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Why you should read this article: • To enhance your knowledge of the causes, risk factors and symptoms of common neurological complications following cardiac surgery, specifically delirium and post-operative cognitive decline • To familiarise yourself with the assessment, diagnosis and management of delirium and post-operative cognitive decline • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Despite recent technological advances in the field of surgery, neurological complications remain a significant post-operative issue. Two of the most common post-operative complications are delirium and post-operative cognitive decline, which occur frequently after cardiac surgery. This article provides an overview of delirium and post-operative cognitive decline, including risk factors, signs and symptoms, and diagnosis. The author also considers the nurse's role in managing patients who are at risk of, or have experienced, delirium or post-operative cognitive decline after cardiac surgery. [ABSTRACT FROM AUTHOR]

Delirium is a common condition experienced by people in hospitals and long-term care settings. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the effects that the coronavirus disease 2019 (COVID-19) pandemic has had on the care of people with dementia • To understand the importance of dementia awareness and education for nurses • To consider how nurses can promote person-centred dementia care in their practice In recent years, nurses have experienced increased workplace pressures in part due to the coronavirus disease 2019 (COVID-19) pandemic, which exacerbated challenges in the delivery of person-centred dementia care. This article examines how people with dementia were affected by the COVID-19 pandemic, as well as exploring the ongoing effects on nurses and the care they provide for people with dementia. The author discusses the importance of dementia awareness and education for nurses that supports them to promote the needs of people with the condition. The article also outlines how nurse leaders can promote person-centred care for people with dementia through reflection and clinical supervision. [ABSTRACT FROM AUTHOR]

Delirium is a disorder of attention and consciousness and the most relevant risk factor is age. However, a history of neurodegenerative disease is also associated with an increased risk of developing delirium. [ABSTRACT FROM AUTHOR]

The article highlights a study undertaken in a United Kingdom hospital which found that the overall anticholinergic drug burden did not change significantly during an inpatient stay on five wards typically caring for older people. It discusses that Anticholinergic burden (ACB) is defined as the "accumulation of higher levels of exposure due to one or more ACM and the attendant increased risk of medication-related adverse effects.

Why you should read this article: • To understand how agitation secondary to hyperactive delirium can affect deteriorating patients • To learn more about the burnout experienced by nurses when caring for patients with delirium • To enhance your knowledge of why restraint should be a last resort in patients with delirium Delirium is an under-recognised condition which adversely affects deteriorating patients. Delirium can be an acute or long-term condition and is associated with increased morbidity and mortality, and extended length of hospital stay. The management of delirium is often reactive rather than proactive, which can lead to the inappropriate use of chemical and physical restraint to control agitation secondary to hyperactive delirium. Caring for patients with delirium presents physical and emotional challenges for nurses, who are sometimes inclined to use restraint, which should be a last resort. This article describes the challenges of caring for patients with delirium, presents the risk factors for and assessment of delirium, and describes the management of agitation secondary to hyperactive delirium. Support and education for nurses caring for patients with delirium is essential to ensure optimal patient care and avoid staff burnout. [ABSTRACT FROM AUTHOR]

Delirium is one of the most common medical emergencies, but it is not always understood or identified quickly. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To enhance your knowledge of the features of dementia, delirium and depression • To understand how to differentiate between dementia, delirium and depression, and the validated clinical assessment tools available to assist in this • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Older people can find hospital stays challenging and distressing. When their presenting symptoms make it challenging for healthcare professionals to differentiate between dementia, delirium and depression, their experience may be increasingly distressing, and can result in delays in diagnosis and treatment, as well as an increased risk of morbidity. This article considers each of the conditions of dementia, delirium and depression, their presenting features and how nurses can differentiate between them to enable comprehensive assessment, diagnosis and treatment in older people. [ABSTRACT FROM AUTHOR]

