First, the physician must determine whether the patient is critically ill, as reflected by cardiorespiratory status and level of consciousness. Irregular respiratory patterns, particularly apneic episodes, and stupor may necessitate intensive cardiac and respiratory monitoring. All unnecessary medications with potential adverse effects on the central nervous system must be discontinued. Infections, which frequently precipitate delirium will require antibiotics and patients with and fluid and electrolytes will require corrective measures. T he presence or absence of nonpharmacologic factors will influence the course of delirium.
Continuity of care provided by staff familiar to the delirious patient greatly allays agitation.
Patients should be given their eyeglasses and hearing aides, and staff should employ simple and repetitive instructions regarding tests and other procedures. Verbal reminders of the setting and time should be used regularly. Physical restraints, in particular, should be avoided as they may induce fear and anger, exacerbating motor restlessness. They should be used only when necessary to facilitate evaluation and treatment. There will almost never be an indication for all four extremities to be restrained in the elderly.