT!