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Psychological Symptom Management

 

 

Symptoms

Treatment

Delirium
Delirium is a disturbance in consciousness and cognition characterized by changes in mental status with impaired attention, awareness, and cognition.

 

Hyperactive

  • Agitated

  • Uncooperative

  • Combative

  • Labile

Hypoactive

  • Pleasantly confused

  • Sluggish

  • Lethargic

Mixed

  • Fluctuating between hypo and hyperactive delirium symptoms

Non-pharmacologic:

  • Maintain clear day/night distinction

  • Orient frequently as condition allows

  • Minimize noise

  • Limit iatrogenic factors that may be contributing-

    • Deliriogenic medications

    • Lines and tubes

    • Restraints

Pharmacologic:

  • Haloperidol 0.01 - 0.02 mg/kg PO/IV up to q30 minutes PRN

Anxiety
Anxiety is a common symptom in children at or near the end of life. Some children may experience mild anxiety to severe panic attacks. 

Anxiety is driven by adrenaline, and symptoms such as hyper-alertness or rapid shallow breathing can be observed.

Benzodiazepines should be avoided in delirious patients, as they can cause worsening of delirium and agitation.

  • They may be considered if anxiety:

    • Is a prominent feature of the patient’s delirium
      or

    • As a means of sedating a patient with refractory delirium.

May consider Lorazepam If a patient is anxious because of dyspnea.

  • Treat with Lorazepam 0.05 mg/kg PO/IV up to q30 minutes PRN.

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

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