The condition known as delirium

The condition known as violenceIntroductionThis engagement exit examine the condition known as violence and give focus on a clinical case study (please see appendix 1. for the full overview of the clinical case study) of a homo c all(prenominal)ed Halim* who has presented in the emergency segment with his two daughters.This assignment will be separated into two distinguishable parts the first part of this assignment will provide a clinical overview of delirium and will explore what the condition is, the common features, clinical causes and interventions available to exert and treat the condition. This will provide the subscriber with an understanding of the components that constitute the condition of delirium.The second part of the assignment will then focus on placing the acquired knowledge of delirium on to the clinical case study of Halim so that a more particular clinical exploration atomic number 50 be effected with focus being rated on the graphic symbol of the p ractitioner and their interventions in addressing the key issues.*To protect and respect client confidentiality all names have been changed and some(prenominal) identifiable data censored for the purpose of this assignment.Delirium Clinical OverviewDelirium, in all case sometimes referred to as an astute confusional state, is a common clinical condition that presents with individuals experiencing disturbances in consciousness, cognitive function and perception, which has an acute onset and move social class (NICE, 2010). The heavy clinical characteristic of a delirium is that the onset is quite rapid it whitethorn present and develop within a truly short period of time, usually over the course of a few hours or days (Brown Boyle, 2002).It is not uncommon for an individual to present to infirmary contexts with symptoms of delirium and it is important to acknowledge that individuals who already ar hospital inpatients or in a electric charge setting may to a fault dev elop delirium it is a condition that traverses the inpatient and community settings.Literature suggests that on that point are two types of delirium hypoactive delirium is characterised by individuals experiencing withdrawal, lethargy, introversion and sleepiness whereas people with overactive delirium have heightened arousal, restlessness, agitation and aggression (NICE, 2010). There is also a third variation where individuals may experience a mixture of both hyper and hypoactive symptoms which can make diagnosing very difficult.It is suggested that delirium can often be mistaken for dementia, worsening of pre-existing cognitive problems and old age barely delirium is a clinical syndrome that differs from these other conditions as it is the sudden and acute onset that tends to vary passim the course of the day that identifies it as delirium preferably than any other disorder (Meagher, 2001).It is account often within the literature (Wong et al., 2010 NICE, 2010 Meagher, 2001 Brown Boyle, 2002 Cole, 2004 and Siddiqi House, 2006) that patients with delirium experience a reduce ability to focus and endure perceptual disturbances which includes delusions, paranoia and hallucinations fluctuations in presentation difficulty in following conversation or direction jog or changing topic disorganised thinking and disturbances in consciousness. In addition to these clinical symptoms there also may be mood disturbances and changes in neurological presentation with individuals experiencing changes in muscle tone, misgiving and involuntary jerking (Map of Medicine, 2011).Delirium occurs due to inherent physical pathology (American Psychiatric Association, 2000) and although symptoms may present as symptoms of rational illness the condition itself has originated usually from some kind of be infection, disease or matter that has impacted on the individuals physical health locating (Wong et al., 2010). Examples of possible causes for delirium include hypovolae mic shock, cardiac failure, myocardial infarction, head trauma, seizure, metabolic disorders such(prenominal) as liver or renal failure, politic and electrolyte imbalance, infection, malignancy, dehydration, military post operative state, pain, constipation or urinary retention. In addition to these common causes delirium may also be induced by individuals experiencing complications from drug interactions and withdrawal and included in this is prescribed medications, illicit drugs and alcoholic drink (Map of Medicine, 2010).Delirium is a very serious condition and it cannot be underestimated as the mortality rate for individuals is very high even after discharge from hospital for up to 12 months (McCusker et al., 2002), other complications from delirium also include patients having to stay longer in hospital which means they are exposed longer to hospital acquired infections, persistent cognitive deficits and an summationd risk of the individual being discharged into residentia l care rather than return to living independently are also factors (Wong et al., 2010).With the symptoms of delirium presenting as the onset of an acute mental illness it is possible for debate to arise as to which clinical squad should be responsible for the instruction of the patient additionally in light of the evidence presented it would be easy for the individual with delirium to be overlooked or not be investigated for the reasons behind the onset of the condition which is probably why the mortality rate is so high underlying physical conditions that are not assessed, treated or managed will continue to affect the health status of the individual. Statistically more than half of delirium cases go unrecognised by health professionals (Inouye et al., 1998).Prevention of delirium is more effective than treating it once it has develop (Brown Boyle, 2002) accordingly it is important for healthcare professionals to be aware of the risk factors, symptoms and causes of delirium f or individuals under their care either in hospital or in the community. If delirium has already developed then it is the responsibility of the healthcare team to manage the condition quickly and efficiently to reduce further problems and difficulties for the individual recognizing the mortality rates associated with a diagnosis of delirium should facilitate efficiency.To assist with obtaining a clearer clinical perspective of delirium and the impact it has on an individual a clinical case study shall now be explored.Halim Clinical ExplorationHalim was admitted to the emergency department