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Treatments for Delirium tremens

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Book Excerpts: Treatment of Delirium tremens

• Treatment - Delirium
• Treatment - Dementia
• Treatment - Hallucinations
• Treatment - Delirium
• Treatment - Hallucinations
• Emergency interventions - Level of consciousness, decreased
• Treatment - Alcohol-related disorder
• Emergency Interventions - Level of consciousness, decreased
• Nursing considerations - Level of consciousness, decreased
• Emergency Actions - Level of consciousness, decreased
• Patient counseling - Agitation
• Patient counseling - Confusion
• Nursing considerations - Level of consciousness, decreased
• Nursing considerations - Agitation
• Nursing considerations - Confusion

Treatments of Delirium tremens: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Delirium tremens.

Delirium: Treatment
(In a Page: Signs and Symptoms)

• Delirium is usually reversible with correction of the underlying cause
  –Discontinue possible contributing medications
  –Treat infection if present
  –Correct metabolic or electrolyte abnormalities
• Pharmacologic therapy
  –Antipsychotics (e.g., haloperidol) for hallucinations, delusions, or illusions
  –Benzodiazepines (e.g., lorazepam) for anxiety, agitation, insomnia, or alcohol withdrawal
• Environmental supports (e.g., calendars, direction signs) to help with orientation
• Psychosocial support
• Physical restraints paradoxically increase patient agitation; thus, other alternatives (e.g., safe environment, door alarms) should be used initially

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Dementia: Treatment
(In a Page: Signs and Symptoms)

• Treat reversible causes (e.g., hypothyroidism, vitamin deficiency, cerebral vasculitis, neurosyphilis, HIV)
• Manage nonreversible etiologies, including genetic risks, health care planning, and help groups (e.g., Alzheimer's Association)
• Alzheimer's disease: Anticholinesterases (e.g., tacrine, donepezil) may improve cognitive function; selegiline and α
• -tocopherol may delay progression
• Vascular dementia: Treat risk factors (e.g., discontinue tobacco use, lower blood pressure and lipids)
  –Note that lost cognitive function will not return despite treatment

Parkinson's disease: Dopamine and dopamine agonists; anticholinergics improve function but do not affect progression of disease; selegiline may slow disease progression

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Hallucinations: Treatment
(In a Page: Signs and Symptoms)

• Treat hallucinations symptomatically with antipsychotic drugs (e.g., haloperidol, risperidone, olanzapine)
• Delirium: Treat underlying cause (e.g., hydration, proper nutrition, oxygen, thiamine, and glucose)
• Alcohol/sedative withdrawal: Monitor and treat for seizures with benzodiazepines
• Schizophrenia: Traditional antipsychotics (e.g., haloperidol, chlorpromazine)
  –Extrapyramidal side effects (parkinsonism, akathisia, dystonia) are common
  –Neuroleptic malignant syndrome (hyperthermia, rigidity, hypertension, tachycardia) may rarely occur in first week of treatment and can be fatal
  –Clozapine carries a 1% risk of fatal agranulocytosis

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Delirium: Treatment
(In A Page: Pediatric Signs and Symptoms)

• Correction of any metabolic derangements, including alterations of glucose and sodium
• Drug ingestion
  –Discuss with poison control center
• Infectious causes
  –Use of appropriate antibiotics based on likely organisms
• Psychological disturbance
  –Antipsychotics if appropriate
• Heat stroke
  –Aggressive rehydration
• Hepatic failure
  –Supportive therapy
  –Lactulose may help to improve mental state/cognition
• Hartnup
  –Supplemental nicotinamide
• Pellagra
  –Supplemental niacin

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Hallucinations: Treatment
(In A Page: Pediatric Signs and Symptoms)

• Hallucinogens and other drugs of abuse
  –May require intensive outpatient or inpatient management for successful cessation
  –Cessation of the drug usually results in cessation of hallucination; however, for some hallucinogens such as LSD, flashbacks may occur for years
• CNS insults generally require neurologic and multisystem intensive care
• Schizophrenia is generally treated with antipsychotics; compliance is frequently problematic
• Narcolepsy is treated with daytime stimulants and nighttime sleep aids or tricyclic antidepressants
• Medications: Discontinue the causative drug

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Level of consciousness, decreased: Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))

After evaluating the patient’s airway, breathing, and circulation, use the Glasgow Coma Scale to quickly determine his LOC and to obtain baseline data. (See Glasgow Coma Scale.) If the patient’s score is 13 or less, emergency surgery may be necessary. Insert an artificial airway, elevate the head of the bed 30 degrees and, if spinal cord injury has been ruled out, turn the patient’s head to the side. Prepare to suction the patient if necessary. You may need to hyperventilate him to reduce carbon dioxide levels and decrease intracranial pressure (ICP). Then determine the rate, rhythm, and depth of spontaneous respirations. Support his breathing with a handheld resuscitation bag, if necessary. If the patient’s Glasgow Coma Scale score is 7 or less, intubation and resuscitation may be necessary.

