I-Delirium

Nakuba i-delirium ingenzeka kunoma ibuphi ubudala, ivame kakhulu kubantu abadala abangaphezu kweminyaka engu-65. Lesi simo esibucayi sibonakala ngezimpawu ezihlukahlukene, kuhlanganise nokudideka, ukucabanga okungahlelekile, nezinguquko ezingokomzwelo ezivame ukukhula ngokushesha. Lo mhlahlandlela obanzi uhlola konke okudingeka ukwazi iziguli nabanakekeli mayelana ne-delirium, kusukela ezimpawini zayo ezicashile kuya kumasu okuphatha aphumelelayo nezindlela zokuvimbela.

Iyini i-Delirium?

I-Delirium imelela i-neurobehavioral syndrome ebonakala ngokushintshashintsha kwesimo sengqondo, ukudideka, ukudideka nokuziphatha okungafanele. Ngokungafani ukuwohloka komqondo, ekhula kancane ngokuhamba kweminyaka, i-delirium ibonakala ngokushesha (phakathi namahora noma izinsuku), futhi izimpawu zivame ukushintshashintsha usuku lonke.

Izinhlobo ze-Delirium

Odokotela bezinzwa bahlonza izinhlobo ezintathu eziyinhloko ze-delirium ngokusekelwe kumazinga omsebenzi nezimpawu:

• I-Hyperactive delirium: Ibandakanya ukuyaluza, ukungahlaliseki kanye nokubona izinto ezingekho. Iziguli zingase zivele ukukhathazeka, ukulwa, noma ukunakekelwa kwenqaba.
• I-Hypoactive delirium: Uhlobo oluvame kakhulu kodwa oluvame ukugejwa, oluphawulwa ukozela okungajwayelekile, ukukhathala kanye nokusabela okuncishisiwe. Iziguli zibonakala zihoxisiwe noma "ziphumile kuyo".
• I-Mixed Delirium: Ibandakanya izimpawu ezishintshayo zazo zombili izimo ezingasebenzi kahle nezingasebenzeki kahle, iziguli zishintshashintsha phakathi kokungahlaliseki nokuvilapha.

Izimpawu kanye nezimpawu ze-Delirium

Uphawu oluyinhloko lwe-delirium ukudideka okuvame ukuba kubi kakhulu ebusuku. Okuhlangenwe nakho kweziguli:

• Ukuqwashisa okuncishisiwe ngendawo ezungezile
• Amakhono okucabanga ampofu kanye nezinkinga zenkumbulo
• Ukungaqondi isikhathi nendawo
• Ubunzima bokukhuluma noma inkinga yokuqonda abanye
• Izinguquko ezingokomzwelo, kuhlanganise nokukhathazeka, ukwesaba noma ukushintsha kwemizwelo
• Ama-hallucinations noma ukukhohlisa
• Iziphazamiso zomjikelezo wokulala

Izinkinga ze-Delirium

Izimbangela ezijwayelekile zifaka:

• Imithi noma imithi side effects
• Ukutheleleka (ikakhulukazi i-UTIs noma inyumoniya)
• Ukuhlinzwa kanye i-anesthesia
• Ukungalingani kwe-metabolic okufana namazinga e-sodium noma ushukela ongajwayelekile
• Ukusetshenziswa kotshwala noma izidakamizwa/ukuhoxa
• Ukuntuleka komoyampilo
• Ubuhlungu, ukuqunjelwa noma ukugcinwa komchamo

Izingozi zeDelirium

Kunezici ezimbalwa ezikhulisa ubungozi bokuthuthukisa i-delirium:

• Iminyaka yobudala (ikakhulukazi engaphezu kuka-65)
• Ukuwohloka komqondo okwakukhona ngaphambili noma ukungakhuli engqondweni yethu
• Isifo esibi kakhulu
• Izimo eziningi ezingapheli
• Ukukhubazeka kwezinzwa (ukubona/ukuzwa)
• Iziqephu zangaphambili ze-delirium
• Ubuthakathaka nokungondleki kahle
• I-Polypharmacy

Izinkinga ze-Delirium

Ngaphandle kokuqashelwa nokuphathwa okufanele, i-delirium ingaholela ezinkingeni ezinkulu:

• Ukwanda kokufa 
• Ukuhlala okwengeziwe esibhedlela okunwetshiwe (izinsuku ezingu-2-3 ezengeziwe ngemva kokuhlinzwa)
• Ukuwa nokulimala
• I-aspiration pneumonia
• Izilonda zengcindezi
• Ukungondleki
• Ukukhubazeka kwengqondo kwesikhathi eside kanye nokwehla kokusebenza

Ukuxilongwa kwe-Delirium

Odokotela baxilonga isimo se-delirium ngenhlanganisela yomlando wezokwelapha, ukuhlolwa ngokomzimba, nokuhlola isimo sengqondo. Inqubo yokuxilonga ngokuvamile ihlanganisa:

• Ukuhlolwa kwegazi ukuhlola ukutheleleka, ukungalingani kwe-electrolyte, nokusebenza kwesitho
• I-urinalysis ukuthola ukutheleleka kwe-urinary tract
• I-Brain imaging (CT noma i-MRI) lapho kusolwa izimbangela zemizwa
• I-Electroencephalogram (EEG) yokuhlola amaphethini amaza obuchopho
• Ukubuyekezwa kwemithi ukuze kuhlonzwe izidakamizwa ezingaba nomthelela
• Olunye ucwaningo luphakamisa ukuthi iphrotheni ebopha i-calcium S-100 B ingase ibe umaka we-delirium.

