Assessment

Action

Medications with anti-cholinergic properties (e.g. Benadryl-diphenydramine) often cause delirium.

Eliminate unnecessary medications

Avoid polypharmacy

Avoid use of Benadryl in older patients

Assessment of pain/discomfort is important to improve delirium

Evaluate and treat the pain or discomfort

Even mild infections (patient not septic, labs not very abnormal) can cause confusional state in geriatric patients

Evaluate elderly delirious patients for infection even when afebrile (check U/A, CXR, blood and urine cultures)

Metabolic abnormalities may precipitate delirium (eg, hypo-hyperglycemia, hypoxia, hypo-hyperthyroidism, hypo-hypernatremia,)

Check CBC, chemistry, TSH (if indicated), RBC folate, B12 and correct metabolic abnormalities.

Dehydration, malnutrition may trigger delirium

Keep patient hydrated

Assess and improve nutritional status

Preventing UTI will reduce the incidence of delirium.

Remove Foley catheter as soon as possible

Keeping patients in bed, using physical restrains may contribute to delirium

Early mobilization is important

Get your patient out of bed!

Environmental changes can cause delirium symptoms

Familiar faces, voices and environmental stimuli can help to improve symptoms. Get family involved with patient’s care and provide appropriate environmental stimuli (eg, hearing aids, eyeglasses, clock, calendar)