Delirium - Risk Factors | Case Study

Running head: DELIRIUM
Delirium
Name of the student:
Name of the University:
Author’s note

1DELIRIUM
Introduction:
Delirium is a serious medical condition associated with impaired cognitive function and
reduced ability to focus and pay attention. The diagnosis of dementia is associated with
significant morbidity, persistent decline in function, increased medical cost and high mortality. It
is also a risk factor of later onset of dementia. Despite being preventable, delirium is a major
burden as it remains a common complication in hospitalized elderly patients (Pezzullo et al.
2019). Delirium can be prevented by implementation of best practices related to dementia care
and management. The main aim of this essay is to undertake a review of the literature to identify
best practices related to delirium care and compared this evidence with the case of Mr. Lars De
Jong who suffered from delirium during hospital stay. The essay will critically assess risk factors
for Mr. De Jong Lars and evaluate how delirium could be managed in the case.
Review of risk factors for Mr. De Jong:
Based on the review of the case study, it has been found that Mr. Lars De Jong is a 69
years old man who developed symptoms of delirium following mechanical ventilation during
hospital stay. He was brought to the hospital by his daughter Hanna as he was found to
unresponsive and breathless. He remained in mechanical ventilation for more than three days and
he was displaying unusual behaviors. For example, he looked agitated and restless. He avoided
eye contact and appeared withdrawn. According to the review of high level of evidence on risk
factors of dementia, age greater than 70 years, pre-existing cognitive impairment, use of
indwelling catheter, abnormal sodium, visual impairment and use of three or more medications
during hospitalization increases the risk of delirium (Department of Health and Ageing 2011,
ACSQHC 2016). Age was one of the factors linked to high risk. In addition, indwelling catheter

2DELIRIUM
use and mechanical ventilation were identified as other links for risk factors of delirium. The
study by Bulic et al. (2017) investigated about the risk of delirium after mechanical ventilation in
intensive care units (ICU) and revealed that delirium risk increase due to sedation, mechanical
ventilation and lack of sleep. Toft et al. (2019) highlighted that delirium develops in patient
within 72 hours of ICU admission and Mr. Lars was found to have such symptoms in the same
interval. The study indicated that high level of serum markers like creatinine level increases the
risk of delirium. In the case study, change in the creatinine level for Mr. Lars was observed as his
creatinine value was 20 mg/Dl. Hence, it can be concluded that mechanical ventilation and long
period of hospitalization exposed Mr. Lars to risk of delirium.
Literature review on prevention and management of delirium:
In the case study, the nurse suspected Mr. Lars to be suffering from delirium and started
non-pharmacological protocols to control and manage his symptoms. However, the drawback of
the nursing action is that no formal assessment was conducted to confirm the risk of delirium.
According to clinical practice guidelines for management of delirium, there is a need to use
structured process for screening and diagnosing the condition using assessments tools like
Confusion Assessment Method (CAM). In case of high risk patient, formalized process of
screening is suggested by means of regular cognitive assessment and using the DSM-V
diagnostic criteria for detection of the disease (ACSQHS 2019, Department of Health and
Ageing 2011). In case of the case study, it has been found that formal assessment method was
missing.
Mr. Lars was a high risk patient considering his age and long duration of hospitalization.
Considering this, it was important for the nurse to implement preventive strategies related to