Delirium and dementia can present with the same signs and symptoms but the treatment regimens for both are different Thomas Beary highlights the issues associated with delirium and how this disorder can be detrimental to a resident's welfare

Delirium prevention: early recognition and treatment

Background The National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care. Methods Analysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium. Results The number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH. Conclusions The addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown.

https://www.rcpjournals.org/content/clinmedicine/19/2/104.full.pdf

The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals .

Dementia is one of the commonest and most devastating diseases of later life. People with mild cognitive impairment and diabetes mellitus are reported to be at increased risk of developing dementia. In this article, the key role of primary care nurses in early recognition of memory problems in people with diabetes is emphasized. There is also a need for improving understanding of cognitive impairment. It is important that primary care nurses receive training in recognising impairment early

Early recognition of cognitive impairment in people with diabetes: role of primary care nurses

Background: Acid-base and electrolytes disorders are commonly seen in critically ill patients. Electrolyte abnormalities were the most frequent extra cranial occurrence of altered consciousness. There are multiple studies which reported altered survival outcome in low GCS patient and some did not. Aims: To assess the survival outcome of acid-base electrolyte imbalance associated with low GCS patients in the medical ICU. Methods: This retrospective, cohort study conducted in the medical ICU of a tertiary center in Chennai, India, for a period of six months included patients above 18 years old with various acid-base and electrolyte imbalances. During the study period of six months, a total of 276 patients were admitted in the medical ICU. Among these 100 patients were included in the study after excluding the patients who didn’t meet the inclusion criteria and those that had incomplete medical records. Following data were collected from medical records admission history, age, sex, anion gap, serum electrolytes, ABG, BUN, creatinine, PCO2, PO2, GCS and days in ICU. Results were analyzed and outcomes were noted (patient discharged, dies or seeks discharge against medical advice). Results: The study population included 68 male and 32 female with a mean age of 47.24±17.54 years. Metabolic acidosis was seen in 67% of patients. Mortality was significantly higher in patients with low GCS (51.06% vs. 20.75%, p<0.0001). Sodium and chloride increased significantly (p=0.0126, 0.0464 respectively) and potassium decreased significantly (p=0.0008) when GCS was low. The patients with hypernatremia and metabolic acidosis had 71.44% mortality rate. The patients with a low GCS have a higher incidence for multiple electrolyte disturbances. Low GCS leads mostly to an increased mortality especially in the patients with acid base disorders with electrolyte disorders compared to those with pure acid-base disturbances. To identify prognostic factors of the patients in the ICU, we performed multiple regression analysis using the data we collected. Among all the variables only three independent factors (GCS, BUN and Creatinine) significantly correlated with the criterion. Conclusions: Electrolyte and acid base disturbances should be seriously considered in low GCS patients to allow timely and appropriate therapeutic intervention to improve survival outcome.

/pdf/acid-base-electrolyte-imbalance-and-survival-outcomeof-low-4xqnnumxpa.pdf

Acid Base Electrolyte Imbalance and Survival Outcomeof Low Glasgow Coma Scale (GCS) patients in theMedical Intensive Care Unit

Review Objective: The overall aim of this review is to systematically review the various factors that affect nurses’ performance in conscious level assessment. This review question will focus on three specific areas, namely, ‘knowledge’, ‘attitude’ and ‘demographic factors. More specifically, ‘knowledge’ in the context of this systematic review refers to their understanding of the conscious level assessment and the rationale for its use, as well as neurological and physiological knowledge.5 ‘Attitude’, refers to ‘thoughts and disposition’ towards the conscious level assessment and how it is used in the clinical setting Questions: 1. How does level of knowledge and nurses’ attitude affect their performance of conscious level assessment? 2. What are, and how do demographic factors affect nurses’ performance of conscious level assessment? 3. How accurate are nurses’ skill in performing conscious level assessment? Types of interventions/Phenomena of Interest: Studies that examine factors such as knowledge and attitudes, as well as demographic factors including, but not limited to, such as age, educational history, recency of practice, years of practice and clinical context and how they impact nurses’ performance of the conscious level assessment will be considered for this review. The phenomena of interest will focus on nurses’ assessment of conscious level. Types of participants: The review will include studies with these participants: • Nursing staff in an acute hospital, more specifically Registered Nurses (RN), Nursing Students and Enrolled Nurses (EN) • Working in clinical settings such as Critical Care, Emergency Medicine, Neuroscience or General Ward Types of outcome measures/anticipated outcomes: More specifically, the outcomes of interest in this study will include the following: • The level of accuracy and interrater reliability of nurses’ performance of conscious level assessment • The consistency in nurses’ performance of conscious level assessment • Nurses’ knowledge in conscious level assessment in their clinical setting, e.g. the GCS • The confidence level of nurses in performing conscious level assessment

A Comprehensive Systematic Review of the Factors that Impact Nurses' Performance in Conscious Level Assessment.

Terms used to describe a patient's mental state, such as ‘confused’, are often considered to be ambiguous and the meaning personal to individuals describing what they observe Cognitive deficits are often subtle in their presentation and can easily be overlooked in the arena of acute nursing, with its focus on physical status Clinicians are reported as not adequately assessing cognitive status and yet such deficits may impact on a patient's activities of living at all levels Identification of alterations in a patient's mental status is important in maintaining patient safety and dignity This article aims to review bedside assessment of a patient's mental status and the implications for nursing practice

Nursing tools and strategies to assess cognition and confusion

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Michelle McIntosh

Author Tools

Chat about Author

Papers

Nursing tools and strategies to assess cognition and confusion