Delirium

I-Delirium kukudideka okukhulu ngesiquphe ngenxa yotshintsho olukhawulezileyo ekusebenzeni kwengqondo okwenzeka ngokugula emzimbeni okanye engqondweni.

I-Delirium ihlala ibangelwa kukugula ngokwasemzimbeni okanye ngokwasengqondweni kwaye ihlala ihlala okwethutyana kwaye ibuye ibuye. Ukuphazamiseka okuninzi kubangela i-delirium. Rhoqo, ezi azivumeli ukuba ingqondo ifumane ioksijini okanye ezinye izinto. Banokubangela neekhemikhali eziyingozi (ityhefu) ezakha kwingqondo. I-Delirium ixhaphakile kwicandelo lezonyango elinamandla (i-ICU), ngakumbi kubantu abadala.

Izizathu zibandakanya:

• Utywala okanye amayeza libanda okanye ukurhoxa
• Ukusetyenziswa kweziyobisi okanye ukugqithisa, kubandakanya ukuhlala kwi-ICU
• I-Electrolyte okanye olunye uphazamiseko lweekhemikhali zomzimba
• Usulelo olufana nosulelo lomchamo okanye inyumoniya
• Ukungalali kakhulu
• Ityhefu
• I-anesthesia ngokubanzi kunye notyando
  

I-Delirium ibandakanya utshintsho olukhawulezileyo phakathi kwemeko yengqondo (umzekelo, ukusuka ekuyekeni ukuya ekuphazamisekeni nasekubuyeni kuburharha).

Iimpawu zibandakanya:

• Utshintsho kwisilumkiso (ngesiqhelo kusasa ngakumbi ekuseni, isilumkiso esincinci ebusuku)
• Utshintsho kwiimvakalelo (imvakalelo) kunye nokuqonda
• Utshintsho kwinqanaba lokuqonda okanye lokwazisa
• Utshintsho ekuhambeni (umzekelo, kunokuba nokuhamba kancinci okanye ukungasebenzi kakuhle)
• Utshintsho kwiipateni zokulala, ukozela
• Ukudideka (ukudideka) malunga nexesha okanye indawo
• Ukunciphisa kwimemori yexesha elifutshane kunye nokukhumbula
• Ukucinga okungalungelelananga, njengokuthetha ngendlela engavakaliyo
• Utshintsho lweemvakalelo okanye lobuntu, ezinje ngomsindo, ukuphazamiseka, uxinzelelo, ukuba nochuku, kunye nokonwaba kakhulu
• Ukungakwazi ukuzibamba
• Iintshukumo ezibangelwa lutshintsho kwinkqubo yeemvakalelo
• Ingxaki ukugxila

Olu vavanyo lulandelayo lunokuba neziphumo ezingaqhelekanga:

• Uvavanyo lwenkqubo yemithambo-luvo (uviwo lwe-neurologic), kubandakanya uvavanyo lweemvakalelo (uvakalelo), imeko yengqondo, ukucinga (umsebenzi wokuqonda) kunye nokusebenza kwemoto.
• Izifundo ze-Neuropsychological

Ezi mvavanyo zilandelayo zinokwenziwa:

• Uvavanyo lwegazi kunye nomchamo
• I-x-ray yesifuba
• Uhlalutyo lweCerebrospinal fluid (CSF) (impompo yomqolo, okanye ukubhoboza i-lumbar)
• I-Electroencephalogram (i-EEG)
• Ukuskena iNtloko ye-CT
• Iskena seNtloko seMRI
• Uvavanyo lobume bengqondo

Injongo yonyango kukulawula okanye ukuguqula unobangela weempawu. Unyango luxhomekeke kwimeko ebangela ukuphazamiseka. Umntu lowo angafuna ukuhlala esibhedlele ixesha elifutshane.

Ukuyekisa okanye ukutshintsha amayeza enza mandundu ukudideka, okanye okungafunekiyo, kunokuphucula ukusebenza kwengqondo.

