I-Delirium

UDelirium ukudideka okukhulu okungazelelwe ngenxa yezinguquko ezisheshayo ekusebenzeni kobuchopho ezenzeka ngokugula ngokomzimba noma kwengqondo.

I-Delirium ivame ukubangelwa ukugula ngokomzimba noma kwengqondo futhi imvamisa iba yesikhashana futhi iyahlehliswa. Ukuphazamiseka okuningi kubangela i-delirium. Imvamisa, lezi azivumeli ubuchopho ukuthi buthole umoya-mpilo noma ezinye izinto. Kungadala namakhemikhali ayingozi (ubuthi) ukwakha ebuchosheni. UDelirium ujwayelekile egumbini labagula kakhulu (i-ICU), ikakhulukazi kubantu abadala asebekhulile.

Izimbangela zifaka:

• Utshwala noma umuthi okweqile noma ukuhoxa
• Ukusetshenziswa kwezidakamizwa noma ukweqisa izidakamizwa, kufaka phakathi ukuhlala e-ICU
• I-Electrolyte noma okunye ukuphazamiseka kwamakhemikhali omzimba
• Izifo ezinjengezifo zomgudu womchamo noma i-pneumonia
• Ukuntuleka okukhulu kokulala
• Ubuthi
• I-anesthesia ejwayelekile nokuhlinzwa
  

I-Delirium ifaka phakathi ushintsho olusheshayo phakathi kwezimo zengqondo (ngokwesibonelo, kusukela ekuqineni kuya ekuyalukeni nasekubuyiseleni ekuyekeni).

Izimpawu zifaka:

• Izinguquko zokuxwayisa (imvamisa isexwayiso esiningi ekuseni, ukuqapha okuncane ebusuku)
• Izinguquko kumuzwa (ukuzwa) nokubona
• Izinguquko ezingeni lokwazi noma lokuqwashisa
• Izinguquko ekunyakazeni (ngokwesibonelo, zingahamba kancane noma zingasebenzi)
• Izinguquko emaphethini wokulala, ukozela
• Ukudideka (ukudideka) mayelana nesikhathi noma indawo
• Nciphisa inkumbulo yesikhashana futhi ukhumbule
• Ukucabanga okungahlelekile, njengokukhuluma ngendlela engenangqondo
• Izinguquko ezingokomzwelo noma zobuntu, ezifana nentukuthelo, ukuyaluza, ukudana, ukucasuka, nokujabula ngokweqile
• Ukungazibambi
• Ukunyakaza kudalwe izinguquko ohlelweni lwezinzwa
• Inkinga yokugxila

Lezi zivivinyo ezilandelayo zingaba nemiphumela engajwayelekile:

• Ukuhlolwa kwesistimu yezinzwa (ukuhlolwa kwe-neurologic), kufaka phakathi ukuhlolwa kwemizwa (ukuzwa), isimo sengqondo, ukucabanga (ukusebenza kwengqondo), nokusebenza kwemoto
• Izifundo ze-Neuropsychological

Ukuhlolwa okulandelayo kungenziwa futhi:

• Ukuhlolwa kwegazi nomchamo
• I-x-ray yesifuba
• Ukuhlaziywa kweCerebrospinal fluid (CSF) (umpompi womgogodla, noma ukubhoboza i-lumbar)
• I-Electroencephalogram (EEG)
• Iskena sekhanda le-CT
• Iskena sekhanda le-MRI
• Ukuhlolwa kwesimo sengqondo

Inhloso yokwelashwa ukulawula noma ukuguqula imbangela yezimpawu. Ukwelashwa kuya ngesimo esibangela i-delirium. Umuntu kungenzeka adinge ukuhlala esibhedlela isikhashana.

Ukumisa noma ukushintsha imithi edala ukudideka, noma okungadingekile, kungathuthukisa ukusebenza kwengqondo.

Ukuphazamiseka okufaka isandla ekudidekeni kufanele kulashwe. Lokhu kungafaka:

• Ukushoda kwegazi
• Ukwehlisa umoya-mpilo (i-hypoxia)
• Ukwehluleka kwenhliziyo
• Izinga eliphezulu le-carbon dioxide (hypercapnia)
• Izifo
• Ukuhluleka kwezinso
• Ukuhluleka kwesibindi
• Ukuphazamiseka kokudla okunempilo
• Izimo zengqondo (njengokucindezeleka noma i-psychosis)
• Izinkinga ze-thyroid

Ukwelapha ukuphazamiseka kwezokwelapha nezengqondo kuvame kakhulu ukuthuthukisa ukusebenza kwengqondo.

Imithi ingadingeka ukulawula isimilo esinolaka noma esikhungathekile. Lokhu kuvame ukuqala ngemithamo ephansi kakhulu futhi kulungiswe lapho kudingeka.

Abanye abantu abane-delirium bangazuza ngezinsiza-kuzwa, izibuko, noma ukuhlinzwa ngamehlo.

Ezinye izindlela zokwelashwa ezingasiza:

• Ukuguqulwa kokuziphatha ukulawula isimilo esingamukeleki noma esiyingozi
• Ukuma kweqiniso ukunciphisa ukudideka

Izimo ezinzima ezibangela i-delirium kungenzeka ngezinkinga zesikhathi eside (ezingapheli) ezibanga ukuwohloka komqondo. Ama-syndromes obuchopho abukhali angabuyiselwa emuva ngokuphatha imbangela.

I-Delirium ivame ukuhlala cishe isonto elilodwa. Kungathatha amasonto ambalwa ukuthi ukusebenza kwengqondo kubuyele kokujwayelekile. Ukululama ngokugcwele kujwayelekile, kepha kuya ngesizathu esiyimbangela ye-delirium.

Izinkinga ezingabangelwa yi-delirium zifaka:

• Ukulahleka kwekhono lokusebenza noma lokuzinakekela
• Ukulahlekelwa kwamandla okuxhumana
• Ukudlulela ekulahlekeni noma ekuqulekeni
• Imiphumela emibi yemithi esetshenziselwa ukwelapha lesi sifo

Shayela umhlinzeki wakho wezokunakekelwa kwezempilo uma kukhona ushintsho olusheshayo esimweni sengqondo.

Ukwelapha izimo ezidala i-delirium kunganciphisa ubungozi bayo. Kubantu abasesibhedlela, ukugwema noma ukusebenzisa isilinganiso esiphansi sezidakamizwa, ukwelashwa ngokushesha kokuphazamiseka komzimba kanye nokutheleleka, nokusebenzisa izinhlelo zokuma kweqiniso kuzonciphisa ubungozi be-delirium kulabo abasengozini enkulu.

Isimo esididayo sokudideka; I-Acute brain syndrome

• Isistimu yezinzwa emaphakathi nesistimu yezinzwa ezungezayo
• Ubuchopho

UGuthrie PF, uRayborn S, uButcher HK. Umhlahlandlela womkhuba osuselwe ebufakazini: i-delirium. UJ Gerontol Umhlengikazi. 2018; 44 (2): 14-24. I-PMID: 29378075 www.ncbi.nlm.nih.gov/pubmed/29378075.

Inouye SK. I-Delirium esigulini esidala. Ku: IGoldman L, iSchafer AI, ama-eds. Imithi yeGoldman-Cecil. Umhla ka-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 25.

UMendez MF, uPadilla CR. I-Delirium. Ku: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, ama-eds. I-Neurology kaBradley ekwenziweni kwemitholampilo. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2016: isahluko 4.