Regular review: Delirium: optimising management

Meagher, David

doi:10.1136/bmj.322.7279.144

Cited by 276 publications

(197 citation statements)

References 32 publications

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“…Management 3,4,17 This begins with increased awareness of delirium and regular measures of cognitive function. The underlying cause needs to be treated.…”

Section: Differential Diagnosismentioning

confidence: 99%

Risk Factors: Pathogenesis, Diagnosis and Management of Delirium

2016

IJSR

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Delirium is a change in mental status characterized by a reduced awareness of the environment and a disturbance in attention. Pathogenesis: The underlying mechanisms contributing to delirium are poorly understood. Risk factors for delirium The following are risk factors which are associated with an increased risk of delirium: Age ≥65 years. Male sex. Pre-existing cognitive deficit, e.g. dementia, stroke. Severity of dementia. Severe comorbidity etc. Medical management: Using drugs to treat delirium can lead to adverse effects and worsening of delirium; therefore, careful consideration is required.

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“…Management 3,4,17 This begins with increased awareness of delirium and regular measures of cognitive function. The underlying cause needs to be treated.…”

Section: Differential Diagnosismentioning

confidence: 99%

Risk Factors: Pathogenesis, Diagnosis and Management of Delirium

2016

IJSR

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“…Acute delirium is usually defined as sudden onset, impaired cognitive functioning -often involving reduced attention, memory, planning ability, organizational skills, and orientation to time and place (Meagher, 2001). Most research studies report that while around 10-15% of all hospital patients experience acute delirium, it is much more common among older than younger patients (Arnold, 2005).…”

Section: Introductionmentioning

confidence: 99%

“…Regardless, most literature has focused on the medical care of patients after they exhibit acute delirium. Medical care generally consists of pharmaceutical management, often with some drugs stopped and others started (Meagher, 2001;Meagher et al, 1996). A growing body of literature is focused on improved diagnosing of acute delirium after it is has become apparent (Kales et al, 2003).…”

Section: Introductionmentioning

confidence: 99%

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Nursing Practices to Detect Acute Delirium, Safeguard Patients Experiencing Acute Delirium, and Help Reduce or Eliminate Acute Delirium

Wilson¹,

Low²,

Thurston³

et al. 2010

GJHS

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Acute delirium is very common among hospital patients, particularly older patients. Nurses have a major role in the care of these patients, yet there are no evidence-based nursing care guidelines to help nurses detect patients who are experiencing acute delirium, safeguard them, and assist their recovery. This study sought to identify and prioritize nursing practices for detecting these patients, safeguarding them, and assisting their recovery from acute delirium. A two-stage voluntary paper Delphi survey was used for this purpose. This study targeted all nurses who worked on adult medical/surgical units at two full-service acute care hospitals in Western Canada Global Journal of Health Science www.ccsenet.org/gjhs 82 who had cared for a patient diagnosed with acute delirium in the past 12 months. The first survey revealed many nursing practices exist to detect, safeguard, and assist recovery. The second revealed one preferred practice and four others for each of the following: Detecting acute delirium, safeguarding patients, and helping patients recover. Research is now needed to establish if these constitute "best practice" nursing care for enhanced patient outcomes.Keywords: Acute delirium, Confusion, Delphi technique, Hospital care, Nursing practice, Survey Acute delirium is common among hospital patients, although it is often unrecognized or misdiagnosed (Morandi et al., 2009). Acute delirium is therefore typically under reported (Kales, Kamholz, Visnic & Blow, 2003, Minden et al., 2005. Regardless, acute delirium is clearly understood as a serious health condition. It is associated with prolonged hospital stays, long-standing (if not permanent) cognitive impairment, high risk of nursing home admission, and death (Gonzalez et al., 2009;MacLullich, Beaglehole, Hall & Meagher, 2009). Many studies have sought to identify the incidence or prevalence of acute delirium, its many causes, and its medical management. Few studies have focused on the nursing perspective, yet nurses are the most likely healthcare professional to detect patients who are experiencing acute delirium. Nurses are also responsible for planning and managing the day-to-day care of these patients with a need to be kept safe and a need for nursing care that will help them recover.No studies were found through a systematic review of acute delirium research that reveal how nurses identify patients who are experiencing acute delirium, what they do to safeguard these patients, and what they do to help them recover. This research gap lends credence to the assertion of Rapp, Mentes, and Titler (2001) that over half of all nursing care that is considered "appropriate" practice is not evidence based. The need for nurse researchers to focus on acute delirium was pointed out many years ago. In 1996, Meagher, O'Hanlon, O'Mahony, and Casey emphasized the importance of early nursing identification of patients who are confused, as well as the need for best-practice nursing care for patients who are suffering from acute delirium. This lack of nursing r...

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“…Postoperative delirium possibly caused by the usage of benzodiazepines depends on the dose: big doses provoke post operative delirium more often compared with small doses (10). In some cases benzodiazepines are used for the treat ment of postoperative delirium (11,12). Opioids are referred to as the risk factor for delirium to ap pear.…”

Section: Introductionmentioning

confidence: 99%

Sedation in the post-anaesthesia care unit

Macas¹,

Andriuškevičiūtė²,

Paltanavičiūtė³

et al. 2012

AML

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Background. Post-anaesthetic sedation is a common practice as it pro vides greater comfort and psychological stability for patients. Some spe cialists claim that sedation in the post-anaesthetic care unit (PACU) is applied too seldom due to several reasons. The goal of this study is to evaluate sedation in PACU in several aspects. Materials and methods. A total of 299 patients admitted to the PACU after general, orthopedic-traumatologic or urologic surgical procedures were enrolled in this prospective study. The patients evaluated their qual ity of sleep and the worst intensity of pain experienced in PACU, which was assessed using the Numerical Rating Scale. Nurses evaluated sedation using the Motor Activity Assessment Scale and filled in the questionnaire about the importance of sedation. Results. Statistically significant difference was observed in the quality of sleep between the patients sedated using benzodiazepines and opioids together and non-sedated patients (p = 0.025). There is no considerable difference in the statistics concerning the behavior of the patients. The patients prescribed only with opioids IV or IM, as well as the patients prescribed with opioids together with benzodiazepines, feel less intense pain compared to the non-sedated patients (p = 0.016, p = 0.03). Accord ing to the personnel, sedation is necessary in PACU. Half of them think that patients prescribed with opioids need additional sedation. Conclusions. Sedation is necessary in PACU. This fact is evident in the statistically significant difference of comfort factors among the patients as well as in the opinion of the nursing personnel that spend most of the time communicating and caring about the comfort of the patients.

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Regular review: Delirium: optimising management

Cited by 276 publications

References 32 publications

Risk Factors: Pathogenesis, Diagnosis and Management of Delirium

Risk Factors: Pathogenesis, Diagnosis and Management of Delirium

Nursing Practices to Detect Acute Delirium, Safeguard Patients Experiencing Acute Delirium, and Help Reduce or Eliminate Acute Delirium

Sedation in the post-anaesthesia care unit

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