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Confusion and Terminal Restlessness




This chapter explores the phenomena of acute confusion and terminal restlessness. Optimising quality of life within the limitations of the disease process is a key factor in measuring clinical outcomes in all aspects of palliative care. The current evidence regarding assessment and management is discussed and practical strategies are provided for nurses caring for confused patients.


Contents include

  • Introduction
  • Definition of terms
  • Prevalence of confusion and terminal restlessness
  • Scope of the problem
  • Clinical presentations
  • Causes of delirium
    • Predisposing Factors
  • Assessment
    • General
    • Examination
  • Early recognition of acute confusion
    • Alert nursing assessment
    • Screening instruments
  • Search for a precipitating cause
  • Management of confusion in palliative care
    • General
    • Environmental issues
    • Family education
    • Treatment of confusion
      • Pharmacological treatment
      • Rehydration
  • Management of terminal restlessness
    • Medications
    • Ethical issues in sedation
  • Conclusion
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Author / Editor Biographies

Karen is a registered nurse with a background in various medical, surgical and midwifery specialites and graduate qualifications in palliative care. Before commencing full-time research study at the University of Melbourne (Victoria, Australia) in 2001, she had worked on an inpatient palliative-care unit for seven years. While working in palliative care, Karen developed an interest in evidence-based practice and later undertook a research project aimed at identifying appropriate screening for acute confusion in palliative care. Her current research involves a systematic review of screening for...
MB BS, BEd, B Theol, Dip Ger Med, FRACGP and FRACMA
Eleanor Flynn is the lead Senior Medical Clinician for Inpatient Services at the St Vincent's campus of Caritas Christi Hospice. She is also a Palliative Care Consultant with Melbourne Citymission Palliative Care Community Service and a Senior Lecturer in Medical Education for the Melbourne Medical Scho

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