Preventing Delirium Trauma Patients,
Introduction of Jane
Patient: Jane, a 65-year-old female
Background Information:
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Trauma Event: Severe car accident resulting in multiple fractures and a mild
traumatic brain injury (TBI).
Medical History: Hypertension, Type 2 diabetes, mild cognitive impairment.
Current Symptoms: Confusion, agitation, fluctuating levels of consciousness,
difficulty concentrating.
Risk Factors for Delirium: Advanced age, pre-existing cognitive impairment, recent
trauma, and hospitalization.
Treatment Plan Based on the Bio-Psycho-Social Model
Biological Interventions:
1. Pharmacologic Interventions:
o Dexmedetomidine: Administered to prevent and manage delirium symptoms.
o Antipsychotics: Haloperidol may be used as needed for severe agitation.
o Medical Management: Monitor and manage hypertension and diabetes.
2. Non-Pharmacologic Interventions:
o Sleep Hygiene: Implement strategies to improve sleep patterns, such as
maintaining a regular sleep-wake cycle and minimizing nighttime
disturbances.
Psychological Interventions:
1. Cognitive-Behavioral Therapy (CBT):
o Targeting anxiety and confusion, providing strategies to cope with stress and
trauma.
2. Orientation Techniques:
o Frequent reorientation to time, place, and person using clocks, calendars, and
familiar objects.
Social Interventions:
1. Family Involvement:
o Engage family members in care, providing emotional support and reassurance.
2. Social Support:
o Social worker involvement to address social needs and connect Jane with
community resources and support groups.
3. Environmental Modifications:
o Create a calm, safe, and familiar environment to reduce agitation and
confusion.
Jane’s Treatment Journey
Initial Phase:
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Challenges:
o Initial high levels of agitation and confusion.
o Difficulty in establishing a routine due to hospital environment.
Adjustments:
o Gradual titration of dexmedetomidine dosage to balance sedation and
alertness.
o Regular visits from family to provide familiarity and comfort.
Mid-Treatment Phase:
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Collaboration:
o Daily meetings between healthcare team members (physicians, nurses,
psychologists, social workers) to review Jane’s progress and adjust treatment
as needed.
o Regular communication with Jane and her family to involve them in the
treatment process.
Interventions:
o Continued pharmacological management with close monitoring for side
effects.
o Implementation of cognitive and physical rehabilitation therapies to support
recovery.
Final Phase:
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Outcomes:
o Gradual reduction in delirium symptoms with improved orientation and
decreased agitation.
o Enhanced emotional well-being through consistent psychological support and
family involvement.
Discharge Planning:
o Comprehensive discharge plan including follow-up appointments, home care
services, and a clear medication regimen.
o Connection to community resources and support groups for ongoing social
support.
Conclusion
Jane’s treatment journey illustrates the importance of a multidisciplinary approach in
managing delirium. Through the combined efforts of medical, psychological, and social
interventions, Jane’s condition improved significantly. Active involvement from healthcare
professionals and Jane’s family played a crucial role in her recovery, emphasizing the value
of collaboration and patient-centered care.