Name___________________________________
Date___________________
PRE-PLANNING ACTIVITY
CLP NP4
This activity is designed to enhance your clinical knowledge and experience. Students are required to
complete this pre planning clinical assignment focused on safe patient care and turn into the drop box
via simchart by 5 pm the day prior to 0630 clinical or by 10 am the day of 1430 clinical. This assignment
counts as two (2) hours of pre planning clinical hours as reported to the Oklahoma Board of Nursing
(OBN). Failure to complete this assignment will result in a clinical absence and the student will not be
able to attend clinical.
Please use your course textbooks as your primary source. Credible, scientific and professional websites
and texts are also acceptable. Please list the references you utilized in the space provided at the end of
the activity.
Delirium
1. Define delirium?
Delirium is a state of confusion that develops over days to hours. The patient
has decreased ability to direct, focus, sustain, and shift attention and
awareness. Symptoms represent a change from the patient's baseline and
tend to fluctuate throughout the day. Delirium is rarely caused by a single
factor
2. DSM - 5 Classification, go to The DSM-5 criteria for delirium; list the 5 classifications of
delirium.
A. Disturbance in attention (I.e., reduced ability to direct, focus,
sustain, and shift attention) and awareness (reduced orientation to
the environment)
B. The disturbance develops over a short period of time (usually hours
to a few days), represents an acute change from baseline attention and
awareness, and tends to fluctuate in severity during the course of a
day.
C. An additional disturbance in cognition (e.g., memory deficit,
disorientation, language, Visio spatial ability, or perception).
D. The disturbances in Criteria A and C are not better explained by a
pre-existing, established or evolving neurocognitive disorder and do
not occur in the context of a severely reduced level of arousal such as
coma
E. There is evidence from the history, physical examination or
laboratory findings that the disturbance is a direct physiological
consequence of another medical condition, substance intoxication or
withdrawal (I.e., due to a drug of abuse or to a medication), or
exposure to a toxin, or is due to multiple etiologies.
3. Please address the following elements of delirium in the hospital setting:
Delirium
Risk Factors
Medications
List at least 6 risk factors for developing delirium:
1.Age 65 yr or older; male gender
2. Dehydration; Malnutrition
3. History of falls; Immobility
4. Acute infection, sepsis, fever; Electrolyte imbalances; Fracture or trauma
5. Sensory deprivation; sensory overload; Visual or hearing impairment
6.Emotional stress; Pain; Sleep deprivation
What are the most common medications or combination of medications that can trigger
delirium?
anticholinergics
Opioids
Sedative-hypnotics
Digitalis, steroids, lithium, levodopa, benzodiazepines, CNS depressants,
tricyclics antidepressants
Anticholinergic delirium from the use of multiple drugs with anticholinergic side
effects
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List at least 5 signs and symptoms of delirium.
1. Emotional state: Rapid swings; can be fearful, anxious, suspicious, and
Signs and
Symptoms
2. aggressive and have hallucinations and/or delusions
3. LOC: Altered
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Emotional state: Rapid swings; can be fearful, anxious, suspicious, and
aggressive and have hallucinations and/or delusions
5. Activity level: Can be increased or reduced; restlessness; behaviors may
worsen in evening (sundown syndrome); sleep-wake cycle may be reversed
How are the manifestations different for a patient with dementia as compared to a
patient with a delirium?
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Memory: One of the major differences between delirium and dementia is that,
while delirium affects attention and concentration, dementia is primarily
associated with memory loss.
Attention: Though seniors with dementia may have some issues with attention
in the late stages of the condition, for the most part, they are able to remain
relatively attentive. By contrast, individuals in a state of delirium will be easily
distracted, unable to concentrate, and generally going in and out of consciousness.
Speech: Although individuals with dementia in late stages may have difficulty
putting their thoughts to words, they usually won't demonstrate the sudden
slurred speech common to delirium.
Hallucinations: Though hallucinations occasionally occur with dementia, they
are very common with delirium.
Illness: Delirium is often caused by illness, surgery, or drugs. Those with
dementia often will have no signs of physical illness or conditions.
The RNs role can make a difference.
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Screen patients: list at least 3 types of tools that may be used in a hospital.
Screen
1. Confusion Assessment Method (CAM)
2. Memorial Delirium Assessment Scale (MDAS)
3. Delirium Rating Scale (DRS)
Institute prevention strategies: list at least 4.
Prevent
1.Both spontaneous Awakening Trials & Spontaneous Breathing Trials
2.Choice of Analgesia and Sedation
3.Early Mobility and Exercise
4.Family Engagement and Empowerment
Implement prompt and appropriate intervention: list at least 6.
Intervention
1. Eliminating precipitating factors
2.Protecting the pt from harm
3. Have eye-glasses or hearing aids readily available to decrease sensory deprivation
4. Reduce Environmental stimuli
5.Personal contact through touch and verbal communication
6.Use reorientation and behavioral interventions
Family
Education
Family members are seldom aware of delirium and family members do not know how to
identify or assist with the treatment of delirium. Describe 3 educational interventions that
can be taught to family members to assist them to be an integral part of the health care
team.
1. Teach the family to recognize signs of early confusion and seek medical help.
2. Teach family members need to understand precipitating factors, as well as the
potential outcomes
3. Counsel the client and family regarding the management of delirium and its
sequelae. Increased care requirements at discharge may be needed for clients
who have experienced delirium; frailty. And delirium can lead to functional decline
and institutionalization
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Why is delirium often missed by nurses?
Manifestations of delirium are sometimes confused with those of dementia.
Because delirium manifests in older clients, the signs and symptoms can easily be
contributed to "aging"
Can delirium be prevented?
Yes and no, it can be mitigated or minimized depending on the physiological concerns of
the patient
During clinical ask about delirium screening tools (used by nurses), delirium family
brochures and bring copies to post conference for discussion.
References:
Essentials of Psychiatric-Mental Health Nursing
BMC Medicine, table 1 comparing DSM classifications of delirium
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5141598/
Lewis, Chapter 59, reference 22. Delirium prevention and safety: Starting with the
ABCDEF's
HTTPS://bmcmedicine.biomedcentral.com/track/pdf/10.1186/s12916-0141-2.pdf
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