Ukwelashwa kwe-Delirium

Ukwelashwa kuqala ngokubhekana nezimbangela kuyilapho kwakhiwa indawo ekahle yokuphulukisa. Ukwelashwa okusebenzayo kuhlanganisa:

• Ukulawulwa kwezifo, ukuphazamiseka kwe-metabolic, noma ezinye izimbangela ezihlonziwe
• Ukulungisa umthamo wemithi ebangela i-delirium
• Yiba ne-hydration efanele, ukudla okunomsoco, kanye nezindlela zokulala
• Ukusekela ukuhamba ngenkathi uqinisekisa ukuphepha kwesiguli
• Ukunikeza umumo ngamawashi, amakhalenda, nezinto ezijwayelekile

Uzoyibona Nini Udokotela

Amalungu omndeni noma abanakekeli kufanele bafune usizo lwezokwelapha uma bebona izinguquko ezingazelelwe ekucabangeni, ekuqwashiseni, noma ekuziphatheni kothandekayo. Ngaphezu kwalokho, odokotela kufanele bahlole ngokushesha iziguli ezisesibhedlela ezibonisa ukudideka, ukudideka, noma ukozela okungavamile.

Prevention

Amasu okuvimbela aqondise izici eziyingozi ngokusebenzisa ukungenelela kwezingxenye eziningi. Izinyathelo zokuvimbela ezisebenzayo zihlanganisa:

• Ukuma okuvamile, kanye nokukhuthazwa kwengqondo
• Khuthaza ukunyakaza kusenesikhathi kanye nokuvivinya umzimba lapho kufanele ngokwezokwelapha
• I-hydration efanele kanye nokudla okunomsoco
• Misa imikhuba yokulala ngomsindo oncishisiwe nokukhanya okufanele
• Ukulawula ubuhlungu obuphumelelayo
• Ukusebenzisa izinsiza-kubona nezezwa lapho kudingeka
• Ukunciphisa imithi engadingekile nokugwema ukuvinjelwa ngokomzimba

Isiphetho

Uma ucela indlela enamandla kakhulu yokuphatha i-delirium, impendulo izoba ukubonwa kusenesikhathi. Odokotela manje basebenzisa amathuluzi aqinisekisiwe njengeNdlela Yokuhlola Ukudideka ukuze bakhombe amacala ngokushesha. Ukwengeza, basebenzisa izindlela zokwelapha eziphelele ukubhekana nezimbangela eziyisisekelo. Nakuba imithi ngezinye izikhathi isiza ekulawuleni izimpawu, ukungenelela okungezona ezemithi kwakha isisekelo sokunakekelwa okufanele.

Imibuzo Evame Ukubuzwa

1. Ungakwazi yini ukululama ngokugcwele ku-delirium?

Ukululama ku-delirium kuyehluka kakhulu phakathi kwabantu. Iziguli eziningi ziyalulama phakathi nezinsuku noma amasonto, kuye ngesimo sazo sezempilo esingaphansi kanye nobukhulu bokuqala. Kwezinye izimo, iziguli zingase ziqhubeke nokuba nezinkinga izinyanga ezimbalwa ngemva kwesiqephu sokuqala. Ngokuvamile, labo abanempilo enhle ngaphambili banemiphumela engcono yokululama uma kuqhathaniswa nalabo abaphatha izifo ezingelapheki noma ezibulalayo.

2. Indlela yokuvimbela i-delirium?

Ukuvimbela kuyindlela ephumelela kakhulu yokulawula i-delirium.

• Qinisekisa ukuthi i-hydration efanele kanye nokudla okufanele
• Thuthukisa imikhuba emihle yokulala kanye nemijikelezo evamile yokulala nokuvuka
• Sebenzisa izibuko, izinsiza-kuzwa kanye nezinye izisekelo zezinzwa
• Gcina izinto ezijwayelekile, izithombe, namakhalenda kubonakala ukuze kumiswe umumo
• Gcina indawo ezolile ngokukhanya kwemvelo emini nobumnyama ebusuku

3. Ingabe kukhona ukuhlolwa kwegazi kwe-delirium?

I-Delirium ayikwazi ukutholwa ngokuhlolwa kwegazi okukodwa. Kunalokho, ukuxilongwa kuncike kakhulu ekuhlolweni komtholampilo kusetshenziswa amathuluzi okuhlola akhethekile njengeNdlela Yokuhlola Ukudideka (i-CAM).

• Ukuhlolwa kwaselabhorethri kusiza ukuhlonza izimbangela eziwumsuka kunokuhlonza i-delirium ngokwayo.
• Ukuhlola okuvamile kuhlanganisa inani legazi eliphelele, ama-electrolyte, i-glucose, isibindi nokusebenza kwezinso.
• I-urinalysis ngokuvamile isiza ukuthola izifo zomgudu womchamo ezivame ukubangela i-delirium.

CARE Medical Team