Delirium Prevention Strategies

Excited delirium syndrome is a rare but dangerous disease generally recognized by agitation, aggression, disorientation, and sometimes sudden death. Often associated with drug usage. There has been some documentation as early as the 1800s, but it manly started to come back around in the 1980s. These patients will often need to be restrained, usually by law enforcement, and pose a great danger to the crew’s safety until restrained and sedated. Excited deliriums cause is somewhat unknown. There is much conflict from researcher’s on the why and how.

An A to E assessment is the approach to access a deteriorating and critically I’ll patients, each letter stands for an assessment nurses will undertake A- airway B- breathing C- circulation D- disability and E- exposure (Thim, Krarup, Grove, Rohde, & Lofgren, 2012). This essay will look at disability in the A to E assessment of a critically ill patient which will focus on the Glasgow coma scale. The essay will discuss what is the Glasgow coma scale?, Glasgow coma scale is the most common source in monitoring and assessing the neurological statues of a critically ill patient, despite the fact the Glasgow coma scale has limitations on execution it remains the main standard in comprehensive neurological assessment of patients. It

Any of these issues have the potential to extend the patients length of stay in the hospital. The restraints have the potential to make the patient more agitated, thus increasing his risk of injury. Understanding the nursing-sensitive indicators can greatly contribute to a better outcome for all patients.

A policy for conscious sedation was in place and not followed by staff. As all staff had been trained in the procedure, completed the appropriate modules, and

Delirium is a serious condition that can affect patients in and outside the hospital. With its presence being unknown to many nurses and providers, delirium has significant long term complications that can last well beyond discharge. Noise, medication, and infection are significant in the development and progression of delirium and these are more than abundant within intensive care patients. The importance of nurse’s knowledge cannot be stressed enough regarding the assessment, symptoms, and interventions of delirium, in an effort to decrease its occurrence

The investigation of how anesthesia effects cognitive functioning has had a long history. Overtime, it has been suggested that there is an association between anesthesia, surgery, delirium, dementia and postoperative cognitive dysfunction (Inan & Ozkose Satirlar, 2015). The theory of anesthesia’s impact on cognitive functioning was derived in 1887, by Savage, who began to observe the “insanity” that follows the use of anesthesia. He suggested that “Any cause which will give rise to delirium may set up a more chronic form of mental disorder quite apart from any febrile disturbance” (Savage, 1887, p. 1199). Delirium can be defined as an altered level of consciousness that may cause a sudden decline in attention and focus perception (Isik, 2015). Postoperative delirium was reevaluated in 1955 when Bedford used a series of case studies collected over a 50 year span to describe a connection between anesthesia and dementia. The results suggest that 10% of the patients had postoperative cognitive dysfunction (Bedford, 1955). Since these initial studies, research has persisted using a variety of methods, in an attempt to determine: both long- and short-term effects of anesthesia on cognitive functioning and memory; whether the anesthesia administration technique will change the outcome of postoperative cognitive dysfunction; and other risk factors that may be associated to AD.

The treatment options should be prefaced with knowledge sharing and education surrounding the topic of delirium with the care team. Education will need to include assessment, prevention, and management (Trogrlic et al., 2015, p. 15). Assessment components will need to include an evidence-based tool that is appropriate for the population and applies to patients with and without cognitive impairments (Voyer et al., 2015). Preventive processes need to be taught, understood, and operationalized. This would include identification of reversible causes and risk factors, optimization of medications and elimination of inappropriate medications, integration of family, and team collaboration (Resnick, 2016). Management options will need to include treatment of electrolyte abnormalities, visual screening and correction for an identified impairments, ear aids, bowel

In order to decrease the likelihood that such sentinel event will occur again, a change must be put into place. In this case, the change should involve the process in which conscious sedation is carried out as well as the knowledge of those providing care for those patients. The registered nurse in this case is most likely very good at her job, she probably felt that she had everything under control and has most likely provided conscious sedation many times in the past. As an experienced nurse, however, it is wise to understand that one should never become complacent and it is okay to ask for additional help, especially when a change in patient’s status can occur so quickly. And while this nurse is up to date on her sedation modules

My coworker had a 40-year-old patient who came to the hospital for alcohol withdrawal. All the nurses on our floor knew him really well because he visits our hospital frequently. At around 7:30 pm, our telemetry showed that the patient was having a heart rate of 180s to190s. We all were still getting report. Charge nurse went to assess the patient, patient started yelling in a loud voice, throwing pillows and a blanket. It turned out that the patient went to the delirium tremens (DT) phase. He was confused, disoriented, hallucinating, agitated, irritated and had muscle tremor. When reviewing the medication administration record (MAR), charge nurse noticed that CIWA scale was not done as ordered and as a result patient did not get enough Lorazepam

This paper address the lack of communication between interdicinplnary staff and the patients they care for also the significance of the care giver when patient enter an ICU setting. There are several problems that can occur to patient in an ICU setting when communication between collaborative care is broken down. The biggest issue can be death when this happens or even patient injuries which are two of the biggest concerns when it comes to care of patients. “Notably, when asked to evaluate interprofessional collaboration, nurses consistently rate is lower than doctors, suggesting discipline-specific perspectives on the nature of collaboration (Baggs, Miller, Sexton,2002).” Showing that nurses and physicians are where the problems seems to lye

The use of Olanzapine is contraindicated in patients with diseases such as dementia or diabetes mellitus. Caution should also be taken when administering olanzapine to patients with cardiac defects, liver problems and patients with a history of seizures. If allergic to any of the ingredients within the drug or if the individual is pregnant it should also not be administered. The dosage of the drug may need to be altered if the individual smokes and the consumption of alcohol is not also not advised when taking the drug (Keefe, R. S., et al (2014), (Heres, S., et al

Yuma Regional Medical Center (YRMC) does not currently have a standardized delirium prevention protocol or policy

With nursing staff continuing the medication regime without assessing new needs patient X may have, those goes against the practice standard set out by CNO practice guidelines. Alongside frequent sedation, patient X’s ability to engage in activities of daily living are compromised such as maintaining a consistent sleep schedule, eating at appropriate/regular meal times, and socializing with others. All these factors in patient X’s situation reveal how the deontological theory was not being followed in her care, making chemical restraints an ethical

In the Delirium Assessment and Management as found on the American Association of Critical-Care Nurses the organization indicate delirium is a major problem that can affect up to eighty percent of patients that are admitted to the ICU (“American Association of Critical-Care Nurses”, 2015). Additionally, complications associated with delirium such as longer LOS in the hospital and ICU as well as increased time on the mechanical ventilator increases mortality and costs which can range from “$4 billion and $16 billion annually in the US” (“American Association of Critical-Care Nurses”, 2015). In the past many health care providers and nurses gave delirium a laissez-faire attitude by assuming delirium will resolve itself when they are leave

In the research article Flagg, Cox, Mcdowell, Mwose and Buelow (2010) focus on nurses’ ability to recognize delirium on both intensive care unit and medical- surgical units. The authors argued that only by improving knowledge of nurses on presenting symptoms and consequences of delirium, detecting delirium among the patients at early stages will be more practical and effective. Study was conducted using Barriers to Delirium Assessment to indulge critical thinking, clinical reasoning, and reflection among nurses. The result showed that nurses assumed standard neurological examination as delirium identifier. “A lack of knowledge about delirium is likely the main factor preventing nurses from routinely assessing for delirium in patients” (Flagg,