PubMed · 8600721
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J H Becker. 1996. When you need to use restraints.. https://pubmed.ncbi.nlm.nih.gov/8600721/
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Confusion in the elderly patient is usually a symptom of delirium or dementia, but it may also occur in major depression and psychoses. Until another cause is identified, the confused patient should be assumed to have delirium, which is often reversible with treatment of the underlying disorder. Causes of delirium include metabolic disorders, infections and medications. Thyroid dysfunction, vitamin deficiencies and normal-pressure hydrocephalus are some potentially reversible causes of dementia. Major irreversible causes include Alzheimer's disease, central nervous system damage and human immunodeficiency virus infection. All but the rarest causes of confusion can usually be identified based on the complete history, medication review, physical examination, mental status evaluation and laboratory evaluation with longitudinal reevaluation.
Sleep-wake disorders are common in patients who are treated in coronary care units (CCU). We report a clinical trial aimed at developing an observational assessment of patients sleep complaints in a CCU. Thirty-four inpatients with coronary heart diseases in the CCU (Tokyo Metropolitan Hiroo General Hospital) participated in the study. The patient's sleep state was assessed by nursing staff and classified as wakefulness, drowsy and asleep according to a semi-structured observation. Subjective sleep feelings upon rising was also investigated. Sleep disruptions during the latter half of the night was found to be an important determining factor of sleep feeling upon rising.
PURPOSE/OBJECTIVES: To review the literature on confusion at the end of life, provide accurate definitional and defining characteristics of confusion, and outline nursing strategies for its resolution. DATA SOURCES: Published articles, computerized databases, book chapters, reference lists from chapters and journal articles. DATA SYNTHESIS: As a major component of symptom distress in terminal care, confusion has not been defined clearly and therefore has not benefited from rigorous assessment and study as have other end-of-life symptoms. CONCLUSIONS: Increased knowledge about confusion that occurs in patients with widely metastatic cancer will assist in accurate symptom identification, early recognition, and timely management to reduce cognitive symptom distress at the end of life. Improved symptom resolution also can benefit family coping during terminal care. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses can devise management protocols for confused patients that include screening criteria, pharmacologic interventions, environmental support, and prophylactic safety measures.