Delirium is the most common neuropsychiatric disorder in patients with palliative and end of life care needs; therefore, providing effective care for patients, and their families, is a clinical priority for nurses. Delirium is characterised by a fluctuating state that affects an individual's attention, orientation, thinking, perception, memory, psychomotor behaviour, emotions and sleep-wake cycle. Early recognition, assessment and management of delirium is essential, because this has the potential to relieve distress and improve the quality of life and death for patients. This article discusses the causes, effects, and signs and symptoms of delirium. It also outlines the non-pharmacological and pharmacological strategies that can be used to assess and manage patients with delirium at the end of life, alongside the support that should be provided to their families. [ABSTRACT FROM AUTHOR]

Delirium is common in patients who are critically ill, often resulting in extended hospital stays and increased mortality and morbidity. There are several subtypes of delirium, which are often undiagnosed and untreated, resulting in suboptimal patient outcomes. This article examines delirium in patients in the intensive care unit, including its signs and symptoms, incidence, causes and subtypes. It outlines the assessment of delirium and the pharmacological and non-pharmacological interventions that can be used to manage the condition, as well as describing the optimal prevention measures. [ABSTRACT FROM AUTHOR]

People with serious mental illness (SMI) are at risk of dying many years earlier than the general population. Providing an effective, cost-efficient healthcare service requires a holistic approach, and improving the physical health of people with SMI should be integral to all healthcare roles. It is important for nurses to identify and understand the barriers that people with SMI may experience when accessing physical healthcare. A range of factors contribute to reduced life expectancy, including lifestyle factors, symptoms of mental illness and the side effects of medications. This article discusses four areas of health that commonly affect people with SMI: metabolic syndrome, smoking, oral health and sexual health. Metabolic syndrome is a cluster of risk factors that increase an individual's risk of cardiovascular disease stroke and type 2 diabetes mellitus. Smoking is increasingly prevalent in people with SMI, with rates remaining steady despite a decline in smoking rates nationally. Oral health and sexual health can negatively affect the physical health and well-being of people with SMI; however, these aspects of health are often neglected. This article identifies ways that nurses in all practice settings can use health promotion, assessment and treatment to improve the physical health of people with SMI in relation to these four areas. [ABSTRACT FROM AUTHOR]

Aim To increase awareness of the needs of patients with dementia in the trauma and orthopaedics unit of one acute hospital, and to collaborate with staff on the unit to identify ways of improving the care experienced by these patients and their families. Method An action research approach was used and three action research cycles were completed. Data were obtained retrospectively for 20 patients with dementia who were admitted to the unit for treatment. Deficiencies in the care of these patients were identified and related to communication, pain management and the recognition of delirium. In response, a dementia toolkit was developed by nurses and implemented on the unit to improve the care of patients with dementia. Findings Comparison of pre-implementation and post-implementation audit results indicated a significant improvement in all aspects of care for patients with dementia in the trauma and orthopaedics unit, as a result of the implementation of the dementia toolkit. Education and training were provided to staff on the ward to ensure the toolkit was implemented appropriately. Conclusion It is important to consider the specific needs of patients with dementia in acute care settings, not only the primary reason for their admission. The involvement and inclusion of staff in determining what change was needed on the unit, how change would be undertaken and the positive effects of change, demonstrates how action research can inform and improve clinical practice. [ABSTRACT FROM AUTHOR]

Agitation commonly affects older adults, particularly those living in care homes and in hospital settings. Agitation can be distressing to experience, may be associated with poorer health outcomes and can present a challenge to staff in keeping the person and those around them safe. This article examines why agitation can occur in older people and discusses current best practice, focusing on communication and non-pharmaceutical interventions. Agitation is commonly associated with dementia and delirium. This article indicates how these conditions can affect the older person and their interactions with the surrounding environment. A case study is used to illustrate application in practice. [ABSTRACT FROM AUTHOR]

The article discusses the Royal College of Nursing's (RCN) campaign to improve the early identification of delirium in the community and reduce the need for hospital admissions of older people. Topics discussed include how nurses working in the community can help in the early detection of the symptoms, the difficulty of distinguishing between delirium and dementia and the National Institute for Health and Care Excellence's (NICE) recommendations to help reduce the risk of delirium.