Continue to monitor the patient’s vital signs, being alert for signs of increasing ICP, such as bradycardia and a widening pulse pressure. When his airway, breathing, and circulation are stabilized, perform a neurologic examination.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Alcohol-related disorder: Treatment
(Professional Guide to Diseases (Eighth Edition))

Total abstinence from alcohol is the only effective treatment. Supportive programs that offer detoxification, rehabilitation, and aftercare, including continued involvement in Alcoholics Anonymous (AA), may produce good long-term results.

Acute intoxication is treated symptomatically by supporting respiration, preventing aspiration of vomitus, replacing fluids, administering I.V. glucose to prevent hypoglycemia, correcting hypothermia or acidosis, and initiating emergency treatment for trauma, infection, or GI bleeding.

Treatment of chronic alcohol abuse requires a varied approach that may include medications to deter alcohol use and treat effects of withdrawal; psychotherapy, consisting of behavior modification techniques, group therapy, and family therapy; and appropriate measures to relieve associated physical problems.

Aversion, or deterrent, therapy involves a daily oral dose of disulfiram to prevent compulsive drinking. This drug interferes with alcohol metabolism and allows toxic levels of acetaldehyde to accumulate in the patient’s blood, producing immediate and potentially fatal distress in the event he consumes alcohol up to 2 weeks after taking it. Disulfiram is contraindicated during pregnancy and in the patient with diabetes, heart disease, severe hepatic disease, or any disorder in which such a reaction could be especially dangerous. Another form of aversion therapy attempts to induce aversion by administering alcohol with an emetic.

The first drug approved by the U.S. Food and Drug Administration for the treatment of alcohol-related disorder since disulfiram is naltrexone, an opiate antagonist that effectively reduces the amount of intake, severity of craving, and relapse incidence. It’s believed to work by preventing the effects of increased endorphins produced as a product of increased alcohol intake.

For long-term success, the recovering individual must learn to fill the place alcohol once occupied in his life with something constructive. Therapy using disulfiram or naltrexone may only substitute one drug dependence for another, so it should be used prudently.

Benzodiazepine isn’t recommended during rehabilitation due to its addictive nature and the potential for reinforcing the substance abuse behavior.

ELDER TIP Because the older patient may be more sensitive to these drugs, withdrawal may take longer (weeks or months) and be more severe than in a younger adult.

Supportive counseling or individual, group, or family psychotherapy may help. Ongoing support groups are helpful. In AA, a self-help group with more than 1 million members worldwide, the alcoholic finds emotional support from others with similar problems. About 40% of AA’s members stay sober as long as 5 years, and 30% stay sober longer than 5 years.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Level of consciousness, decreased: Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))

After evaluating the patient’s airway, breathing, and circulation, use the Glasgow Coma Scale to quickly determine his LOC and to obtain baseline data. (See Using the Glasgow Coma Scale, page 480.) If the patient’s score is 13 or less, emergency surgery may be necessary. Insert an artificial airway, elevate the head of the bed 30 degrees and, if spinal cord injury has been ruled out, turn the patient’s head to the side. Prepare to suction the patient if necessary. You may need to hyperventilate him to reduce carbon dioxide levels and decrease intracranial pressure (ICP). Then determine the rate, rhythm, and depth of spontaneous respirations. Support his breathing with a handheld resuscitation bag, if necessary. If the patient’s Glasgow Coma Scale score is 7 or less, intubation and resuscitation may be necessary.