and when the clinical history was obtained from his daughters it was identified that there had been a rapid change in his cognitive status which had been observed within a 24 hour period as his daughter had not been alerted to any concerns when she had spoken to him the previous evening. In light of the evidence it is possible for practitioners at this point to consider that Halim has developed an acute syndrome such as delirium and the next stage is to explore this further.On completion of the canonical observations it was evident that there are physical abnormalities present. From visual observation of the patient it is clear he has modify mental status, dry skin and cracked lips. From clinical measurement of heart rate, blood pressure, temperature and oxygen intensity take aims, there is further evidence of physical abnormalities that may contribute to changes in cognitive function to such an acute degree.Obtaining clinical history often involves information being sought from third parties to support clinical findings particularly if the patient is impaired cognitively. Halims daughters were able to give an account of a gentleman who had experienced married problems and divorce due to alcohol misuse and evidence remains that he continues to consume alcohol regularly. In addition to this there is a history reported of Halim neglecting his diet to the extent his daughter s provide food for him when they visit, he also engages in health limiting behaviours by smoking and consuming high levels of caffeine on a daily basis.The history obtained from Halims daughters identifies a gentleman who is successfully self- employed, he has hobbies and interests although his social network has reduced and although he engages in health limiting behaviours such as smoking, drinking alcohol and neglecting his dietary ineluctably he has remained independent within his own home. The evidence suggests there has been an acute change and with this information and the clinical evidence indicating Halim is experiencing tachycardia, high temperature, hypotension and dehydration the clinical evidence provides a strong indication that he is experiencing symptoms of delirium. however investigations are required to gain a greater understanding of what physical changes have occurred so that underlying causes are treated, however the practitioner should take some time to explain to the family members what tests are being completed and what the medical team are treating Halim for. The family must be very distressed by the changes to their father and by communicating the outcomes of the assessment and responding to any questions they may have will be beneficial as it is reported that the experience of delirium is frightening for both the patient and their carers and the value of reassurance cannot be underestimated (Mohta et al., 2003 Jacobson Schreibman, 1997).Managing Halim in terms of obtaining his accept to agree to treatment and investigations may be difficult because of the level of cognitive change and because his understanding and perspicaciousness may be impaired because of the delirium therefore it is important that the practitioner and family are familiar with reasoned frameworks and hospital policies that are in place to consider the rights of all parties are being protected. An example of this would be practitioners being familiar with the hospitals delirium policy, being well versed in patients rights and by having knowledge or so legislation such as the Mental Capacity Act (The Stationary Office, 2005).As stated previously the experience of delirium may be frightening for Halim and therefore the practitioner should endeavour to implement nurse and care strategies that reduce distress, improve orientation, address physical health status and ultimately minimise the length and impact of the delirium. Examples of the interventions that can be implemented include working with the multi disciplinary team to treat the underlying cause of the delirium. This may include providing pain control, regulation of bowel and bladder function, ensuring adequate diet and fluid intake is promoted and recorded.Another intervention that is reported to be effective in supporting patients with delirium is for care staff to provide a safe and therapeutic environment. This would mean that Halim is offered reassurance and support, all act ivities are carefully explained and for Halim this may mean that a Farsi speaking interpreter is found to facilitate communication between him and the medical team as he reverts to the language of his birth when speaking with the clinicians. In expanding the opportunity to communicate with Halim, this may increase his comprehension of what the medical team are trying to achieve and reassure him that the procedures being carried out give care attempting to obtain a urine screen.Due to the life threatening nature of Delirium it is essential for all physical screens and assessments to be carried out to ensure early identification of the reason for the onset of the condition, if the therapeutic interventions are unable to be implemented due to Halim remaining agitated and acutely confused then as a last resort medication may be considered in an attempt to reduce his level of arousal enough to ensure clinical procedures and care can be delivered.Psychotropic medication can be prescribed in delirium in an attempt to reduce the levels of distress and agitation and for Halim it may be beneficial to ease his levels of arousal enough so that medical interventions can take place it is important to telephone line however that psychotropic medications have side effects that include extra pyramidical side effects, mobility impairment, sedation and cardiac interaction therefore they must be used with extreme safeguard and Halim should be monitored closely.ConclusionHalim has presented to the emergency department with a delirium and the impact of this on his health and well-being should not be underestimated by practitioners. With mortality rates in delirium being worthy to note it is essential that care pathways are developed to ensure the physical health and mental wellbeing of patients like Halim are met concurrently.Clinical, environmental and behavioural interventions are acknowledged to reduce the impact, intensity and duration of the condition therefore practition ers should work intensively to ensure a delirium presentation is treated efficiently and effectively to ensure mortality rates are reduced and recovery is facilitated as quickly as possible.