Overview of the DIMS-PLUS5 framework
| DELIRIUM TRIGGERS | ASSESS FOR … |
|---|---|
| Drug | Intoxication or overdose, withdrawal, or deliriogenic side effects due to the following: alcohol, cannabinoids, recreational drugs, sedatives or benzodiazepines, anesthetics, anticholinergics or antihistaminergics (eg, dimenhydrinate, diphenhydramine, antispasmodics, muscle relaxants), antidepressants, antipsychotics, anticonvulsants, narcotics (including those causing opioid-induced neurotoxicity), steroids, dopaminergics (eg, levodopa and carbidopa combination), digoxin, lithium, and drugs containing heavy metals or toxins |
| Infection | Bodily infection, such as respiratory infection, urinary tract infection, cellulitis, and bacteremia |
| Metabolic | Metabolic triggers such as hypoxia, hypercarbia, hyperglycemia, hypoglycemia, hematologic abnormalities (eg, anemia, hypereosinophilia), electrolyte abnormalities (eg, sodium, calcium, magnesium, phosphate), renal failure, hepatic failure, thyroid or pituitary or adrenal dysfunction, and acid-base abnormalities |
| Structural and systems | Neurologic factors (eg, stroke, encephalitis or encephalopathy, intracranial hemorrhage, tumour, head injury, seizure or nonconvulsive status epilepticus), cardiopulmonary factors (eg, shock, hypertensive crisis, respiratory failure, acute coronary syndrome, arrhythmia, heart failure, pulmonary embolism), and any other acute medical or surgical event |
| Pain | Poorly controlled pain |
| Liquids and solids | Dehydration and malnutrition, including macronutrient and micronutrient deficiencies (eg, thiamine and vitamin B12) and restrictive diets |
| Urine and bowels | Urinary retention and constipation |
| Senses | Uncorrected vision, hearing, or communication deficits |
| Sleep | Poor sleep habits (eg, disrupted sleep, napping) |
| Setting | Disruptive or unfamiliar environment, lack of orientation devices, absence of natural day-night cues, social isolation, or lack of family presence |
| Stasis | Restraints (including immobilizing equipment such as intravenous lines, indwelling urinary catheters, tubes, drains) or deconditioning |
| Stress | Psychological distress |