Introduction
Terminal delirium is a potentially reversible confusional state that occurs in clients nearing death with advanced illnesses. Delirium frequently has a physiologic cause which leads to cognitive impairment (Potter & Perry, 2014). There are many different risk factors related to terminal delirium; ranging from dehydration to metabolic imbalances. If a terminal patient develops the condition, they will start to have behaviours such as restlessness and agitation. Many studies have been completed which show a prevalence of delirium in terminal patients, but unfortunately it frequently goes unnoticed. Recently there have been more attempts to educate health care professionals on the symptoms of delirium and more treatments are becoming available.
Risk Factors
In 2012, the Journal of Palliative Medicine published a chart review focusing on delirium risk factors for terminal patients with cancer. Delirium was observed in 42% of the subjects, and the mean age of the group that screened positive was higher than the group that did not have delirium. According to the results of this study, the male gender and a positive smoking history also appeared to be a common factor in those with delirium. In a terminally ill client’s last days, up to 83% experienced delirium. In most clients, terminal delirium usually began around the sixth day before death. Nagase et al. (2012) suggests that “In the future, it is necessary to separate terminal patients with cancer into high- and low-risk groups according to their risk factors.” By doing this nurses will be able to adjust their care for exactly what the patient needs (Nagase et al., 2012).
In 2010, Keeley released a review that says if patient’s have a terminal illness, up to 88% will ex...
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Nagase, M., Okamoto, Y., Tsuneto, S., Tanimukai, H., Matsuda, Y., Okishiro, N., & … Uejima, E. (2012). A
Retrospective Chart Review of Terminal Patients with Cancer with Agitation and Their Risk Factors. Journal Of Palliative Medicine, 15(11). doi: 10.1089/jpm.2012.114
Potter, P. & Perry, A. (2014). Fundamentals of Canadian nursing. 5th. Ed. Toronto: Elsevier 383
Rao, S., Ferris, F., & Irwin, S. (2011). Ease of screening for depression and delirium in patients enrolled in inpatient hospice care. Journal Of Palliative Medicine, 1(3), 275-279. doi:
10.1089/jpm.2010.0179
Shinno, H., Matsuoka, T., Yamamoto, O., Noma, Y., Hikasa, S., Takebayashi, M., & Horigughi, J. (2007).
Successful treatment with quetiapine for delirium in terminally ill cancer patients.
Psychogeriatrics, 7(2), 64-68. doi: 10.111/j.1479-8301.2007.00182.x
Ramachandria, C. T., Subramanyan, N., Bar, K. J., Baker, G., & Yeragani, V. K. (n.d.).
Loiselle, C. G., Profetto-McGrath, J., Polit, D. F., Beck C. T., (2007). Canadian essentials of nursing research (2nd ed.) Philadelphia: Lippincott Williams & Wilkins.
Terminally ill patients deserve the right to have a dignified death. These patients should not be forced to suffer and be in agony their lasting days. The terminally ill should have this choice, because it is the only way to end their excruciating pain. These patients don’t have
Delirium in the Intensive Care Unit (ICU) has become a genuine phenomenon and can be problematic for the patient and the staff caring for them. Delirium occurs when a patient is placed in an unfamiliar environment and has to endure the stress of not just the hospitalization but the stimuli of the environment, which can cause disturbances in consciousness. Patients can become confused, anxious, and agitated; making this difficult for the staff to correctly diagnosis and care for them. Sleep deprivation and environmental factors along with neurotransmitters are strongly related to the occurrence of ICU delirium. ICU staff needs to become more educated on prevention, detection, and proper treatment for the patient experiencing this condition.
Thanks in part to the scientific and technological advances of todays’ society, enhanced medicinal treatment options are helping people battle illnesses and diseases and live longer than ever before. Despite these advances, however, many people with life threatening illnesses have needs and concerns that are unidentified and therefore unmet at the end of life, notes Arnold, Artin, Griffith, Person and Graham (2006, p. 62). They further noted that when these needs and concerns remain unmet, due in part to the failure of providers to correctly evaluate these needs, as well as the patients’ reluctance to discuss them (p. 63, as originally noted by Heaven & Maguire, 1997), a patient’s quality of life may be adversely affected. According to Bosma et al. (2010, p. 84), “Many generalist social work skills regarding counseling, family systems, community resources, and psychosocial assessments are relevant to working with patients and families with terminal illness”, thereby placing social workers in the distinctive position of being able to support and assist clients with end of life decisions and care planning needs. In fact, they further noted that at some point, “most social work practitioners will encounter adults, children, and families who are facing progressive life limiting illness, dying, death, or bereavement” (p. 79).
The New England Journal of Medicine reports that early introduction of palliative care was shown to be effective in prolonging the life of lung cancer patients. Whether it is a terminal illness, chronic condition, recovery from surgery or physical rehabilitation, palliative care has expanded benefits still being discovered. It appears that whatever the ailment may be, there are beneficial results in pain control, treatment of symptoms and discomfort of side effects. It is also effective in alleviating the physical and mental stress that accompanies those
Tackett, J. L., Lahey, B. B., van Hulle, C., Waldman, I., Krueger, R. F., & Rathouz, P. J. (2013).
To “live as fully and comfortably as possible” is a key phrase in the care and treatment of a patient under hospice care. Hospice care focuses on the comfort and quality of life for a person with a terminal illness. The focus is not on a cure. A hospice care provider wants to help the patient be as pain free and comfortable as they can be, so that they can live the rest of their life as fully as possible. Unfortunately, more often than not, patients with terminal illnesses are viewed to be too frail to participate in occupations (Russell, M., & Bauh-Lampe, A., 20016). It is also true that people facing the end of their life feel helpless or depressed, lose their ability to participate in a lot of the daily activities they once enjoyed, and experience a loss of dignity. (Badger, S., Macleod, R., & Honey, A. 2016). However, with hospice care, many patients are able to find some degree of comfort, safety and control over their lives during their final days.
Stair, J. (1998). Understanding the Challenges for Hospice: Fundamental for the Future. Oncology Issues [Online]. 13(2): pages 22-25. *http://ehostweb6.Epnet.com: (2000, October 13).
Delirium is a sudden, fluctuating, and usually reversible disturbance of mental function (Fan, Guo, Li, & Zhu, 2012). Delirium has been identified in several hospital settings, however occurs more frequently in an Intensive Care setting. Risk factors are not limited to a certain age, race, or gender. There are several long and short term adverse effects associated with Delirium, and may even leave the patient in a decreased mental state after discharge. It is important to use the proper assessment tools to identify delirium in patients. More so, it is imperative that the medical and nursing staff be aware of all risk factors, signs and symptoms, and interventions to minimize and properly treat delirium in the ICU setting.
Brand, B., Classen, C., Lanins, R., Loewenstein, R., McNary, S., Pain, C., Putnam, F. (2009). A
In end of life care, a nurses responsibility is to make the patient as comfortable as possible, manage any health complications with appropriate measures, and maintain their overall quality of life. Death could be a long or short process and nurses and other health care providers have to be prepared for anything. Managing a patient’s...
Polit, D. F., & Beck, C. T. (2010). Essentials of Nursing Research (7th ed): Lippincott, Williams & Wilkins.
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (Seventh ed.). St. Louis, Mo.: Mosby Elsevier.
Barker, V., Giles, H., Hajek, C., Ota, H., Noels, K., Lim, T-S., & Somera, L. (2008).