Think: What management strategies could you implement to help Mr. Williams?
The management of delirium requires a multifaceted approach(1). This approach entails identifying and treating risk factors and precipitating factors through careful assessment of the person's prior health, cognitive and functional status. Additionally investigation and management of the person's current clinical status and potential and real environmental precipitants must be initiated.
Importantly the management of the person with delirium includes careful monitoring, assessment and review as well as communication and involvement of the carer/family, other health professionals and the person themselves(1).
Steps to management include:
- Find the cause: Important to review current medications
- Has hypoxia been ruled out?
- Has hypotension been ruled out?
- Has hypoglycaemia been ruled out?
- Has major electrolyte disturbance been ruled out?
- Has a history regarding all medications currently taken been obtained?
- Has an infection been ruled out?
- Has urinary retention been rules out?
- Has constipation and faecal impaction been ruled out?
- If person agitated/distressed; have pain, thirst and hunger been ruled out?
- Is alcohol withdrawal syndrome possible?(1)
- Address the cause and any precipitating factors for delirium
- Manage the symptoms - non-pharmacological if possible (pharmacological may be necessary)
- Prevent complications
- Educate the patient and their carers/family
- Provide supportive care environment