Once delirium is diagnosed, its causes can be sought and its manifestations treated. Common and important manifestations of delirium include disorientation, illusions, hallucinations, delusions, and agitation. Recommended interventions for disorientation include frequent reorientation, especially every time there is an interaction with the patient (e.g., "Hello, Mrs. Jones. I'm Dr. Smith. I'm glad to say that your heart failure is better and we expect your breathing to be better soon"); moderate levels of stimulation; and placement of wall calendars and clocks in the patients room.
Illusions, hallucinations, and delusions are often frightening to patients and can lead to dangerous behavior. If they do not abate rapidly with reversal of the underlying cause of the delirium, they are best treated with neu-roleptic drugs. Haloperidol, 0.5 mg po or im q2-4h, or risperidone, 0.5-1 mg po q4h, is often effective. Patients should be monitored for extrapyramidal side effects such as rigidity and tremor. Patients who are agitated or aggressive may require higher doses of neuroleptics or benefit from a fast-acting agent such as droperidol, 0.5-2 cc im, to initiate therapy. Benzodiazepines should be given when alcohol or benzodiazepine withdrawal is suspected, but they will not reverse hallucinations and delusions, as neuroleptics do. Parenterally administered short-acting benzodiazepines such as midazolam hydrochloride or intermediate-acting agents such as lo-razepam are, however, useful for rapid sedation of delirious patients whose behavior is dangerous and for whom neuroleptics are risky. When parenteral neuroleptics or benzodiazepines are needed, constant observation and frequent monitoring of vital signs in an appropriate environment are indicated.
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