Tag Archive for: course-nocourse

ICU Delirium

I found an article titled “their altered mental states: the confusion of delirium.” This was a magazine article from 2007 published in U.S. News & World report. Whose summary concludes with a quote from Wesley Ely, a critical-care specialist who founded the ICU Delirium and Cognitive Impairment Study Group at Vanderbilt University School of Medicine. Mr. Ely introduces the Idea that “Delirium is a predictor of death, a longer hospital stay, and increased costs.” This article episodes of delirium are not uncommon in the ICU, particularly amongst the elderly. Delirium is not always apparent and can present as simply as disorientation or inattentiveness.

We learned from the video that we watched as instructed for the class, that often times patients, while having episodes of delirium can feel as if they are being bound, and/or incarcerated. These patients describe a confused longing to be set free from whatever they perceive as binding them. Having never experienced this myself, I can only imagine the feeling as exaggeratedly unpleasant to the patient and, as is mentioned in this article “enormously distressing to the families.” Furthermore, researchers have unearthed evidence that “sun-downing,” as delirium states are nicknamed because of their timing, may be far from benign and could have lasting effects. We learn that sedated and ventilated patients are far more vulnerable to these delirium-like states. These patients are also likely to experience increased instances of pneumonia, infection, low blood oxygen, a specific drug or combination of medications, too much fluid in the body, and out-of-balance electrolytes.

I agree with the author in that these patients are confused and can be re-oriented to their situation. The medical staff as well as visiting friends and family can intervene crucially by continually reminding patients where they are and what is going on. Anything that can be brought into the ICU such as stuffed animals or bedside clocks can help to keep the patient oriented to time and place as well. Psychiatric consultation is often employed in efforts to find the root causes of delirium states as intervening physicians can be often too focused on the reasons for the hospitalization rather than the resulting delirium states. Findings during cognitive functioning examination may indicate the need for further mental health screening (Zator Estes, 2010, p. 713).

References

Baldauf, S. (2007). Their altered mental states: The confusion of delirium. U.S. News & World Report, 143(3), 64.

Zator Estes, M. (2010). Health assessment and physical examination (4th ed.). Vienna, Virginia: Delmar.

I found the video by the ICU delirium and cognitive impairment study group to be very touching. Dr. Wes Ely talks about how geriatrics need advocates in the critical care unit (CCU) and intensive care units (ICU). This topic is very interesting for me because I work in an ICU step-down unit with patients on ventilators .He noted that the patients were leaving these units with worsening cognitive effects that he called an “acquired dementia” from the sedatives they were receiving in the CCU or ICU. This is the first time that I had ever heard about oversedating patients into a delirium to the point where they were having residual cognitive defects after discharge. This prompted me to do some research of my own on ICU delirium. I really loved that he said that he was trying to improve the lives of people he will never meet.  I guess that is what medical research is all about .

I was able to find an article written by a nurse in a Health Science article. In the article named, Delirium: a distressing and disturbing clinical event in a Intensive Care Unit, they talk about tools nurses can use to control the levels of severity of delirium encountered in critical care units. The article found that if tools to classify the severity of delirium were more readily available to nurses, we would be able to identify patients who are at the highest risk for adverse outcomes from sedation medications. I think this a perfect step towards reducing this problem found in the critical care units.

“Several studies have now confirmed that delirium occurs in 60% to 80% of mechanically ventilated patients.” (Maniou , 2012) This number is astonishingly large and something must be done to help these patients. I strongly agree with this article because I think that nurses, as patient advocates, must do something to help stop this. This article offers many screening tools and interventions a nurse can use to help prevent ICU delirium. This includes things such as the Confusion Assessment Method – Intensive Care Unit (CAM-ICU) and using the patient’s glasses and/or hearing aids to help prevent sensory deprivation. Overall, I learned a lot about this topic that I knew little about and I hope that I can bring something back to help care for my patients at work.

Maniou, M. (2012). Delirium: a distressing and disturbing clinical event in a Intensive Care Unit. Health Science Journal, 6(4), 587-597.

Hello Everyone,

My name is Tiffany Garcia.  I am 26 years old and originally from Chatsworth, Ca.  I received my Associates Degree in Registered Nursing from Moorpark College in December 2013. Shortly after, I got my first job as an R.N. in the D.O. U. at Sherman Oaks hospital. I will be graduating with most of you in August of 2015 from CSUCI. I was an L. V. N. before I became an R. N. so I have been in the field of nursing for 6 years now. I enjoy learning something new everyday and furthering my knowledge of nursing as I grow academically. I’ve wanted to be a nurse since I was little so, as you can imagine, I’m super proud be be able to call myself an R. N. and finally have the career I’ve wanted for so long. So far this class has been very fulfilling and has taught me a lot. I look forward to continuing my education and one day getting my doctorate degree. On my free time I enjoy hanging out with friends and family , camping, traveling, hiking, and going to the beach with my Huskey.

My web page url is: tiffanygarciarn.cikeys.com