Atlanta Legal Nurse Consultant At Delirium – A Hospice Emergency
"Causes of delirium are medical, not psychiatric."
Dr. Alice Irene Lawver presented “Delirium – A Hospice Emergency” to The Piedmont Georgia Chapter of the Hospice and Palliative Nurses Association in Athens, Georgia on March 22, 2016 at St. Mary’s Hospital.
End of Life Delirium:
Delirium was defined as a progressive confusional state that leads to “restless irritability” and agitation, fear, anger and paranoia that has multiple etiologies according to “Adams and Victor’s,” the primary neurology text used by neurologists.
Symptoms as the delirium progresses include difficulty concentrating, restless irritability, insomnia, at times paranoia and/or hallucinations and combativeness.
Dr. Lawver stressed that the causes of delirium are medical, not psychiatric.
- Sleep deprivation secondary to pain or difficulty breathing.
- Withdrawal states such as alcohol, opiate or benzodiazepine withdrawal.
- Toxins to include atropine, amphetamines, scopolamine, sinemet, anti-cholenergics or street drugs.
- Metabolic encephalopathies: hyponatremia, hypernatremia, metabolic acidosis, renal failure, hepatic failure, prolonged hypoglycemia, hypoxemia, hypercarbia, bacterial sepsis, viral meningo-encephalitis or mixed metabolic encephalopathy.
Treatments for Delirium:
1. Discontinue all possible offending agents (medications).
2. Dim lights and create a quiet environment.
3. If possible, calm loved one at bedside or remove them from the room.
4. If in documented withdrawal state, resume the lost medication (such as benzodiazepine), if alcohol follow a detox regimen.
5. If not a withdrawal state, then always use Haldol. Lowver recommended starting at moderate doses and then move fast, meaning to increase doses until the patient is sedated or calm.
Lowver stressed that the advantage of Haldol is that there is no respiratory suppression with dosing. It is not expensive, it is effective and it is also good for nausea and less sedating than Phenergan.
She said once the patient has calmed, it is important to let that patient sleep for as long as needed and it is important to educate family on the extreme need for sleep for these patients.
Lowver distributed the article “Choosing an Antipsychotic for the Treatment of Delirium” by Robert Arnold, MD, in the Palliative Care Case of the Month, University of Pittsburgh, January 2013, Volume 12, No. 20.
Arnold stated “benzodiazepines should not be used in delirium (unless due to alcohol or benzodiazepine withdrawal) as they do not improve symptoms and may make them worse.”
Lowver stressed the importance of recognizing delirium as early as possible and begin treatments.
Atlanta Legal Nurse Consultant:
- Contact Information
- Liz Buddenhagen, RN
- Buddenhagen and Associates
- (1) 770-725-2997
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