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Table of Contents

What is delirium?

Is delirium different from dementia?

How common is delirium in the ICU?

How might we discover delirium?

What does delirium look like?

What might cause delirium?

Who is at risk?

What will the ICU healthcare team do?

What can you (families) do?


We understand that it can be very difficult to see your loved one acting differently or in a state of confusion. Please talk to a member of our team if you are concerned or notice any changes.


We hope that the following informational poster can provide you with more insight and understanding into delirium within the ICU.



What is delirium?


Delirium is a sudden confused state of mind. It is characterised by fluctuations in attention, perception, and awareness.

 

Delirium can be hyperactive, hypoactive or a mix of both. A patient with hyperactive delirium has increased motor activity and may display symptoms of agitation, restlessness, aggression, and hallucinations. Hypoactive delirium is more common and characterised by reduced motor activity with symptoms associated with drowsiness, lethargy, poor perception, and attention.



Is delirium different from dementia?


Yes, but patients with dementia are more likely to develop delirium. Delirium and dementia have overlapping features such as impaired memory, confusion, and disorientation.


Delirium

Dementia

Onset

Abrupt

Usually insidious; can be abrupt in stroke/trauma

Course

Fluctuates

Slow decline

Duration

Hours to weeks

Months to years

Attention

Impaired

Intact early; often impaired late

Sleep-Wake

Disrupted

Usually normal

Alertness

Impaired

Normal

Orientation

Impaired

Intact early; impaired late

Behaviour

Agitated, withdrawn or depressed; or combination

Intact early

Speech

Incoherent; rapid/slowed

Word finding problems

Thoughts

Disorganised, delusional

Impoverished

Perceptions

Hallucinations/illusions

Usually intact early



How common is delirium in the ICU?


Delirium is common. 2 out of 3 patients in ICU will develop delirium.


7 out of 10 patients develop delirium while ventilated (requiring a breathing machine) or soon after (Ali et al., 2021).


Ali, M. A., Hashmi, M., Ahmed, W., Raza, S. A., Khan, M. F., & Salim, B. (2021). Incidence and risk factors of delirium in surgical intensive care unit. Trauma Surgery & Acute Care Open, 6(1). https://doi.org/10.1136/tsaco-2020-000564



How might we discover delirium?


Nurses in ICU regularly screen patients for delirium and escalate any concerns to the medical team for further tests and assessments.


CAM-ICU (Confusion Assessment Method) is a simple test used by staff to help determine if a patient is experiencing delirium. It involves asking the patient a series of simple questions to see if they can think clearly. A patient who is CAM-positive has signs of delirium and requires further investigation.



What does delirium look like?


People with delirium:


  • Can be confused with the time of day or where they are

  • Have a limited attention span or seem withdrawn

  • Have difficulty interpreting certain situations or following directions

  • May have trouble following a conversation

  • May see or hear things that are not there

  • May seem agitated or easily bothered

  • May become scared or nervous easily

  • May be quiet or sleepy during the day and restless and awake during the night



What might cause delirium?


Delirium can be caused by the following:


  • Chemical changes in the brain

  • Difficulty hearing or seeing (not wearing glasses or hearing aides)

  • Infections

  • Lack of sleep

  • Certain medications

  • Medical illnesses

  • Sedatives and pain relief

  • Withdrawal from alcohol or nicotine

  • Unfamiliar surroundings



Who is at risk?


People who:


  • Are over 65 years

  • Have had recent surgery

  • Have an infection

  • Have underlying brain diseases such as dementia, stroke, or Parkinson’s disease

  • Have heart disease

  • Have poor eyesight or hearing

  • Take multiple or high-risk medications



What will the ICU healthcare team do?


The ICU team understand each patient is unique and different in managing delirium. When delirium is identified, the ICU team will do everything they can to help your loved one.


  • The ICU team will do a thorough assessment, ask questions, and do some tests such as an X-ray or Computed Tomography Scan (CT) to identify an underlying cause.

  • Blood and urine tests are done to rule out any imbalances or infections

  • Your loved one may be moved to a bed space closer to the nursing station so they can be more frequently monitored.

  • Different members of the ICU healthcare team may check your loved one’s mental status regularly to identify changes early.

  • The team will encourage a routine for a good sleep-wake cycle.

  • Physiotherapists will work closely with the patient to encourage early and frequent mobilisation to assist with environmental awareness.

  • A dietician will be involved to ensure adequate nutrition for regular meals.

  • Medications for sleep or to calm your loved one may be used for a short period of time.



What can you (families) do?


  • Remind your loved one of the date, time, place, and situation when possible. 

  • Provide a supportive setting - be calm and reassuring. Let them know you care, and that you will be there for them. A familiar face can make your loved one feel safer.

  • Speak softly and clearly and use simple words or phrases.

  • Talk about family and friends.

  • If your loved one requires visual or auditory aids, such as glasses or hearing aids, check with the bedside nurse if they can wear them.

  • Bring in familiar objects from home – photos, a quilt, radio, etc.

  • Provide the patient with their favourite music or TV shows/movies.

  • Reduce noise and distractions around the bedside when your loved one is resting or sleeping.

  • Talk to the staff about your concerns and anything that might help us better care for your loved one.

  • Complete the “All about Me” poster that is next to each bedside to assist the ICU team to better understand the patient.



Delirium

Delirium

More Information

1

Visiting the ICU

Please access for more information regarding visiting times, our recommendation for children visiting the ICU and if a member of your family is unwell.

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2

Taking Care of Yourself

It is vital that you take the time to look after yourself and reach out for support and guidance during this stressful time. We have provided a number of tips and recourses on ways that can help you during your journey as a family member in the ICU.

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3

Patient Safety

Patient safety is an essential component of high-quality care provided in the ICU. Our team have worked hard to establish a number of tools and strategies that ensures the ICU provides safe care, in the context of evidence-based practice and the National Safety and Quality Health Service (NSQHS) requirements.

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4

The ICU Environment

We understand that entering the ICU can be very overwhelming. The environment is often very busy with many unfamiliar sights and sounds. We hope that this page can better orientate you to the bedspace and the various equipment you may encounter.

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5

Medical Rounds

Please access for further information about medical rounds within the ICU including rounding times, what rounds involve and how to receive updates from the medical team.

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6

Spiritual Care

In Nepean ICU we aim to accommodate for all kinds of spiritual care required and welcome families to speak to the team for recourses available within the hospital or to organise their own external support.

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7

Helpful Tips

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8

Your ICU Team

The Nepean ICU team consider patients and their families a central and vital part of our team, we value working together to deliver high quality care with compassion and respect to every patient. Our team are here to support and guide you and your loved one through this ICU admission.

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9

Delirium

We understand that it can be very difficult to see your loved one acting differently or in a state of confusion. Please access for more information about delirium.

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10

Activities to do in ICU

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11

End of Life Care

The transition from active treatment to palliative/end of life care in ICU can often be sudden and unexpected. We recognise this is an overwhelming and emotional time for families and friends.

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12

Beyond Critical Care

Leaving critical care and going to the ward is an important step in your recovery process as your ICU stay only plays a small part in your journey in hospital. The following information will help you and your family learn more about the ward environment and provide some general information about your recovery process.

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