Self Directed Learning Package - University of Queensland

100 • The Palliative Approach ToolkitEnvironmental strategies 19• lighting appropriate to time of day – windows with a view to outside, curtainsand blinds open during the day, and minimal lighting at night• quiet environment especially at night• provision of clock and calendar• avoid room changes• encourage family and friends to be involved in resident care• encourage family to bring in resident’s personal and familiar objects• staff caring for residents with delirium should establish a communication strategythat incorporates elements of both reality orientation and validation techniques• modify the environment to minimise risk of injury (nurse in a low bed with cot sidesdown, bed against the wall, potential hazards such as beside tables removed)• allow family members to stay with resident including overnight• endeavour to have the same staff members care for the resident during andacross shifts• information regarding the diagnosis, cause and management plan should becommunicated to the resident and their family.Clinical practice strategies 19• encourage/assist with eating and drinking to ensure adequate intake• ensure that residents who usually wear hearing and visual aids are assisted to usethem• regulation of bowel function – avoid constipation• encourage and assist with regular mobilisation unless the residents conditiondoes not warrant this• encourage independence in basic ADLs unless the residents condition does notwarrant this• medication review• promote relaxation and sufficient sleep – can be assisted by regular mobilisation,massage, encouraging wakefulness during the day• manage discomfort or pain• provide orienting information including name and role of staff members• minimise use of indwelling catheters• AVOID use of physical restraints• use interpreters and communication aids with CALD patients.Medications 19The primary aim of medications for delirium is to reduce theresident’s distress by targeting any agitation or hallucinations.Antipsychotic drugs are considered first line therapye.g. haloperidol, risperidone or olanzapine.Benzodiazepines do not improve cognition but may helpassociated anxietye.g. short acting agents such as lorazepam or midazolam areusually indicated.Key PointBenzodiazepines may worsen delirium if not used incombination with an antipsychotic drug.When all else failsSometimes agitation and delirium can cause such severe distressand does not respond to medical management, especially in theterminal phase. This is a challenging problem and may requiresedation as the only appropriate intervention.ActivityPlease spend some time reading the section on deliriumin “Therapeutic Guidelines: Palliative Care (version 3)” -included in the PA Toolkit.