Hip fracture is one of the most common admission diagnoses in the UK, accounting for more than 75,000 hospital admissions per year in England and Wales. Fractured neck of femur can be classified as a 'frailty' presentation because of an average age of over 80 years, a clear association with 'pathological falls', including syncope, and a high number of co-morbidities. The combination of traumatic injury, frailty and surgery presents significant challenges to the managing team and requires an multidisciplinary approach to reduce the risk of perioperative complications, most commonly postoperative delirium, sepsis, cardiac complications, stroke and metabolic disturbance. Close monitoring with geriatric co-management has been shown to reduce complications and resultant morbidity, length of stay and mortality. Many lessons learnt from the experience of managing these very challenging patients are transferable to other frail patients undergoing surgery. [ABSTRACT FROM AUTHOR]

This article discusses the management of acute confusion and aggression in patients with infections of the central nervous system (CNS). The issues discussed are applicable to the management of acute confusion of any cause and the principles of care apply to all confused patients. The article addresses many of the challenges encountered by nurses caring for confused patients, including the recognition of acute confusion, use of screening tools, and the management and treatment of these patients. [ABSTRACT FROM AUTHOR]

Dementia is a progressive terminal condition affecting all aspects of a person's functioning. People with dementia require sensitive communication approaches and skilled interventions. In addition, medications may be used to promote wellbeing, but concerns have been raised about covert medication and use of antipsychotics for managing behavioural problems. In the middle and later stages of dementia, nurses and pharmacists can work in partnership to promote effective person-centred care, ensuring medication is used safely as part of a holistic approach. [ABSTRACT FROM AUTHOR]

Delirium is a common condition among hospitals inpatients and people in long-term care settings. It is an acute confusional state associated with poor outcomes. Delirium is poorly recognised and managed despite evidence to suggest it is preventable in up to one third of cases. In 2010, the National Institute for Health and Clinical Excellence published a comprehensive clinical practice guideline on the diagnosis, prevention and management of delirium. This article discusses the clinical features of delirium in relation to the guideline. It recommends that all clinical staff caring for older people should take on the responsibility to 'think delirium' and improve the quality of care of these patients. [ABSTRACT FROM AUTHOR]

Mental health problems are common in older people admitted to general hospitals. With an increasing ageing population, admissions will rise and nurses will be expected to manage patients' co-existing mental health problems as well as physical problems. This article explores potential strategies for the management of patients with depression, delirium and dementia. The emphasis is on improving guality of care for this group of vulnerable patients. [ABSTRACT FROM AUTHOR]

The author describes how a team of nurses, called the Delirium Care Group, at Saint George's University Hospitals National Health Service (NHS) Foundation Trust in England raised awareness of delirium and introduced a screening tool on their intensive care unit (ICU). She offers an overview of the study the team conducted to improve patient experience and ensure safe and quality health care. Steps take to assess patient compliance through staff feedback and audit are outlined.

Acute psychosis can be caused by a range of organic and functional disorders. Initial assessment in primary care should focus on potentially reversible causes and any high risks to the patient or others present. Early involvement of secondary psychiatric services to consider appropriate and timely treatment is essential. In the UK, specialist teams in secondary care have been developed in recent years to support patients with psychosis and their families. Newer antipsychotic drugs have a different side-effect profile and require specific monitoring in this patient group. This may be challenging to deliver, and this could be explored through a shared care model between primary and secondary care. [ABSTRACT FROM AUTHOR]

Delirium is a common and under-reported problem in older adults. It can have a negative effect on patient outcomes and nurses often fail to identify it. This is the second part of an article that outlines nursing interventions based on the Roper, Logan and Tierney model of the activities of living. The first part of this article, which examined the clinical features, risk factors and assessment of delirium, was published in last week's Nursing Standard (Farley and McLafferty 2007). [ABSTRACT FROM AUTHOR]

Delirium is a common and under-reported problem in older adults. A lack of consensus over the terminology used to describe delirium may contribute to its underdiagnosis, and a number of predisposing factors are linked to it. This article, the first of two, aims to define delirium, describe the different types and identify risk factors associated with its development. Delirium is an important condition as it has a deleterious effect on patient outcomes and quality of life if it is not detected early and managed effectively. The detection of delirium and a variety of assessment tools are also considered. Part two, to be published in next week's Nursing Standard, examines the nursing management of delirium. [ABSTRACT FROM AUTHOR]