Continue to monitor the patient’s vital signs, being alert for signs of increasing ICP, such as bradycardia and widening pulse pressure. When his airway, breathing, and circulation are stabilized, perform a neurologic examination.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Level of consciousness, decreased: Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Reassess the patient’s LOC and neurologic status at least hourly. Carefully monitor ICP and intake and output. Ensure airway patency and proper nutrition. Take precautions to help ensure the patient’s safety. Keep him on bed rest with the side rails up and maintain seizure precautions. Keep emergency resuscitation equipment at the patient’s bedside. Prepare the patient for a computed tomography scan of the head, magnetic resonance imaging of the brain, EEG, and lumbar puncture. Maintain an elevation of the head of the bed to at least 30 degrees. Don’t administer an opioid or sedative because either may further decrease the patient’s LOC and hinder an accurate, meaningful neurologic examination. Apply restraints only if necessary because their use may increase his agitation and confusion. Talk to the patient even if he appears comatose; your voice may help reorient him to reality.

Patient teaching

Explain the treatments and procedures the patient needs. Teach safety and seizure precautions. Provide referrals to sources of support. Discuss quality of life issues with the patient and his family, as indicated.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Level of consciousness, decreased: Emergency Actions
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

After evaluating the patient’s airway, breathing, and circulation, use the Glasgow Coma Scale to quickly determine his LOC and to obtain baseline data. (See Glasgow Coma Scale.) Insert an artificial airway, elevate the head of the bed 30 degrees and, if spinal cord injury has been ruled out, turn the patient’s head to the side. Prepare to suction the patient, if necessary. You may need to hyperventilate him to reduce carbon dioxide levels and decrease intracranial pressure (ICP). Then determine the rate, rhythm, and depth of spontaneous respirations. Support his breathing with a handheld resuscitation bag if necessary. If the patient’s Glasgow Coma Scale score is 7 or lower, intubation and resuscitation may be necessary. Continue to monitor the patient’s vital signs, being alert for signs of increasing ICP, such as bradycardia and widening pulse pressure. When his airway, breathing, and circulation are stabilized, perform a neurologic examination.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Agitation: Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Orient the patient with agitation to the unit and its procedures and routines. Provide reassurance and emotional support. Explain the need to reduce stressors and maintain a quiet environment.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Confusion: Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

To help the patient stay oriented, keep a large calendar and a clock visible, and make a list of his activities with specific dates and times. Always reintroduce yourself to the patient each time you enter his room.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Level of consciousness, decreased: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ Reassess the patient's LOC and neurologic status at least hourly.

▪ Carefully monitor ICP and intake and output.

▪ Ensure airway patency and proper nutrition.

▪ Keep the patient on bed rest and maintain seizure precautions.

▪ Keep emergency resuscitation equipment at the patient's bedside.

▪ Prepare the patient for a computed tomography scan of the head, magnetic resonance imaging of the brain, EEG, and lumbar puncture.

▪ Elevate the head of the bed to at least 30 degrees.

▪ Don't administer an opioid or sedative because either may further decrease the patient's LOC and hinder an accurate, meaningful neurologic examination.

▪ Talk to the patient even if he appears comatose; your voice may help reorient him to reality.

Patient teaching

▪ Explain the underlying cause of decreased LOC and its treatments and procedures to the patient and his family.

▪ Teach them about safety and seizure precautions.

▪ Provide referrals to sources of support.

▪ Discuss quality of life issues, if appropriate.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Agitation: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ Because agitation can be an early sign of many different disorders, monitor the patient's vital signs and neurologic status while the cause is being determined.

▪ Eliminate stressors, which can increase agitation.

▪ Provide adequate lighting, maintain a calm environment, and allow the patient ample time to sleep.

▪ Ensure a balanced diet, and provide vitamin supplements and hydration.

▪ Remain calm, nonjudgmental, and nonargumentative.

▪ Avoid using restraints, unless absolutely necessary, because they tend to increase agitation.

▪ If appropriate, prepare the patient for diagnostic tests, such as a computed tomography scan, skull X-rays, magnetic resonance imaging, and blood studies.

Patient teaching

▪ Orient the patient to the unit and its procedures and routines.

▪ Explain stress-reduction measures.

▪ Offer reassurance and emotional support.

▪ Explain all tests and procedures, the underlying cause, and treatment plan.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Confusion: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ Never leave a confused patient unattended, to prevent injury to himself and others.

▪ Take measures to ensure patient safety.

▪ Keep the patient calm and quiet, and plan uninterrupted rest periods.

▪ Correct the underlying cause of the patient's confusion.

Patient teaching

▪ To help the patient stay oriented, keep a large calendar and a clock visible, and make a list of his activities with specific dates and times.

▪ Always reintroduce yourself to the patient each time you enter his room.

▪ If possible, explain to the patient and his family the cause of his confusion.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

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