Ukuphazamiseka okunegalelo kudideko kufuneka kunyangwe. Oku kunokubandakanya:

• Ukunqongophala kwegazi
• Ukunciphisa ioksijini (hypoxia)
• Ukumelwa yintliziyo
• Amanqanaba aphezulu ecarbon dioxide (hypercapnia)
• Usulelo
• Ukungaphumeleli kwezintso
• Ukungaphumeleli kwesibindi
• Ukuphazamiseka kwesondlo
• Iimeko zengqondo (ezinje ngoxinzelelo okanye isifo sengqondo)
• Iingxaki ze-thyroid

Ukunyanga ukuphazamiseka kwezonyango nakwingqondo kuhlala kuphucula kakhulu ukusebenza kwengqondo.

Amayeza anokufuneka ukuze kulawulwe isimilo esigwenxa okanye esikhathazayo. Ezi zihlala ziqala ngeedosi ezisezantsi kakhulu kwaye zilungelelaniswe njengoko kufuneka.

Abanye abantu abane-delirium banokuxhamla kwizincedisi zokuva, iiglasi, okanye kutyando lwamehlo.

Olunye unyango olunokuba luncedo:

• Ukulungiswa kwendlela yokuziphatha ukuze ulawule isimilo esingamkelekanga okanye esiyingozi
• Ukuqhelaniswa kwenyani ukunciphisa ukudideka

Iimeko ezibi ezibangela ukuphazamiseka zinokubakho kukuphazamiseka kwexesha elide (okungapheliyo) okubangela isifo sengqondo esixhalabisayo. Ii-syndromes ezinobuchopho ezinokubuyela umva ngokunyanga unobangela.

I-Delirium ihlala ihlala malunga neveki enye. Kungathatha iiveki ezininzi ukuba umsebenzi wengqondo ubuyele esiqhelweni. Ukuchacha okupheleleyo kuqhelekile, kodwa kuxhomekeke kwisizathu sedelirium.

Iingxaki ezinokubangelwa kukungaboni kakuhle zibandakanya:

• Ukuphulukana nokukwazi ukusebenza okanye ukuzikhathalela
• Ukuphulukana nokukwazi ukusebenzisana
• Ukuqhubela phambili ukuya kubuthongo okanye isiqaqa
• Iziphumo ebezingalindelekanga zamayeza asetyenziselwa ukunyanga esi sifo

Tsalela umnxeba umboneleli wakho ukuba kukho utshintsho olukhawulezileyo kwimeko yengqondo.

Ukunyanga iimeko ezibangela i-delirium kunokunciphisa umngcipheko. Kubantu abasesibhedlele, ukunqanda okanye ukusebenzisa idosi ephantsi yokuthomalalisa, unyango olukhawulezileyo lokuphazamiseka emzimbeni kunye nosulelo, kunye nokusebenzisa iinkqubo zokuziqhelanisa nokwenyani kuya kunciphisa umngcipheko we-delirium kwabo basemngciphekweni omkhulu.

Imeko edidayo; Isifo sengqondo esibuhlungu

• Inkqubo ye-nervous central kunye ne-peripheral system
• Ingqondo

UGuthrie PF, uRayborn S, uButcher HK. Isikhokelo esisekwe kubungqina: delirium. J Gerontol Umongikazi. 2018; 44 (2): 14-24. IINKCUKACHA: 29378075 www.ncbi.nlm.nih.gov/pubmed/29378075.

Inouye SK. I-Delirium kwisigulana esidala. Ku: IGoldman L, iSchafer AI, ii-eds. Amayeza eGoldman-Cecil. Ngomhla wama-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 25.

IMendez MF, iPadilla CR. Delirium. Ku: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, ii-eds. I-Neurology kaBradley kwiKlinikhi yokuziqhelanisa. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2016: isahluko 4.