Delirium: Opportunity for Comfort in Palliative Care

Jacqueline F. Close, PhD, RN, GCNS-BC, FNGNA; Carol O. Long, PhD, RN, FPCN

Disclosures

Journal of Hospice and Palliative Nursing. 2012;14(6):386-394. 

In This Article

Case Study: Part 3

On her fifth postoperative day, Mrs Smith was walking with the aid of a front-wheeled walker; she was alert to her baseline, was eating and drinking without encouragement, and seemed ready for discharge to her home with home healthcare. Prior to discharge, a medical social worker held a family conference to ensure that the plan of care was clear for Mrs Smith. The palliative care team collaborated with Mrs Smith and spent time with her and her family to make certain all understood the goals of care. Mrs Smith was adamant that she would not undergo any further diagnostic tests or aggressive treatments for her heart failure. She wanted to spend what time she had at home with family and friends. This was vitally important to her. The palliative care team assured Mrs Smith and her family that her wishes would be followed and they were there to support her. Mrs Smith's husband and daughter agreed with her wishes as they realized she would not want to live if she had no quality of life to do the things that brought her joy.

Summary

Delirium is stressful for both the patient and family across all settings. The prevalence is highest in vulnerable populations and particularly for older individuals, in intensive care units, those who are postoperative, and those with advanced illness.[44] The predisposing risk factors of advanced age, severity of illness, multiple comorbidities, and vision and hearing impairments, as well as her fall and subsequent surgery to repair her fractured hip, left Mrs Smith very vulnerable to delirium. The precipitating risk factors, or the events happening after hospitalization, contributed to Mrs Smith's delirium, which included immobilization, dehydration, malnutrition, urinary tract infection, pneumonia, and sleep deprivation. These predisposing and precipitating risk factors alert nursing staff that delirium is an acute onset that requires immediate intervention. Nurses play a key role in the prevention and recognition of delirium, thus contributing to optimal outcomes for hospitalized patients. An array of interventions that range from safety to comfort must be considered for the patient experiencing delirium, regardless of setting. Palliative care teams can provide support and assistance in symptom control, pain management, and family support. The patient and family goals for palliative care are a difficult balancing act for all involved but, when done well, bring comfort to those for whom we care.

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