Isimo esibucayi se-Confusional State
Isimo esiyinkimbinkimbi esiyinkimbinkimbi, esaziwa nangokuthi i-delirium noma i-encephalopathy, ivame kakhulu ezibhedlela ukuthi cishe sekubonakala njengendlela evamile yabasebenzi abaningi esibhedlela. Amaphesenti angu-14 kuya kwangu-56 azo zonke iziguli ezibhedlela adala ukudideka. Iziguli ezikhulunywe kahle ezinyunithi zokunakekelwa okujulile zinenani eliphakeme kakhulu, lifinyelela cishe ngamaphesenti angu-82.
Ngesikhathi i-delirium ijwayele kakhulu abasebenzi basebhedlela, ayinakunqikaza futhi ihlupha kakhulu kubangani namalungu omndeni.
Abathandekayo babo, isiguli, kungenzeka bangaboni. Kwezinye izimo, isiguli singasolwa ngisho nezihlobo noma abangane bezenzo ezithandwa kakhulu njengokuzama ukuboshwa noma ukumbulala. Kungase kubonakale sengathi umuntu ongazi kahle ngokomzimba unomzimba wesiguli.
I-Delirium ngokuvamile ihamba kancane futhi ithuthukisa njengoba isiguli siphulukisa ekuguleni kwabo. Noma kunjalo, lokho akusho ukuthi i-delirium iyingozi. I-Delirium ihlotshaniswa nokukhuphuka kokuphindwe kabili kokufa kwezinyanga ezingu-12, ngisho nangemva kokulungisa ukuqina kwesifo. Iphinde ihlotshaniswe nokuhlala isikhathi eside esibhedlela kanye nengozi eyengeziwe yokwenza u- dementia .
Izimpawu zikaDelirium
Iziguli eziphethwe yi-delirium kungenzeka zingazi ukuthi ziphi noma zikwazi ukuthi unyaka onjani. Bangase baphutha iphutha lawobantu abajwayele ukuwavakashela. Ama-hallucinations ajwayelekile. Esinye sezibonakaliso eziqine kakhulu zombuso odidekile kakhulu kunzima ukulalela noma yini isikhathi eside.
Ngezinye izikhathi i-delirium ingabangela umuntu ukuba agxumeke, uma kunjalo bangase bamemeza noma balwele ukuphuma embhedeni. Iziguli ezivuthayo zingase zizame ukususa amashubhu noma imigqa engu-IV ehlinzeka ngemithi yokonga impilo. Ngenhlanhla, kuphela amaphesenti angu-10 kuphela weziguli ezidliwayo ezibizwa ngokuthi yi-subtype "hyperactive".
Esikhathini esiningi, i-delirium ayitholakali kancane futhi iziguli zingase zilale ngokulala embhedeni, kodwa ngaphandle komqondo wangempela walokho okwenzeka kuzo. Laba bantu bangase baphumelele noma bangaphenduli. Lokhu kwaziwa ngokuthi "i-hyporium" ye-delirium, futhi cishe amaphesenti angaba ngu-40 weziguli ezithandayo azoba nalolu hlobo. Amaphesenti angu-50 asele weziguli ezine-delirium "ahlangene," okunye ukuhlupheka ngenxa yezimpawu ezingasebenzi kanye nezimpawu ezingasebenzi.
Ukushintshashintsha kwemikhawulo ngokweqile kuyimbonakaliso ye-delirium. Ngomzuzu owodwa isiguli singase sibonakale singumuntu wabo ojwayelekile, futhi ngomzuzu olandelayo angase enze njengomunye umuntu ngokuphelele. Lezi zinguquko zingase zithathe isikhathi eside. I-Delirium ivame ukukhathazeka ngesikhathi isiguli sivame ukulala, into eyaziwa ezibhedlela njenge "sundowning."
Izimbangela zikaDeliriamu
Indlela yamanje yokucabanga nge-delirium yukuthi umuntu angase abe nezinselele zokuphazamiseka, okungaphansi kwezimo ezithile ezingakunciphisa i-delirium egcwele. Isibonelo, isiguli esasebekhulile singase sibe nokukhubazeka okunengqondo okuncane , kodwa bese uthuthukisa ukutheleleka kwamagciwane okuholela ekutheni udideke kakhulu. Ukusetshenziswa kotshwala, ukucindezeleka, ukungondleki, imithi ethile, nokuphazamiseka kombono nokuzwa kungaphinde kube nomuntu obhekene nesondlo.
Kukhona uhlu olude kakhulu lwezinto ezingabangela umuntu onenkinga engcupheni yombuso onzima wokudideka ukuze abe ngokukhululeka ngokukhululekile. Kungaba usizo ukuthembela embonweni "delirium" ukukhumbula ezinye zezimbangela ezinkulu:
D - Izidakamizwa: Lokhu kungenzeka imbangela evamile kakhulu ye-delirium. Ukwengeza izidakamizwa ezintsha ezintathu esibhedlela ukukhuphula ingozi yokudiliza iziguli ezintathu asebekhulile. Abahlukumezi abavamile kakhulu imishanguzo ye-anticholinergic njengamanye alawo asetshenziselwa ukwelapha ukungalingani kwamagciwane. I-Benzodiazepines nama-opiates nazo zibuye zenzeke. Noma kunjalo, uhlu lweminye imithi engabangela i-delirium iphinde ihlanganise nama- antihistamine , ama- antiepileptics , ama-steroids, amanye ama-antibiotic, nabanye abaningi.
