LESSON PLAN
ON
DELIRIUMPREPARED BY
MISS.AASTHA RAJPUT.
NURSING TUTOR.
INTRODUCTION
NAME OF THE TEACHER : MISS. AASTHA RAJPUT
COURSE : GNM 2nd YEAR
CLASS : GNM 2ndYEAR
SUBJECT : MEDICAL SURGICAL NURSING
METHOD OF TEACHING : LECTURE CUM DISCUSSION
TOPIC : DELIRIUM
LANGUAGE : ENGLISH AND HINDI
DURATION : 30 MINUTES
DATE :
AV AIDS : GREEN BOARD, CHART
Previous knowledge : Students have no previous knowledge regarding delirium .
General objective : On the completion of class, group will acquire knowledge regarding delirium and its management
and apply this knowledge in practice with a positive attitude
Specific objective : On the completion of class, students will able to
• define delirium
• enumerate the characteristics of delirium
• recognise the incidence of delirium
• describe the etiology of delirium
• identify the risk factors of delirium
• explain the subcategories of delirium
• explain the clinical features of delirium
• describe the management of delirium
• discuss the nursing interventions of delirium
Specific Duration Content Teacher’s Learner’s AV Evaluation
objective activity activity aids
Introduce 3 min. Introduction Introduces the Listens to Green What is the
delirium board introduction of
Organic brain disorder is state of topic teacher
delirium
diffuse cerebral dysfunction
associated with a disturbance in
consciousness, cognition, affect and
behaviour in the absence of drugs,
infection or metabolic cause.
Organic mental disorders are
disturbances that may be caused by
injury or disease affecting brain
tissues as well as by chemical or
hormonal abnormalities. Exposure
to toxic materials, neurological
impairment or abnormal changes
associated with aging can also these
disorders.
Define types 3min. TYPES : Define types Listens to Green What are the
teacher. board types of
It can be divided into 2 major delirium?
subgroups:
1.Acute (delirium or acute
confusional state)
2. Chronic (dementia).
Describes
Define 3min. Definition delirium
listens to Green What is
delirium Delirium is an acute organic mental board
teacher Delirium?
disorder characterized by
impairment of consciousness,
disorientation and disturbance in
perception and restlessness
It represents a sudden decline from a
previous level of functioning and is
usually considered medical
emergency that can lead to death a
permanent decline in some cases if
not treated.
Enumerate the 3min. Characteristics explains about listens to Chart What are the
characteristics • Delirium should be characteristics of teacher characteristics
of delirium. considered anytime there is an delirium of delirium ?
acute change in mental status
• Syndrome with many possible
causes and thought to be
result of interaction of
vulnerable patients and
several risk factors
• It can occur at any age,
advanced age is a risk factor
• It can be occur in
hospitalization and in many
cases result from medications
or medical procedures
Incidence :
Recognise the 2min Shows the listens to Chart what is
In the present studies, the prevalence
incidence of Chart and teacher incidence of
rate for delirium was 53.6% and
delirium explain delirium?
incidence rate was 24.4%. It has
highest incidence among organic
mental disorders.
describe the 4min. Etiology describes the listens to Green what are
board
etiology of ➢ Vascular: hypertensive etiology of teacher etiological
delirium encephalopathy, cerebral delirium factors of
arteriosclerosis, intracranial delirium?
hemorrhage
➢ Infections: encephalitis,
meningitis
➢ Neoplastic: space occupying
lesions
➢ Intoxication: chronic
intoxication or withdrawal
effect of sedative-hypnotic
drugs
➢ Traumatic: subdural and
epidural hematoma,
contusion, laceration,
postoperative, heat stroke
➢ Vitamin deficiency: eg-
thiamine deficiency
➢ Endocrine and metabolic:
diabetic coma and shock,
uremia, myxedema,
hyperthyroidism, hepatic
failure
➢ Metals: heavy metals [lead,
manganese, mercury], CO,
toxins,
➢ Sleep medications, pain
drugs
➢ Allergy medications for
asthma
➢ Medications for mood
disorder like anxiety and
depression
➢ Malnutrition and
dehydration
identify the
3min.
Risk factors Shows that chart Looks and Chart What are the
risk factors of • Advanced age and explain notes down risk factors of
delirium • Preexisting dementia about risk the chart. delirium?
