A patient with delirium is in the hospital room and exhibits agitation. What should the nurse do to help manage this situation?

Appeared in: NORCET 7 Prelims -2024

Explanation

Calm reassurance and redirection are the first-line non-pharmacological approaches for managing agitation in delirium.
This strategy aims to de-escalate the situation, reduce the patient's fear and anxiety, and ensure safety without resorting to restrictive measures.
It is the least restrictive and most therapeutic initial intervention, aligning with best practices for delirium care.
This approach respects the patient's dignity while managing challenging behaviors effectively.

Option A: Physical restraints are a last resort and should be avoided whenever possible. They can increase agitation, cause physical injury, and worsen the patient's confusion and fear.
Option C: Increasing stimulation (e.g., noise, bright lights, multiple people talking) can overwhelm a delirious patient's compromised sensory processing, leading to increased confusion and agitation.
Option D: The presence of family is generally encouraged as it provides comfort, familiarity, and can help reorient the patient. Asking them to leave removes a key source of psychosocial support.

Visual 1: Flowchart: 'De-escalation Pathway for Agitation in Delirium', showing non-pharmacological interventions as the first step, followed by consideration of medication, and physical restraints as the final option.
Visual 2: Infographic: 'Creating a Therapeutic Environment for Patients with Delirium', illustrating key environmental modifications like appropriate lighting, low noise, and visible clocks/calendars.

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of Agitation in Delirium to guide bedside assessment, documentation, and the next nursing action.
The nurse's primary role in managing delirium is to maintain patient safety while identifying and facilitating treatment for the underlying cause.
Choosing the least restrictive intervention first is a core principle of patient care, particularly in vulnerable populations like those with delirium.
What if? If the patient's agitation escalates to physical violence despite verbal de-escalation, the nurse's next step would be to ensure immediate safety for everyone, call for additional staff/security, and then consider the use of as-needed medication or, as a last resort, physical restraints per hospital policy.

How to Approach the Question

First, identify the patient's condition and primary symptom: the patient has delirium and is agitated.
Next, recall the principles of managing delirium. The priority is safety, and the preferred approach is using the least restrictive intervention first.
Evaluate each option against this principle.
Option A (restraints) is the most restrictive and a last resort.
Option C (increasing stimulation) is contraindicated as it worsens delirium.
Option D (removing family) is also contraindicated as family presence is therapeutic.

Concept Tested & Keywords

Concept Tested: Management of Agitation in Delirium
Stem keywords: delirium, agitation, hospital room, nurse
Lead-in keywords: what should the nurse do
Clinical cues: The patient's diagnosis of delirium is the key factor guiding the intervention.
Clinical cues: The behavior of agitation requires an immediate but safe response.

Q9USuNgRB6VECh6lSyz0vG

Practise the full NORCET 7 Prelims -2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.