The word delirium means “out of one’s furrow” which refers to the dramatic behavior changes that the person may experience. Some have called delirium "brain failure” because it may represent a variety of caused such as heart failure does in cardiac health. Delirium is an outcome of a general medical condition, head injury and drug intoxication or withdrawal.

1. DELIRIUM
Mr. Vihang Tayde

2. INTRODUCTION
 The word delirium means “out of one’s furrow” which
refers to the dramatic behavior changes that the person
may experience. Some have called delirium "brain
failure” because it may represent a variety of caused
such as heart failure does in cardiac health.

3.  Delirium is the common clinical syndrome characterized
by the inattention and acute cognitive dysfunction.
 Delirium is an outcome of a general medical condition,
head injury and drug intoxication or withdrawal.
 The delirius patient may have visual hallucinations eg-
seeing the multicolor rats or have tactile hallucination,
during which he patient may feel bugs under the skin.

4. DEFINITION:
 Delirium is the most common organic mental disorder
characterized by impairment of consciousness.
 Delirium is the acute organic disorder characterized by
impairment of consciousness, disorientation and
disturbance in the perception and restlessness.

5. INCIDENCE
 Delirium has the highest incidence among organic
mental disorders.
 About 10 to 25% of medical-surgical inpatients, and
about 20 to 40% of geriatric patients meet the criteria
for delirium during hospitalization.

6.  This percentage is higher in post-operative patients.
 Although delirium may occur in any age group, it is
most common among the elderly

7. ETIOLOGY:
 Vascular: Hypertensive encephalopathy, intracranial
hemorrhage.
 Infections: Encephalitis, meningitis.
 Neoplastic: Space occupying lesions.
 Intoxication: chronic intoxication or withdrawal effect
of sedative hypnotic drugs.

8.  Traumatic: Subdural and epidural hematoma,
contusion, laceration, postoperative, heatstroke.
 Vitamin deficiency: For example, thiamine
 Endocrine and metabolic: Diabetic coma and shock,
hyperthyroidism, hepatic failure
 Metals: Heavy metals (lead, manganese, mercury),
carbon monoxide and toxins.

9. CLINICAL FEATURES
 A delirium is characterized by a disturbance of
consciousness and a change in cognition that develop
rapidly over a short period, emotional instability may be
manifested by fear, anxiety, depression, irritability,
anger, euphoria, or apathy. These emotions may be
evidenced by crying.

10.  Impairment of consciousness: clouding of
consciousness ranging from drowsiness to stupor and
coma.
 Impairment of attention: difficulty in shifting, focusing
and sustaining attention.
 Perceptual disturbances: illusions and hallucinations,
most often visual.

11.  Disturbance of cognition: impairment of abstract
thinking and Comprehension, impairment of recent and
immediate memory, increased reaction time.
 Psychomotor disturbances: hypo or hyper-activity,
aimless groping or picking at the bed clothes
(flocculation), enhanced startle reaction.

12.  Disturbance of sleep wake cycle: insomnia or in severe
cases total sleep loss, daytime drowsiness, disturbing
dreams or nightmares.
 Emotional disturbances: depression, anxiety, fear,
irritability, etc.

13. DIAGNOSTIC CRITERIA:
 1. History collection: any history of head injury,
meningitis etc.
 2. Mental status examination

14. 3. Haematological investigation
 Blood “Rh” type (blood grouping)
 Blood glucose
 ESR
 CBC
 Urine examination

15. 4. Tests for memory: i.e. immediate, recent and remote
5. Radiological examination
 CT scan of skull
 MRI of skull
 Electroencephalography
 Brain biopsy

16. TREATMENT:
1. Identification of cause and its immediate correction, for,
example,
 50 mg of 50% dextrose IV for hypoglycaemia,
 O2 for hypoxia,
 100mg of B1 IV for thiamine deficiency,
 IV fluids for fluid and electrolyte imbalance.

17. 2. Symptomatic measures:
 Benzodiazepines (10mg diazepam or 2 mg lorazepam
IV)
 Antipsychotics (5 mg haloperidol or 50 mg
chlorpromazine IM) may be given.

18. MANAGEMENT:
 1. MEDICAL MANAGEMENT:
The delirium management includes supportive therapy
and pharmacological management;

19.  a) Fluid and nutrition:
 • These should be given carefully, because the
patients may be unwilling or physically unable to
maintain a balance intake.
 • The patients suspected of having alcohol toxicity or
alcohol withdrawal, therapy should include
multivitamins, especially thiamine.

