Delirium

Definition

Delirium is an acute, reversible disturbance of consciousness with fluctuating course, inattention, and altered cognition. It develops over hours to days and is often an emergency signaling underlying illness.

Types

• Hyperactive: Agitation, restlessness, hallucinations.
• Hypoactive: Lethargy, withdrawn (often missed).
• Mixed: Fluctuates between both.

Causes (Mnemonic: DELIRIUM)

Drugs (anticholinergics, opioids, benzodiazepines), Electrolytes, Lack of drugs (withdrawal), Infection (UTI in elderly), Reduced sensory input, Intracranial problems, Urinary retention/fecal impaction, Myocardial/pulmonary issues.

Delirium vs Dementia

• Delirium: Acute, fluctuating, inattentive, reversible.
• Dementia: Chronic, progressive, stable attention, irreversible.

Nursing Interventions

Identify and treat underlying cause. Reorient frequently, provide familiar objects, ensure glasses/hearing aids are worn, maintain sleep-wake cycle, minimize restraints and sedatives. Use CAM or CAM-ICU assessment tool. Avoid benzodiazepines (worsen delirium except in alcohol withdrawal).

NCLEX Relevance

Sudden confusion in elderly → check for UTI or medication effect.