The fifth and final article in the series on patients with dementia in acute care examines challenging behaviour. Hospital admission, combined with unfamiliar surroundings and memory problems, can be frightening and disorientating for those with dementia. This can lead to behaviour which is perceived as 'disruptive' or 'difficult'. Aspects of the hospital environment or care practice can contribute to problems that may be misinterpreted and lead to challenging behaviour. Staff should seek to understand the cause of challenging behaviour, assess the possible causes and use strategies to reinforce familiarity and minimise distress for these patients. [ABSTRACT FROM AUTHOR]

The article reports that dizziness and problems with balance are common, with a high proportion of the population being affected by one or both at some time in their lives. Although problems are more likely to occur in the elderly, disorders affecting the ability to maintain upright stance can occur at any age. Based upon years of experience with this patient population, it is clear to me that the evaluation of patients with dizziness and balance complaints must involve a team approach including audiologists, physicians, and in many cases, physical therapists.

Health and social care staff have a vital role in managing continence for people in a variety of settings. [ABSTRACT FROM AUTHOR]

The article relates how a nurse-led project to avoid transferring patients at night has helped reduce the risk of anxiety and distress, and improved relationship with carers. Topics discussed include the success of Nicola Wood's collaborative approach to improving care for people with dementia, the challenges of expanding the work to patients admitted with delirium and numbers of patients with delirium dying in the hospital.

The article discusses latest research from the nursing and scientific journals as of August 2017. A study by researchers from the University of Texas MD Anderson Cancer Center found that advanced cancer patients with delirium are prone to an earlier death. A team of researchers from Brighton and Sussex Medical School argued that patients may not need to complete a course of antibiotics as previously recommended by medical advice.

The article offers information on delirium, a state of heightened mental confusion that mainly affects older people. Delirium is associated with hospital-acquired complications such as falls and pressure ulcers. The Royal College of Nursing (RCN) has launched an initiative help nurses identify the signs of delirium, improve care and save lives.

The article discusses research reported in the article "Cognitive Trajectories After Postoperative Delirium" by J. Saczynski et al. which found that post-operative delirium may lead to longer-term effects on cognitive function in hospital patients.

A learning zone article inspired Eva Richards to improve the quality of life for care home residents with delirium. [ABSTRACT FROM AUTHOR]

The article discusses the treatment options for delirium in older patients. Delirium is described by hyperactive states and fluctuations in level of consciousness, attention, and cognition. Individuals with delirium experience sleep pattern disturbance and psychomotor behavior. The agitation of delirium can be treated through second-generation antipsychotics like olanzapine and quietiapine, benzodiazepines, and melatonin.

The article discusses research being done on the link between statins use and risk of delirium after surgery. It references a study led by Doctor Donald A. Redelmeier published in the September 23, 2008 issue of the "Canadian Medical Association Journal." Researchers found that patients who take statins are more prone to experience delirium following surgery. According to the article, Redelmeier proposed that statins could increase the risk of delirium by shunting blood away from the brain to the heart.

A CPD article enhanced Abby Morrow-Barnes’s understanding of delirium, its many symptoms and underlying causes. [ABSTRACT FROM AUTHOR]

A quiz on delirium is presented.

The article examines the economic impact of undiagnosed and untreated cases of hospital-acquired delirium, which results in extended stays in U.S. hospital intensive care units (ICUs). A brief overview of the patient population most affected by hospital-acquired delirium, the strain on the public health care system of treating patients with delirium, and approaches to diagnosing delirium in elderly patients is presented. INSET: Testing for Delirium.

The article discusses delirium as a medical emergency requiring immediate interventions. Drugs, such as over the counter (OTC)are indicated as the most common cause and cites the drugs that pose the highest delirium risk including antidepressants, antiparkinsonian agents and benzodiazepines. Treatment include treating its underlying cause and pharmacotherapy like neuroleptics for symptom management. It cites the need for pharmacists to develop a healthy suspicion for drug-induced delirium.

The article offers information on delirium in patients with advanced cancer.