Delirium in patients: What a travel nurse needs to know

How do your patients respond when you provide care? A travel nurse may experience anything from a heartfelt "thank you" to the confusion related to delirium. When the latter occurs, it is vital to respond appropriate to avoid related health complications. Learn about this condition and how you can prevent it:

What is delirium?
Considering the prevalence of this condition, you've likely seen delirium at least once during your travel nursing assignments. The Mayo Clinic defines delirium as an occurrence in which a person's mental abilities are disrupted due to surgery, infection or certain medications, among other causes. It is often acute but very serious and can manifest in a number of symptoms.

At its core, delirium results in confusion, but this sense of disorder and inability to focus can change a person's behavior. For example, the patient may get easily distracted, hallucinate, withdraw from conversations, be quick to anger, experience sudden euphoria or become paranoid.

In turn, this can lead to increased mortality rates, higher risk for falling and readmittance to the hospital, according to the American Nurses Association.

The prevalence of delirium
Those in travel nursing see delirium quite often in their work – some more than others depending on their specialty. According to the ANA, about 50 percent of surgical patients experience this condition, and it occurs in about 75 percent of patients in the intensive care unit. The risk for delirium increases with age, and about 20 percent of nursing home patients experience this condition.

Despite its regular appearance in hospitals, delirium often goes undetected. A study published in the journal Cancer found that delirium occurred in 9 percent of advanced cancer patients. However, emergency room doctors missed 41 percent of those same cases. In an accompanying press release, lead author of the study Dr. Knox Todd of the University of Texas MD Anderson Cancer Center said he hopes these results will help oncologists better prevent delirium.

"We also identified many psychoactive medications that could have contributed to delirium, and sharing this information with treating oncologists may help them avoid such complications in the next patient they treat," Dr. Todd said.

It is important for medical professionals to do their part in preventing, identifying and treating delirium.

Preventing and managing delirium
Medical professionals must remain aware of risk factors for delirium. The Mayo Clinic identified vision and hearing problems, older age, brain disorders and previous delirium episodes as criteria for making someone predisposed to this condition. Nurses with patients who have these risk factors should be on higher alert for the signs and symptoms of delirium.

Nurses can also remain proactive about prevention. The New York Times highlighted a program called Hospital Elder Life Program (HELP), created by Dr. Sharon K. Inouy of Vanderbilt to combat delirium in older adult patients. This regimen calls for greater patient movement. Nurses can encourage this behavior by helping the individual walk the hospital halls and educating family members on how to properly assist with this task.

Additionally, always ensure that patients have all necessary visual and auditory tools. For example, they might require glasses or hearing aids to stay oriented. Communicate with family members to learn more about the patient's needs.

If you can't prevent delirium, it is important to take steps to fully manage the condition. Travel nurses would do well to check with their medical facilities about proper protocol. Otherwise, the American-Association of Critical Care Nurses highlighted the THINK strategy, which is especially useful for identifying delirium causes in ICU patients:

• Toxic situations: Is the patient in shock or dehydrated? Is the individual experiencing organ failure?
• Hypoxemia: Check blood oxygen levels.
• Infection/sepsis: Could a serious infection be at play?
• Immobilization: Is the patient confined in some way?
• Nonpharmacologic interventions: Does the patient have the necessary hearing aids or glasses?
• K+ or electrolyte problems: Check potassium levels.

By paying attention to patient behavior and looking for possible causes of delirium, travel nurses can prevent and manage episodes of this condition.