I-E-Epilepsy: Nakuba ukuhlukunyezwa kuye kwacatshangwa ukuthi kungesizathu esincane sezinguquko zesimo sengqondo, ucwaningo lwamuva luye lwabonisa ukuthi amaphesenti aphezulu weziguli, ikakhulukazi kuma-ICUs, empeleni abhekana nesimo esingenasimanga esiphuthumayo, okusho ukuthi basondela ngokuqhubekayo ngaphandle kokunyakaza kwezitho zomzimba ezixubile.
L - Amapulangwe: I- oksijeni encane kakhulu noma i-carbon dioxide kakhulu ngenxa yokuphefumula kanzima kungabangela izingqinamba ezinzima zokudideka. I-apnea yokulala yokuvimbela ingozi yengozi.
I-Ukutheleleka: Ngokuya ngokuthi umuntu obhekene kanjani nesimo sombuso esiyinkimbinkimbi, cishe noma yikuphi ukutheleleka kungabacindezela emaphethelweni okuba yi-delirium, kubandakanya ukutheleleka okunamandla okugciwane. Ngokuvamile, ukutheleleka kwamagciwane, ukuphefumula, noma ukutheleleka kwesikhumba kuyimbangela.
R - Ukugcinwa: Lokhu kungasho ukugcinwa komchamo noma isitokisi. Ukuqokwa kungumnikelo ophindaphindiwe wokudiliza.
I-Ukuvuvukala: Lesi sigaba esibanzi ngokuzithandela ngoba izinto eziningi emzimbeni zingenza impendulo yokuvuvukala. Ukuphendula okwe-allergen kuyinto eyodwa. Ukwelashwa kuyinhlangano evamile ekunikezeni i-delirium. Ukuvimbela izifo noma ukuphazamiseka kungakwenza nalokhu.
U-Unstable: Izimo eziphazamisayo ezimbi zingasebenza njengesibonakaliso sokuthi isiguli sigula kakhulu. Umfutho wegazi ophansi kakhulu noma ophakeme kakhulu ungabangela ukucindezeleka, njengoba kungenzeka ukuthi i-infarction ye-myocardial (ukuhlasela kwenhliziyo). Izibhamu azivami ukudala i-delirium ngaphandle kwesinye isibonakaliso sokushaya , njengokubuthakathaka kwesandla noma umlenze, kodwa kungavamile ukuthi kubangele ukudideka.
I-M - Metabolic: Lokhu kuhlanganisa nezinkinga ze-thyroid kanye nesifo sikashukela, okungabangela amazinga kashukela egazi aphansi kakhulu ( hypoglycemia ) noma ephakeme kakhulu (hyperglycemia). Amanye ama-hormone afana ne-cortisol nawo angaholela ekushintsheni ekucabangeni. Ukungondleki kanye nokwehluleka kwenkunzi kungase kuhlanganiswe nalesi sigaba.
Njengoba ubona, kunesizathu esikhulu sokuba isiguli sidideke esibhedlela. Iziguli eziningi ezididekile zinezici ezingaphezu kweyodwa eziyingozi zokudiliza. Uhlu olungenhla alufaki nezinye izakhi ezivamile ze-delirium njengokunqotshwa kokulala, i-catheterizations, nezinqubo eziningi ezivamile ezindaweni ezibhedlela. Ngezinye izikhathi odokotela kufanele bahambe ngendlela efanele ekulawuleni i-delirium. Isibonelo, ngenkathi ubuhlungu bungabangela i-delirium, ngakho-ke kungaba nemithi ebuhlungu kakhulu. Nakuba ukuvimbela ngokomzimba ngezinye izikhathi kudingeke ukuba umise isiguli esididekile ekudonseni imigqa namathebhu, ukuvimbela ngokomzimba kubuye kube kubi nakakhulu izifunda ezididekile.
Ngenhlanhla, kunezinyathelo ezengeziwe ezenziwa ngabasebenzi bezokwelapha kanye namalungu omndeni ukusiza ukuvimbela i-delirium ekuphumeni ngesikhathi izinkinga ezingaphansi zilungiswa. I-Delirium iyesabisa, kodwa cishe ayinakuhlala unomphela. Ukunakekelwa kahle kwesiguli kungasiza ekuqinisekiseni ukuthi wonke umuntu uthola isipiliyoni ngokuhlukunyezwa okuncane ngangokunokwenzeka.
Imithombo:
UDubois MJ et al. I-Delerium ku-ICU, ukucwaninga ngezici zobungozi Umuthi Wokunakekelwa Okunakekelwa. 2001 27 1297-1304
Ely EW, Shintani A, Truman B. et al. I-Delirium njengendlela yokufa kwabantu ezigulini ezinomoya ophuthumayo ekamelweni lokunakekelwa okukhulu. I-JAMA 2004; 291 (14): 1753-1762.
Peterson JF, Delerium kanye ne-motoric subtypes, J am. I-Geriat. I-Soc 54 (3) 479-484, 2006.
UVanja C. Douglas, A. Andrew Josephson, Delirium. I-Continuum: Ukufunda impilo yonke Neurol 2010; 16 (2) 120-134