Chapter 15: Confusion and Terminal Restlessness
Description:
This chapter explores the phenomena of acute confusion and terminal restlessness. Optimising quality of life within the limitations of the disease process is a key factor in measuring clinical outcomes in all aspects of palliative care. The current evidence regarding assessment and management is discussed and practical strategies are provided for nurses caring for confused patients.
Topics:
- Introduction
- Definition of terms
- Prevalence of confusion and terminal restlessness
- Scope of the problem
- Clinical presentations
- Causes of delirium
- Assessment
- Early recognition of acute confusion
- Alert nursing assessment
- Screening instruments
- Search for a precipitating cause
- Management of confusion in palliative care
- General
- Environmental issues
- Family education
- Treatment of confusion
- Pharmacological treatment
- Rehydration
- Management of terminal restlessness
- Medications
- Ethical issues in sedation
- Conclusion
Author / Speaker:
Dr Eleanor Flynn
Eleanor graduated in medicine from the University of Melbourne (Victoria, Australia) and in education from LaTrobe University, Melbourne, and is a fellow of the colleges of General Practice and Medical Administration. She is a consultant in palliative care at Caritas Christi Hospice, Melbourne, and a senior lecturer in medical education at the University of Melbourne where she is also coordinator of palliative-care input into the new medical curriculum. Eleanor has an active interest in all aspects of clinical education in palliative care. For many years, she has been involved in medical education at undergraduate and postgraduate levels, and in continuing professional education.
Eleanor’s publications include papers on the incidence of psychiatric disease in older people in hospitals and services for sufferers of dementia. She has presented papers at conferences in Australia and overseas on health service management, education of medical students and junior doctors, and delirium in palliative-care patients. Her particular clinical research interest is the recognition and management of delirium in palliative care settings.
Karen Quinn
Karen is a registered nurse with a background in various medical, surgical and midwifery specialites and graduate qualifications in palliative care. Before commencing full-time research study at the University of Melbourne (Victoria, Australia) in 2001, she had worked on an inpatient palliative-care unit for seven years. While working in palliative care, Karen developed an interest in evidence-based practice and later undertook a research project aimed at identifying appropriate screening for acute confusion in palliative care. Her current research involves a systematic review of screening for psychosocial distress in adult patients with cancer. Karen has recently been appointed clinical nurse educator at Caritas Christi Hospice, Melbourne.
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