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Aims and intended learning outcomes
This article describes the management of acute confusion and aggression in patients with central nervous system (CNS) infections. Appropriate screening tools for acute confusion, contributing factors and the nurse's role in caring for these patients are discussed, with the aim of educating nurses in how to identify and assess patients with acute confusion in hospital settings. After reading this article and completing the time out activities you should be able to:
Recognise the importance of using appropriate screening tools to identify patients who are acutely confused.
Discuss some of the CNS infections that can lead to acute confusion.
Educate, support and reassure patients who become acutely confused, and their relatives.
Outline the nurse's role in identifying and caring for patients at risk of acute confusion.
Acute confusion
Acute confusion can be described as acute cognitive impairment associated with severe illness ( Sendelbach and Guthrie 2009 ), and is often termed delirium. The course of delirium can fluctuate, in that it often does not improve steadily but may go through cycles of improving and then worsening ( van Eijk et al 2011 ). There are three subtypes of delirium, as defined by the Intensive Care Society and UK Clinical Pharmacy Association ( Borthwick et al 2006 ):
Hyperactive - agitated, paranoid.
Hypoactive - withdrawn, quiet, paranoid.
Mixed - a combination of hyperactive and hypoactive subtypes.
For clarity, the term acute confusion will be used throughout this article. Common symptoms in patients with the hyperactive subtype include disturbances in sleep and concentration, agitation and restlessness ( Schiemann et al 2011 ). These patients may also experience hallucinations, altered speech (faster or louder), irritability, impatience and extremes of mood ( Wakefield 2002 ). Patients with the hypoactive subtype of acute confusion are often quiet, lethargic and apathetic; show reduced alertness; and may have slurred or slowed speech ( Wakefield 2002 ). Patients with the mixed subtype show behaviour that fluctuates between the hyperactive and hypoactive subtypes.
Acute confusion is a common problem in hospital patients who are acutely ill, occurring in 15-20% of all general hospital admissions in the UK ( Meagher 2001 ). Some of the causes of acute confusion are summarised in Box 1 . There are misconceptions about the causes...