Delirium: Observing and Reporting Mental Status Changes by the Nursing Assistant

presented by Kathleen Fletcher, RN, DNP, GNP-BC, FAAN and Heather Teller, BSN, BA, RN, CMSRN, GRN

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Financial— Kathleen Fletcher and Heather Teller receive compensation from MedBridge for the production of this course. There are no other relevant financial relationships. Nonfinancial— No relevant nonfinancial relationship exists.

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Video Runtime: 47 Minutes; Learning Assessment Time: 28 Minutes

Care team members including nursing assistants, patient care assistants, and rehabilitation aides assist the members of the professional staff in caring for individuals in various settings. These individuals typically spend the most time providing care for patients within facilities. Because of this, they are often in the best position to observe even subtle changes in the patients' mental capacity, function, and behavior. This course will focus on the important role of the UAP in all settings in observing the signs and symptoms of mental status changes and thoroughly reporting these changes to the professional staff in order for the patient to be assessed for possible delirium. Delirium is an emergency and can indicate a life-threatening illness. Too frequently, it is unrecognized until the patient's condition deteriorates. The UAP who takes the initiative to observe and report mental status changes is a valuable member of the care team.

Meet Your Instructors

Kathleen Fletcher, RN, DNP, GNP-BC, FAAN

Kathleen Fletcher is currently working as a PRN staff nurse at the Riverside Center for Excellence in Aging and Lifelong Health and as a Clinical Assistant Professor at the University of Virginia School of Nursing. She maintains a hands-on role, working as a clinician, educator, and researcher in gerontology for more than 35 years. She…

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Heather Teller, BSN, BA, RN, CMSRN, GRN

Heather Teller is a Virginia-based nurse educator and acute care facility staff development coordinator. For the past eight years, she has worked on the subject of delirium as part of an interdisciplinary team at Riverside Health System. During that time, she developed the nursing education program to help reduce hospital-acquired delirium and aid in the…

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1. Delirium: Background and Observations

Delirium is characterized by an acute onset of mental status changes. Three forms of delirium are discussed in this chapter: hyperactive, hypoactive, and mixed. Delirium can indicate a serious illness, so UAPs in all settings need to recognize changes in mental status and report these changes in a timely and thorough manner to expedite treatment.

2. Providing Safe and Supportive Care to the Person with Delirium

Persons with hyperactive delirium may demonstrate unsafe behaviors such as agitation and resistiveness to care. Additionally, patients exhibiting signs of hypoactive delirium can show signs of a decline in function and daytime lethargy. These patients require a high level of supportive care. Several examples of how to provide a safe and supportive care environment are covered in this chapter, including: issues with drinking and eating, mobilizing, and getting adequate sleep and rest. This chapter emphasizes what nursing assistants can do to foster a supportive, therapeutic environment.

3. Communication with Care Team Members Including Family

Working with persons with delirium is challenging, so establishing a good rapport with team members and keeping the lines of communication open is essential. Family members often interact with UAPs in various settings, and they may be fearful and concerned. This chapter will provide insights on how best to help family members manage their loved one, which can prove valuable in implementing a plan of care.

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