Summary: index_delirium

Confusion

Alarm level explanation: The customer shows signs of confusion. The cause should be determined quickly. Make sure that the observation is correct and that the symptom is different from earlier. Consult a nurse or doctor. Some of the findings are due to lack of data and irregular recording of cognition in a customer with memory impairment. If the finding is new,

  1. Check the client’s vital signs.

Body temperature should be 35-38C, pulse 60-100, respiratory rate 16-25/min and blood pressure below 160/95. Abnormalities in vitals may indicate infection.

  1. Dehydration

Assess whether dehydration may be the cause of the confusion.

  1. Pain and pain medication

Setting of pain medication according to need.

  1. Chronic Illnesses

Some chronic illnesses may be associated with confusion. Act based on what has caused the confusion. E.g. low blood sugar in diabetics, etc.

  1. Medication

Is the client using medication that can cause confusion? Have there been deviations in the administration of medicines?

  1. Environmental factors

Is the customer using his hearing aids / glasses? Has the client recently been discharged from the hospital? Have the nurses changed often?

Warning level explanation: The customer may be showing signs of confusion. Make sure that the observation is correct and that the symptom is different from earlier. Consult a nurse or doctor . Some of the findings are due to lack of data and irregular recording of cognition in a customer with memory impairment. If the finding is new,

  1. Check the client’s vital signs.

Body temperature should be 35-38C, pulse 60-100, respiratory rate 16-25/min and blood pressure below 160/95. Abnormalities in vitals may indicate infection.

  1. Dehydration

Assess whether dehydration may be the cause of the confusion.

  1. Pain and pain medication

Setting of pain medication according to need.

  1. Chronic Illnesses

Some chronic illnesses may be associated with confusion. Act based on what has caused the confusion. E.g. low blood sugar in diabetics, etc.

  1. Medication

Is the client using medication that can cause confusion? Have there been deviations in the administration of medicines?

  1. Environmental factors

Is the customer using his hearing aids / glasses? Has the client recently been discharged from the hospital? Have the nurses changed often?

Ok level explanation: The customer has no signs of confusion or there is no data available about it.