1

COURSE : M.Sc NURSING 1st YEAR

UNIT : XII

TOPIC : DELIRIUM

GROUP : B.Sc Nursing IIIYEAR

PLACE : MAMATA COLLEGE OF NURSING

DATE : /0 /2013

DURATION : 1 HRS

METHOD OF TEACHING: LECTURE AND DISCUSSION

AV AIDS : CHARTS, OHP, BLACK BOARD, POWER POINT

SUBMITTED BY : CH. SOWMYA SRI, MSC NURSING Ist YEAR.

SUBMITTED TO : MRS. ASHA KUMARI,

ASST. PROFESSOR.

PREVIOUS KNOWLEDGE: The 3ed year students has the knowledge regarding
the

Memory, intelligence, neuro transmitters and its types etc.

2
GENERAL OBJECTIVES:

By the end of the class the group will be able to acquire knowledge regarding the Epidemiology improve the
skills in managing client with Delirium and develops positive attitudes towards persons who is suffering with delirium.

SPECIFIC OBJECTIVES:

By the end of the class the group will be able to:

- introduce the topic of delirium

- define delirium
- State the prevalence of delirium
- illustrate the causes of delirium
- enumerate the manifestations of a client with delirium
- describe the treatment modalities of a client with delirium
- discuss the nursing care of a patient with delirium
- list down the nursing diagnosis of a client with delirium

3
 Specific Teaching and
S.no objectives Time Content learning Evaluation
activities
1 Introduce the DELIRIUM (ACUTE ORGANIC BRAIN
topic of SYNDROME, Acute confusional state) Teacher:
delirium Introduce the
Although Delirium is unlikely to be encountered by topic with a good
the Decision Maker, it is included for completeness. example
Delirium is disturbed consciousness with disorientation in Student:
time and place, which typically fluctuates over the course Shows interest
of 24 hours.

It is common in people admitted to hospital, especially the

elderly and those with reduced “cerebral reserve” due to,
for example, pre-existing dementia, head injury, stroke
and a history of substance abuse.
2 define
delirium Definition Teacher: What do you
“It is a state of clouded consciousness in which Gives the mean by
attention cannot be sustained, the environment is wrongly definition with delirium
perceived and disturbances of thinking are present’. the help of OHP
—lCD-1O Student:
Listens carefully,
“An acute organic mental disorder characterized by taking notes
impairment in attention, concentration and consciousness
added by disturbances in thinking and perception”
-lalitha.

4
3 state the Incidence Teacher: adopts Which people
prevalence of - 20—40 per cent of geriatric clients in lecture method are more
delirium hospitalization Student: affected with
- In postoperative cases highest incidence was Listens carefully delirium
noticed.

4 illustrate the Causes Teacher: List any 4-5

causes of  Head trauma Explained with common causes
delirium  Postoperative cases the help of chart for delirium
 Heat stroke Student:
 High fever in children Trying to
 Metabolic-thiamine deficiency, uraemia, liver understand
disorders, diabetic coma
 Toxic-metallic poisoning, e.g. lead, manganese,,
mercury, carbon monoxide
 Intoxication, withdrawal effects of alcoholic,
sedative, hypnotic drugs
 Infections, e.g. pneumonia, -meningitis,
encephalitis
 Vascular-hypertensive encephalopathy,
arteriosclerosis, intracranial haemorrhage
 Neoplastic, e.g. space occupying lesions
 Anoxia, e.g. anaemia, cardiac failure/congestive
heart failure
 Epilepsy and cerebral tumours
 Lupus erythematosus, respiratory insufficiency
 Sensory deprivation.
5 enumerate the Teacher:
5
 manifestations Manifestations Explains by using Explain any few
of a client with  Impaired consciousness-cloudiness consciousness power point symptoms of
delirium ranging from drowsiness to coma presentation the patient with
 Disorientation Student: delirium
 Mental confusion Observes power
 Disturbance in memory and comprehension of point and listens
factual knowledge carefully
 Impulsive, irrational and violent behaviour.
 Transient and reversible changes Lack of insight
 Moods are liable to change from apathy to sudden
panic
 Disturbances in perception, e.g. hallucination,
illusion, delusion
 Disturbances in cognition, e.g. impairment in
thinking, distorted thinking
 Dream-like content in thinking
 Disturbances in sleep, nightmares
 Psychomotor disturbances
determine the  Emotional disturbances.
6 treatment Teacher:
modalities of a Treatment Adopts lecture How can we
client with Aim: To maintain appropriate level of independence. method with the treat the patient
delirium  Medical treatment varies greatly among individual, help of flash with delirium
according to age, health status and symptoms cards
 Identify the cause and treat the cause
 Symptomatic treatment Student:
 Administration of sedatives and tranquilizers to calm- Listens carefully
up the mind.
 Family support is needed
6
  Utilization of community resources, social support
networks for supportive services
discuss the  Home care.
7 nursing care of
a patient with PRINCIPLES OF NEURO-PSYCHIATRIC Teacher:
delirium NURSING OF ORGANIC BRAIN DISORDERS: Adopts lecture What are the
 Provide supervision protect the patient from becoming cum discussion principles of
injured, humiliated, or lost. method nursing care for
 Encourage the patient to participate in ADLs for as Student: delirium
long as possible Try to
 Provide for the patient’s nutritional needs Contributing
 Provide the family and patient specific information some points
about the disease
 Make the patient and family be aware of support
resources
 Encourage the family to seek legal advice regarding
financial and legal measures to be taken to protect the
patient and family
 Help to develop short and long term planning
 Suggest to seek medical supervision for the
management of health problems and for periodic
reassessment of cognitive abilities
 Identify caregivers stress and give counselling and
stress management teachings.
 Help the family in decisions concerning
institutionalization

Nursing Assessment:
 History — past psychiatric history medication history What all you
7
 medical history, suicide risk, self-care ability, mental will assess a
competence, mental status, Psychiatric evaluation. client with
 Physical — self injury, agitation, personal hygiene, delirium
shaking tremor, unsteadiness, difficulty in initiating
movements, slowed speech, incontinence
 Mental status examination.
list down the  Neurological assessment
8 nursing
diagnosis of a Nursing Diagnosis Teacher:
client with  Alteration in cognitive functioning related to brain Adopts lecture
delirium damage resulting in impaired mental functions in cum discussion Tell some
thought process, attention, concentration and memory. method nursing
 Impaired physical mobility related to muscle rigidity interventions
and motor weakness postural instability for the clients
 Self care deficits (eating, drinking, dressing, hygiene) Student: with delirium
related to tremor and motor disturbance Listens carefully,
 Imbalanced nutrition less than body requirement taking notes.
related to eating difficulties like chewing, swallowing.
 Altered sleeping pattern related to depression,
aloofness
 Impaired communication related to language
difficulties, speech problems, difficulty in facial
movement.
 Potential for injuries because of sensory deficit.
 Social isolation related to mood changes and
depression.
 Alteration in perception related to hallucinations and
depression.

8
  Inadequate coping related to impaired cognitive
abilities.
 Knowledge deficit related to the disease condition.
 Risk for Constipation related to medication and
reduced activity