Delirium Part 3: Interventions in the Management and Treatment

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: 67 Minutes; Learning Assessment Time: 36 Minutes

The broad spectrum of pathologies for delirium dictates that not all patients in rehabilitation or residents in long-term care have to be hospitalized when they demonstrate signs and symptoms of delirium. Hospitalization, in fact, can make the condition worse due to change in the environment and care providers. However, delirium can be a life-threatening event, and at times emergent care is required. This final course in the three-part series of courses on delirium will emphasize good clinical decision-making skills and the need for all nurses in all settings to have these skills. In many settings, including rehabilitation, long-term care, and outpatient care, management of delirium may be successful, provided an accurate assessment and diagnosis can be made and the interventions necessary to address the care needs in that setting can be accomplished. This course will emphasize both non-pharmacological and pharmacological interventions in the care of persons with delirium.

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. Clinical Decision-Making Skills in Determining the Level of Seriousness of Delirium

Delirium can be a life-threatening condition for patients in all settings if it is not recognized and treated expeditiously. It is critical that all nurses in all settings recognize and respond urgently to this condition. Collaborating and discussing the situation with the primary care provider is essential. If transfer to another setting is necessary, good communications between staff in both settings can assure a safer handoff of care.

2. Non-pharmacological Approaches in Behavior Management in Delirium

Non-pharmacological therapy is the cornerstone of management of delirium. These supportive care strategies need to be part of the plan of care. All interventions need to be tailored to the specific etiology of delirium and the needs of the person experiencing it. This chapter discusses interventions that are appropriate for all settings, including: assuring safety of the person and those around the person, proper nutrition and hydration, adequate pain control, mobilizing the individual, providing good sleep measures, attending to the communication needs of the individual, evaluating the number and type of medications given, and encouraging family involvement.

3. Pharmacological Therapy in Delirium

Medications for delirium are never a first-line approach. There are currently no drugs that are FDA approved for delirium, and many medications can cause serious adverse effects. Nurses can influence the decision to use medications, and they are responsible for proper administration and monitoring relative to medication effectiveness or any side effects or adverse reactions. This chapter will focus on pharmacological treatment options for delirium.

4. Quality Improvement in Delirium

Quality improvement programs are essential to monitor the prevalence, assessment, and effective management of persons with delirium. Nurses in all settings need to be consistent in their identification and appropriate management of delirium.

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