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Delirium

Askep Delirium


Pengertian

Delirium adalah sindroma otak organik karena fungsi atau metabolisme otak secara umum atau karena keracunan yan menghambat mnetabolisme otak.


Gejala

Gejala utama ialah kesadaran menurun. Kesadaran yang menurun ialah suatu keadaan dengan kemampuan persepsi perhatian dan pemikiran yan berkurang secara keseluruhan (secara kuantitatif).

Gejala-gejala lainnya penderita tidak mampu mengenal orang dan berkomunikasi dengan baik, ada yang bingung atau cemas, gelisah dan panik, adanya klien yan terutama halusinasi dan ada yang hanya berbicara komat-kamit dan inkohern.

Dari gejala-gejala psikiatrik tidak dapat diketahui etiologi penyakit badaniah itu, tetapi perlu dilakukan pemeriksaan intern dan nerologik yang teliti. Gejala tersebut lebih ditentukan oleh keadaan jiwa premorbidnya, mekanisme pembelaaan psikologiknya, keadaan psikososial, sifat bantuan dari keluarga, teman dan petugas kesehatan, struktur sosial serta ciri-ciri kebudayaan sekelilingnya.


Psikopatologi

Delirium biasanya hilang bila penyakit badaniah yang menyebabkan sudah sembuh, mungkin sampai kira-kira 1 bulan sesudahnya. Gangguan jiwa yang psikotik atau nonpsikotik yang disebabkan oleh gangguan jaringan fungsi otak. Gangguan fungsi jaringan otak ini dapat disebabkan oleh penyakit badaniah yang terutama mengenai otak (meningoensephalitis, gangguan pembuluh darah ootak, tumur otak dan sebagainya) atau yang terutama di luar otak atau tengkorak (tifus, endometriasis, payah jantung, toxemia kehamilan, intoksikasi dan sebagainya). Bila bagian otak yang terganggu itu luas, maka gangguan dasar mengenai fungsi mental sama saja, tidak tergantung pada penyakit yang menyebabkannya. Jika disebabkan oleh proses yang langsung menyerang otak , bila proses itu sembuh maka gejala-gejalanya tergantung pada besarnya kerusakan yang ditinggalkan gejala-gejala neurologik dan atau gangguan mental dengan gejala utama gangguan intelegensi. Bisa juga didapatkan adanya febris. Terdapat gejala psikiatrik bila sangat mengganggu dapat diberikan neroleptika, terutama yang mempunyai dosis efektif tinggi.


Penatalaksanaan
  1. Pengobatan etiologik harus sedini mungkin dan di samping faal otak dibantu agar tidak terjadi kerusakan otak yang menetap.

  2. Peredaran darah harus diperhatikan (nadi, jantung dan tekanan darah), bila perlu diberi stimulansia.

  3. Pemberian cairan harus cukup, sebab tidak jarang terjadi dehidrasi. Hati-hati dengan sedativa dan narkotika (barbiturat, morfin) sebab kadang-kadang tidak menolong, tetapi dapat menimbulkan efek paradoksal, yaitu klien tidak menjadi tenang, tetapi bertambah gelisah.

  4. Klien harus dijaga terus, lebih-lebih bila ia sangat gelisah, sebab berbahaya untuk dirinya sendiri (jatuh, lari dan loncat keluar dari jendela dan sebagainya) ataupun untuk orang lain.

  5. Dicoba menenangkan klien dengan kata-kata (biarpun kesadarannya menurun) atau dengan kompres es. Klien mungkin lebih tenang bila ia dapat melihat orang atau barang yang ia kenal dari rumah. Sebaiknya kamar jangan terlalu gelap , klien tidak tahan terlalu diisolasi.

  6. Terdapat gejala psikiatrik bila sangat mengganggu dapat diberikan neroleptika, terutama yang mempunyai dosis efektif tinggi.

Artikel Terkait :

Delirium

Delirium or acute confusional state is a transient global disorder of cognition. The condition is a medical emergency associated with increased morbidity and mortality rates. Early diagnosis and resolution of symptoms are correlated with the most favorable outcomes. Therefore, it must be treated as a medical emergency.

Delirium is not a disease but a syndrome with multiple causes that result in a similar constellation of symptoms. Delirium is defined as a transient, usually reversible, cause of cerebral dysfunction and manifests clinically with a wide range of neuropsychiatric abnormalities. The clinical hallmarks are decreased attention span and a waxing and waning type of confusion.

Delirium often is unrecognized or misdiagnosed and commonly is mistaken for dementia, depression, mania, an acute schizophrenic reaction, or part of old age (patients who are elderly are expected to become confused in the hospital).

The word delirium is derived from the Latin term meaning "off the track." This syndrome was reported during Hippocrates' time, and, in 1813, Sutton described delirium tremens. Later, Wernicke described the encephalopathy that bears his name.

Source : http://emedicine.medscape.com
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