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The pathophysiology is not fully understood, but delirium may be due to inflammatory mechanisms and a cholinergic neurotransmitter deficiency in the brain. During acute illness, older patients are at risk of delirium due to a decreased cognitive reserve. Prophylactic antipsychotic use for postoperative delirium: A systematic review and meta-analysis. Causes of physical discomfort such as constipation and urinary retention are common precipitants but are often overlooked.
Involving the patient’s family, primary bedside nurse, and clinical nurse leader in the creation of a nursing care plan can also be instrumental in the success of these nonpharmacological delirium prevention strategies.
A chest X-ray or urinalysis and culture should be considered if symptoms suggest infection, keeping in mind that elderly patients can fail to manifest typical signs of infection (elevated white blood cell count, fever, or focal symptoms).
Neuroimaging is indicated for patients with focal neurological deficits, unexplained confusion, or suspected head trauma. Worsening severity or a prolonged course should prompt a repeat workup for ongoing medical instability, new precipitants, or less common causes of delirium such as encephalitis, rapidly progressive dementia, or seizure. Neuroimaging, lumbar puncture, and electroencephalogram should be considered in these situations.
While antipsychotics can be used off-label to manage symptoms of delirium, they do not treat the underlying cause and are associated with side effects.
Recognizing delirium promptly and treating the underlying cause can prevent the significant consequences of an acute disturbance in cognition, which include cognitive and functional decline, falls, and admission to long-term care. Risk of death with atypical antipsychotic drug treatment for dementia: Meta-analysis of randomized placebo-controlled trials.
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The pathogenesis behind delirium is not fully understood, but several mechanisms have been postulated.