ICU DELIRIUM
Health Science, Volume 6, Issue 4 (October-December 2012) article entitled Delirium: a distressing and disturbing clinical event in a Intensive Care Unit was both informative and compelling.
Delirium, from the Latin word was defined as to “be out of your furrow.” Current day definition is, an “agitated and confused person.” Prior to reading the article, the idea of a patient being agitated and confused while in the ICU appeared normal and acceptable. The patient is in a new surrounding, possibly medically sedated and quite literally connected to machines, monitors, etc. Being a patient and losing complete control of themselves would understandingly provoke agitation and confusion.
The article described delirium not only as agitation and confusion, but as an “acute brain dysfunction.” This was quite an eye opening description. In addition, it discussed the detrimental effects and links between delirium and a high morbidity and mortality rates. Research showed that 30,000 – 40,000 ICU patients in the United States suffer from delirium and with every day spent in this state, it increased the risk of death and negative cognitive function by 10%. It was also noted that patient who suffer with this were twice as likely to die within 6 months than their non-delirious counterparts. With this current information, the article compels nurses to be diligent in understanding the causes and being able to assess their patients for delirium.
Several causes of delirium are: mechanical ventilation, use of benzodiazepines, opiates and other psychoactive drugs, immobilization, unfamiliar surroundings, excessive noises, sensory monotony and absence of dirunal light variation. As nurses, there are assessments and interventions that should be implemented to reduce as many factors as possible.
Assessment screenings must be completed to assess delirium. These include eight features: alerted level of consciousness, inattention, disorientation, hallucinations, psychomotor, agitation/retardation, inappropriate mood/speech, sleep/wake cycle disturbance and symptom fluctuation. In addition preventative strategies are also necessary. These include: frequent orientation to person, place and time, providing patient with their hearing aids, and glasses during wakeful periods, completing personal care activities during daytime hours and minimizing nighttime interruptions.
Understanding the costly repercussions, to both the health of the patient and to their future, it is imperative that all medical professionals view delirium as a “medical emergency” and do everything to minimize the negative effects to the patients that are entrusting themselves to them. Marcella Van Driessche
References:
“ABCDEFs of Prevention and Safety.” ICU Delirium and Cognitive Impairment Study Group. Web. 29 Jan. 2015. .
Maniou, M. (2012). Delirium: A distressing and disturbing clinical event in a Intensive Care Unit. Health Science Journal, 6(4), 587-597.