• Functional dependence factors of
• Preexisting illness delirium
• Bone fracture
• Infection
• Medications
explain the 3min Categories explain the listens to Slides What are
subcategories ✓ Delirium due to general categories of teacher subcategories
of delirium medical condition delirium of delirium?
✓ Substance induced delirium
✓ Substance intoxication
delirium
✓ Substance withdrawal
delirium
✓ Delirium due to multiple
etiologies
Explain about 3min Clinical manifestations . Explain about Listen to What are the
clinical *Impairment of consciousness: clinical teacher. clinical
manifestations clouding of consciousness ranging manifestations of manifestations
of delirium . from drowsiness to stupor or coma. delirium of delirium?
Disturbance in sleep wake cycle state
of awareness may range from that of
hypervigilance to stupor/coma. Sleep
may fluctuate hypersomnolence and
nightmares.
*Impairment of attention: difficulty
sustaining and shifting attention.
Person is extremely distractable and
must be repeatedly reminded to focus
attention.
*Disorganized thinking prevails and
is reflected by speech that is
rambling, irrelevant, pressured and
incoherent and unpredictably
switches from subject to subject.
Reasoning ability and goal directed
behavior is impaired.
*Disturbance in psychomotor.
Explain about 3min. MANAGEMENT Explain nursing Listen to What are the the
the medical management. teacher. medical
I. Identification of cause and its
management . management?
immediate correction
II. Symptomatic measures
Benzodiazepines(10mg
diazepam or 2mg
lorazepam) or
antipsychotics
(haloperidol or 50mg
chlorpromazine IM)
may be given
• Admit patient in
psychiatric hospital
• Identify course by
taking psychiatric
history, general history
and mental status
examination.
Define nursing 3min Define nursing Listen to Green What are the
interventions of interventions . teacher. board nursing
III. NURSING
delirium. interventions of
INTERVENTIONS delirium?
# Hospitalization
*Admit the patient to
psychiatric wards
*Give comfortable bed to the
patient.
*If the patient is agitated then use of
physical restraint may necessary.
SUMMARY
So delirium is one of the organic
mental disorders. I think, you get a
clear idea about delirium
• If the patient is agitated then
use of physical restraint may
necessary
Therapeutic need
• Give drugs prescribed
regularly
• Ensure that patient swallows
oral medicine
• Observe for any side effects
• Record dose frequency in
nurse record
Provide safe environment
• Restrict the environmental
stimuli, keep unit calm and
well illuminated
• There should be somebody at
the patients bedside
reassuring and supporting
• Special precautions to be
taken to protect him from
himself and to protect others
when he showing any
hallucinating behaviour or
harmful behaviour
Alleviating patients fear and anxiety
• Remove any object which
seems to a source of
misinterpreted perception
• As much as possible have the
same person all time by the
patient’s side
• Keep room well lighted
especially at night time
Meeting physical needs of the
patient
• Appropriate care should be
provided after assessment
• Take measures to reduce
fever, if present
• Maintain intake output chart
• Mouth care and skin care
should be provided
• Monitor vital signs
• Observe patient for any
extreme drowsiness and sleep
Facilitate orientation
• Repeatedly explain where,
why, time to the patient
• Introduces people with name
even is patient misidentifier
• Calender should be kept in
room
• When acute stage is over take
the patient out and introduce
him to others
MEASURES INCLUDE
• Biologic assessment- assess
all symptoms. Interaction
with care givers, family
members for valuable
information
• Current and past health status
• Physical examination and
review systems
• Interventions for biologic
domain: providing safe
environment, maintain fluid
and electrolyte balance,
adequate nutrition, preventing
aspiration, bed sore
• Interventions for
psychological domain: staff
should have frequent
interaction with patients and
support them if they are
confused
• Encouraged to express fears,
discomfort
• Interventions for social
domain: a predictable
orienting environment should
be given
SUMMARY
So delirium is one of the organic
mental disorders. I think, you get a
clear idea about delirium
RECAPITULATION
• List any 4 clinical features of
delirium
• What is difference between
substance induced delirium
and substance withdrawal
delirium?
• What are the nursing
interventions for delirium
CONCLUSION
Delirium is serious change in mental
abilities. It results in confused
thinking and a lack of awareness of
someone’s surroundings. Symptoms
of delirium are sometimes confused
with symptoms of dementia. Health
care providers may rely on input
from a family member or caregiver
to diagnose the disorder.
