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Slide 1: Delirium in the Acute Care Setting Kathleen M. Parlanti, RN, BSN The Pennsylvania State University November 10, 2008
Slide 2: Objectives    Clinical significance Assessment & screening Research   Impact APN
Slide 3: Delirium    Acute Reversible Medical emergency
Slide 4: Key Indications   Rapid onset Inattention   Disorganized thinking Altered LOC
Slide 5: Clinical Significance     Earliest presenting sign Geriatric population 10-15% Upon admission 10-40% Develop during admission
Slide 6: Identification     Difficult Awareness Baseline Changes
Slide 7: Characteristics     Abrupt onset Fluctuating Course LOC Disorientation     Decreased attention Loss of memory Disorganized thinking Behavioral changes
Slide 8: Risk Factors     Advanced age Polypharmacy Uncontrolled pain Dehydration     Multiple illnesses Infection Electrolyte imbalance Elevated BUN/cr
Slide 9: Assessment & Screening     Admission CAM MMSE Blessed     Mini-cog Delirium symptom interview Delirium index ICDSC
Slide 10: Underlying Causes      Medications Dehydration Electrolyte imbalance Visual impairment Cardiac      Infection Malnutrition Hypoxia Sleep deprivation Pulmonary
Slide 11: Research     Extensive Quantitative Qualitative Theories
Slide 12: Case Study    Underrecognition Identify & change Influencing factors   Lack of knowledge Ineffective communication
Slide 13: Legal/Ethical     Undiagnosed = untreated Responsible Poor outcomes Death
Slide 14: Impact     Cost Outcomes Complications LOS     Nursing homes Rehabilitation centers Lifestyle Quality of life
Slide 15: Advanced Practice Nursing     Alert Screen/Test Communicate Educate/Resources     Family as client Reduce risk Staffing Agency involvement
Slide 16: Conclusion     Undetected Negative effect Poor outcomes Costly     Family Facility Reversible Patient focus
Slide 17: References Eden, B. M., & Foreman, M. D. (1996). Problems associated with underrecognition of delirium in critical care: a case study. Heart & Lung: The Journal of Acute and Critical Care, 25(5), 388-400. Inouye, S. K., et al. (1990). Clarifying confusion: the confusion assessment method. Annals of Internal Medicine, 113(12), 941-948. Korevaar, J. C., VanMunster, B. C., & deRooij, S. E. (2005). Risk factors for delirium in acutely admitted elderly patients: a prospective cohort study. BMC Geriatrics, 5, 1471-2318. Meagher, D. (2001). Delirium: the role of psychiatry. Advances in Psychiatric Treatment, 7, 433-442. Reuben, D. B., et al. (2008). Geriatrics at your fingertips: 2008-2009, (10th ed.). New York: The American Geriatrics Society.
Slide 18: References (Cont.) Waszynski, C. M. (2001). Confusion assessment method (CAM) [Electronic version]. Try This: Best Practices in Nursing Care to Older Adults. Retrieved November 7, 2008, from http://www.medscape.com/viewarticle/481726 What’re the risk factors for delirium? (n.d.). Retrieved November 8, 2008, from http://neurologyhealth-cares.net/delirium-risk-factors.php