Cerejeira Joaquim, Mukaetova-Ladinska Elizabeta B
Serviço de Psiquiatria, Hospitais da Universidade de Coimbra, Praceta Mota Pinto, 3000 Coimbra, Portugal.
Nurs Res Pract. 2011;2011:875196. doi: 10.1155/2011/875196. Epub 2011 Jun 16.
Delirium is a neuropsychiatric syndrome characterized by altered consciousness and attention with cognitive, emotional and behavioural symptoms. It is particularly frequent in elderly people with medical or surgical conditions and is associated with adverse outcomes. Predisposing factors render the subject more vulnerable to a congregation of precipitating factors which potentially affect brain function and induce an imbalance in all the major neurotransmitter systems. Early diagnosis of delirium is crucial to improve the prognosis of patients requiring the identification of subtle and fluctuating signs. Increased awareness of clinical staff, particularly nurses, and routine screening of cognitive function with standardized instruments, can be decisive to increase detection rates of delirium. General measures to prevent delirium include the implementation of protocols to systematically identify and minimize all risk factors present in a particular clinical setting. As soon as delirium is recognized, prompt removal of precipitating factors is warranted together with environmental changes and early mobilization of patients. Low doses of haloperidol or olanzapine can be used for brief periods, for the behavioural control of delirium. All of these measures are a part of the multicomponent strategy for prevention and treatment of delirium, in which the nursing care plays a vital role.
谵妄是一种神经精神综合征，其特征为意识和注意力改变，并伴有认知、情感和行为症状。在患有内科或外科疾病的老年人中尤为常见，且与不良后果相关。易感因素使个体更容易受到多种促发因素的影响，这些因素可能影响脑功能并导致所有主要神经递质系统失衡。谵妄的早期诊断对于改善需要识别细微和波动体征的患者的预后至关重要。提高临床工作人员尤其是护士的意识，以及使用标准化工具对认知功能进行常规筛查，对于提高谵妄的检出率可能具有决定性作用。预防谵妄的一般措施包括实施相关方案，以系统地识别并尽量减少特定临床环境中存在的所有风险因素。一旦识别出谵妄，应立即去除促发因素，同时改变环境并尽早让患者活动。低剂量的氟哌啶醇或奥氮平可短期使用，以控制谵妄的行为症状。所有这些措施都是谵妄预防和治疗多组分策略的一部分，其中护理起着至关重要的作用。