20.  b) Environmental modification:
 • Reorientation techniques or memory cues such as
calendar, clocks, and family photos may be helpful.
 • The environment should be stable, quiet and well-
lighted, and also support from a familiar nurse and
family should be encourage.
 • Physical restrains should be avoided.
 • These patients should never live alone.

21.  c) Medication:
 Neuroleptics: Haloperidol 0.5-5mg, PO, BD/ TDS.
Risperidone 0.5-2mg, PO, QID or BD.
 Short-acting sedative: lorazepam 0.5-2mg,
PO/IM/IV
 Vitamins: thiamine hydrochloride 100mg IV,
followed by 50-100mg/d, IV/IM, and
cynocobalamine 1000mcg IM monthly or
500mcg/wk. intranasally or 100mcg/d, PO.

22. NURSING MANAGEMENT:

23. A. Nursing Diagnosis:
 - Risk for trauma related to impairment in cognitive
and psychomotor function.

24. Nursing intervention:
 - Store frequently use items within easy access.
 - Keep the dim light on at night.
 - Soft restraints may be required if client is very
disoriented and hyperactive.
 - Frequently orient the client to place,
time, and situations.

25. B. Nursing Diagnosis:
 - Disturbed thought process related to cerebral
degeneration as evidenced by disorientation, confusion,
and memory deficits.

26. Nursing intervention:
 - Frequently orient to reality.
 - Use clock and calendars with large number that are
easy to read.
 - Monitor for medication side effects.
 - Keep simple explanation.
 - Talk about real people and real events.

27. C. Nursing Diagnosis:
 - Self-care deficit related to disorientation, confusion,
and memory deficits as evidence by in ability to fulfil
the need.

28. Nursing intervention:
 - Provide guidance and assistance for independent
action.
 - Provide the structural schedule of activities that
does not change from day to day.
 - Involve the family members in the care of the
patients.

30. DELIRIUM
TREMENS

31.  Delirium tremens is a psychotic condition caused by the
complications from alcohol withdrawal. It involves
tremors, hallucination, anxiety, and disorientation.
 • Delirium tremens typically occurs in people with a
high intake of alcohol for more than a month.
 • When it occurs, it often lies for three days into the
withdrawal syndromes and last for two to three days.

32. SIGNS AND SYMPTOMS:
The main symptoms of delirium tremens are;
 - Nightmares,
 - Disorientation,
 - Hallucinations,
 - Fever,
 - Confusion,
 - High blood pressure

33. CAUSES:
 - Delirium tremens is mainly caused by the long
period of drinking alcohol and stopped suddenly.
 - Head injury,
 - Infections,
 - Illness in the people with a history of having use of
alcohol.

34. CHARACTERISTIC FEATURES:
 - Clouding of consciousness with disorientation.
 - Poor attention span with distractibility.
 - Visual, tactile also hallucination and illusion.
 - Disturbance with tachycardia, fever, sweating,
hypertension.
 - Shouting and evidence fear.

35.  - Insomnia.
 - Will have disorientation related to time and place.
 - Death may occur due to cardiovascular collapse,
infection, hypertension, or self-inflicted injury.

36. MANAGEMENT OF DELIRIUM
TREMENS:
 1. Keep the patients in a quiet and safe environment.
 2. Sedation is usually given with diazepam 10mg, or
lorazepam 4mg, IV or followed by oral administration.
 3. Maintain fluid and electrolyte balance.
 4. Reassure patient and family

37. CONCLUSION:
 Delirium is the acute organic disorder characterized by
impairment of consciousness, disorientation and
disturbance in the perception and restlessness. Delirium
has the highest incidence among organic mental
disorders.

38.  About 10 to 25% of medical-surgical inpatients, and
about 20 to 40% of geriatric patients meet the criteria
for delirium during hospitalization. A delirium is
characterized by a disturbance of consciousness. So the
client may have impairment of consciousness,
impairment of attention, and also emotional disturbance
such as depression, fear, irritability.

39.  Delirium tremens is a psychotic condition caused by the
complications from alcohol withdrawal. It involves
tremors, hallucination, anxiety, and disorientation.

40. SUMMERY:

41. BIBLIOGRAPHY:
 1. R. Sreevani, A guide to Mental Health & Psychiatric
Nursing, JAYPEE BROTHERS, 3rd Edition 2010; page
No – 249-251.
 2. Anbu.T; Text book of Psychiatric Nursing;
EMMESS., 1st Edition 2010; Page No- 188-190.
 3. R.K.Gupta, New Approach To Mental Health
Nursing, 2011 Edition, Page No- 220-224.