How much information to share?

At work today, I was a 1:1 sitter. My patient had gone through a very invasive surgery and developed delerium afterwards. The delerium is likely due to combination of her age, the invasiveness of the surgery, and the narcotic pain medicine she was given. As soon as it developed, the medication was stopped, but her sensorium didn't clear immediately (nor would it be expected to).

Her family had been reassured that this was because of the medication and the surgery and would only be temporary. Likely it will be. However, in some older adults, delerium from medication, surgery, UTI or pneumonia, can spark the long slide into dementia. For some, it may worsen a pre-existing unrecognized dementia and for others, it may spark a dementia that would otherwise not develop for a few more years. This certainly doesn't happen in all cases, but in a larger percentage of cases than we like, it does happen. Almost as bad, often delerium following hospitalization is a sign of impending dementia. She might be all right in a few days, but in a few years, she will likely not be.

All day I wondered about the ethics of not telling her family that this is a possibility. At what point should that information be shared? Right up front when the delerium is recognized? If it doesn't clear within 24 hours? 48 hours? If she's still not cognitively intact at discharge or in rehab? How much information is too much and overwhelming? At what point are we "protecting" the family the same way we used to protect terminally ill patients by not talking about death? One of nurses' main jobs is to translate medical information from medicalese to language that the rest of us can understand and that is pertinent to every day life.

I'm uncomfortable when I need to decide what information at what point needs to be shared. The family wasn't even told that she had developed delerium. Rather, they were told that it was a "medication reaction." I disagree with that as it may prevent her from using the opiod medication in the future when it may be needed and, without the stress of surgery, it may not trigger delerium. A medication reaction is like haldol causing tardive dyskinesia. Even more, if a family member wants to find out more information about what happened later, they won't find it if they don't have the accurate name for what happened to them. The final trigger may have been the medication, but I can guarantee you that if she were 40 years younger and going through the exact same operation, she would not have become delerious.