ABSTRACT
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. Acute confusion presents differently from chronic confusion associated with dementia, and therefore requires assessment and management specific to the problem. The causes of acute confusion can be understood in terms of: predisposing factors; and precipitating factors. Assessment of acute confusion in persons receiving palliative care presents a difficult nursing challenge. 'Nurses have an opportunity to detect subtle cognitive changes early in the development of confusion'. The main issue that arises in using sedation for confused patients—both those with terminal confusion and those with a potentially reversible delirium—is the question of treating people who are unable to consent to the treatment.
