From the Guidelines
If a patient is disoriented in Massachusetts, you should first ensure their immediate safety by staying with them, speaking calmly, and removing potential hazards, and then address cognitive impairment or disorientation by providing appropriate lighting and clear signage, ensuring that a clock and a calendar are easily visible to the person at risk, as recommended by the National Institute for Health and Clinical Excellence guideline for prevention of delirium 1. To address disorientation, it is essential to identify yourself clearly and orient the patient to person, place, and time. Assess for medical causes of disorientation such as hypoglycemia, infection, medication effects, stroke, or head injury. Some key considerations include:
- Providing a calm and structured environment
- Ensuring adequate fluid intake to prevent dehydration
- Assessing for hypoxia and optimizing oxygen saturation if necessary
- Facilitating regular visits from family and friends to help with patient reorientation
- Considering the importance of a multidisciplinary team trained and competent in delirium prevention Contact emergency services (911) if the disorientation is sudden, severe, or accompanied by other concerning symptoms like chest pain, difficulty breathing, or signs of stroke. In Massachusetts, healthcare providers are required to report concerns about an impaired driver to the Registry of Motor Vehicles, so consider this if disorientation might affect driving ability. For elderly patients, Massachusetts has Elder Protective Services (800-922-2275) that can be contacted if abuse or neglect is suspected. The state also has specific involuntary commitment procedures (Section 12) for patients who may be a danger to themselves or others due to mental illness. Disorientation often results from disruptions to brain function, which can be caused by metabolic disturbances, lack of oxygen, infections (particularly UTIs in elderly patients), medication side effects, or neurological conditions. Addressing the underlying cause while providing a calm, structured environment is essential for patient recovery, as emphasized in the guidelines 1.
From the Research
Disoriented Patient in Massachusetts
If a patient is disoriented in Massachusetts, the following steps can be taken:
- Assess the patient's condition and ensure their safety
- Try to determine the cause of the disorientation, which could be due to various factors such as medication, injury, or illness
- Provide a calm and supportive environment to help reduce the patient's agitation or anxiety
Treatment Options
For disoriented patients, especially those with agitation, the following treatment options may be considered:
- Haloperidol and lorazepam combination, as studied in 2 and 3, which showed effective symptom reduction in patients with psychotic agitation
- Risperidone and lorazepam combination, as studied in 4, which was found to be as effective as haloperidol and lorazepam for rapid control of agitation and psychosis
- Haloperidol dosing strategies, as reviewed in 5, which highlighted the need for more research on optimal dosing regimens for delirium treatment in critically ill patients
Considerations for Delirium Treatment
When treating disoriented patients with delirium, the following should be considered:
- Haloperidol may not significantly affect short-term mortality, incidence of delirium, ICU length of stay, or delirium/coma-free days, as found in 6
- The risk of adverse events, such as QTc prolongation or extrapyramidal symptoms, should be monitored, although 6 found no increased risk associated with haloperidol administration.