Delirium in the ICU
On a daily basis, 30,000 to 40,000 ICU patients in the United States suffer from delirium. Delirium is an acute brain dysfunction. It is believed the problem will only get bigger due to the increased age of our population. The article written by Maniou states multiple studies concluded delirium in mechanically ventilated patients is seen in 60-80% of ICU patients. The article also states that each day a patient spends in a state of delirium their risk of death is increased by 10%. Hypoactive delirium may be difficult to diagnose but it is important to recognize it because it may be an early sign of a serious medical condition, such as sepsis, pneumonia, MI, or PE. Delirium may also be linked to longer hospital stays and increased cognitive impairment on discharge. Risk factors associated with delirium include: increased age, severity of disease, use of medications such as psychoactive drugs, opiates and benzodiazepines. Other risks include the patient’s loss of control, loss of personal space, and loss of their ability to communicate. For these reasons it is important for nursing staff to be aware of this medical problem. Nurses must know how to recognize it and how to treat it, as delirium is harmful to patients and costly to hospitals. The Confusion Assessment Method-Intensive Care Unit is the most commonly used method to diagnose delirium, other tools include the delirium check list and The Intensive Care Delirium Screening Checklist. Nurses should be educated on effective methods to identify patients at increased risk for delirium, how to asses for delirium and appropriate interventions to manage the medical problem.
I do agree with the article. Medicine has many new advances and people are living longer than before. The older population is more fragile and sensitive, thus increasing their risk for delirium. It also seems that patients admitted to the hospital are more fragile and sick then in past years. It is important for all nurses to identity patients at risk, assess and implement nursing interventions to prevent complications. I think the next step needed to bring about awareness of this issue is staff education. As this is a big problem, nursing staff especially nurses caring for patients in ICU should be educated on the issue. I think nurse education is the most important step to identify and treat these patients. Nurses are the primary caregivers and we are the ones who interact with the patients the most. We are in the perfect position to assess and identify patients at increased risk for delirium. We are also in the perfect position to intervene to prevent long term complications.
As a nurse working in med/surg and acute rehabilitation I often encounter older patients who become disoriented when taking narcotics, sleeping and psychoactive medications. I believe that it is important to for all nursing staff not just ICU staff to get educated on delirium. Often the patients change in LOC is not associated or linked to these medications and it is important to recognize it and to be aware of the possible causes to prevent its reoccurrence. As nurses we are the doctor’s eyes and we are also the patient’s advocate and it is our responsibility to monitor, prevent and intervene in these situations. We must prevent long term complications and limit hospital costs.
Recourses
Maniou, M. (2012). Delirium: A distressing and disturbing clinical event in a intensive care unit. Health Science Journal, 6(2) 587-597.
