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Assessment and management of delirium: A focus on hepatic encephalopathy

Published online by Cambridge University Press:  08 October 2012

Candace C. Coggins  and
Carol P. Curtiss
Candace C. Coggins*
Affiliation:
Hospice Care of the Low Country, Bluffton, South Carolina
Carol P. Curtiss
Affiliation:
Curtiss Consulting, Greenfield, Massachusetts Tufts University School of Medicine, Boston, Massachusetts
*
Address correspondence and reprint requests to: Candace C. Coggins, Hospice Care of the Low Country, 119 Palmetto Way, Bluffton, South Carolina 29927. E-mail: candacecoggins@me.com
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Abstract

This purpose of this article is to promote comprehensive assessment, differential evaluation and provision of care which optimizes benefit while minimizing burden. Delirium is a debilitating neuropsychiatric complication that is highly prevalent in palliative care. It is multifactorial and may be related to infection, disease progression, metabolic state or medication toxicity. There are three proposed sub-types of delirium with the hypoactive/ hypoalert variant being most often underdiagnosed and undertreated. The inadequate management of all types of delirium is associated with increased personal and family distress, lengthier hospital stays, and escalating healthcare costs. This article reviews the assessment, diagnosis and treatment for delirium in general and hepatic encephalopathy in particular. A number of valid and reliable tools are discussed, as they assist in screening, symptom appraisal, diagnosis, and treatment planning. It is recognized that nurses are particularly well positioned to make bedside observations, to document changes over time, and to educate and support patients and their families. Searching for the etiology of delirium, developing individualized plans of care consistent with patient goals, and endorsing the benefit of consultation/referral are discussed as key roles for palliative care providers from all disciplines. New and novel therapies in the management of hepatic encephalopathy are discussed, as they expand treatment options for patients at all points along the trajectory of liver disease.

Keywords

DeliriumHepatic encephalopathyPalliative careAssessment of deliriumManagement of delirium
Type
Review Article
Information
Palliative & Supportive Care , Volume 11 , Issue 4 , August 2013 , pp. 341 - 352
Copyright
Copyright © Cambridge University Press 2012 

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