Essay about Preventing and Assessing Intensive Care Unit Delirium

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.

While there was a policy in place for conscious sedation, even good policies rely on the vigilance of staff to adhere to them. Often times, working conditions allow for distractions, and even the best of practitioners, with the best of intentions, make errors. There were several areas presented in this scenario that require examination and improvement.

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

Does the compliance with a sedation protocol improve after nurses receive a sedation competency over a three month period?

The Association of Anaesthetists of Great Britain and Ireland (AAGBI, 2010) accentuated that when looking after a patient during anaesthetic care, the anaesthetic nurse must be competent in any circumstances for the safety of patient. On the case of Mrs D, there was an obvious need to communicate, so the anaesthetic nurse needs to be trained and encouraged appropriately (Mellanby, Podmore and McNarry, 2014). It is evident that the anaesthetic nurse needs to be confident enough when looking after patients to voice any concerns to the assembled team, regardless of how senior or intimidating they may appear (NMC, 2015). The anaesthetic nurse said that she communicated with the anaesthetists during this critical incident. Yet, the anaesthetists

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

Over one-third of the surgeries in the United States are performed on patients aged 65 and older, and delirium is one of the most common postoperative complications in this population. Despite the high incidence of delirium, the syndrome often goes undiagnosed. Postoperative delirium is associated with adverse functional and cognitive outcomes, increased hospital length of stay, cost of care, and mortality rate. Knowledge of the risk factors that predict postoperative delirium will aid early identification of the patients at highest risk in order to facilitate preoperative optimization by managing comorbidities or employing targeted prevention strategies.

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.

Breeding, et al. (2013) states that there are a number of published documents addressing the quality, safety, and explicitly medication safety within ICUs worldwide. A large proportion of these studies focused on specific interventions such as: (1) creating “No interruption zones”; (2) addressing drug incompatibilities; (3) implementing automatic drug dispensing systems or electronic prescription of medications; or (4) implementing an ICU pharmacist role (Breeding, et al., 2013, p. 59). It is essential for multidisciplinary teams to be formed for medication safety promotion within this population. These teams would include physicians, pharmacists, and nurses (to also include advanced practicing nurses [APRN], such as nurse practitioners [NPs] or clinical nurse specialists

According to Mc Donnell & Timmons (2012), “Acute delirium is a preventable, treatment, disorder of consciousness and cognition that commonly presents across many healthcare settings, including older care facilitates, medical and surgical ward, intensive care units and children’s ward”(p.2488). In their article, A quantitative exploration of the subjective burden experienced by nurses when caring for patients with delirium, Mc Donnell and Timmins outline a descriptive study. Even though prevention and treatments are well recognized, dealing with delirium can be very difficult. The purpose of this study is to examine the subjective burden nurses experience when caring for patients with delirium and to identify the individual aspects of delirium that nurses find most difficult to deal with. In the introduction of the article, the authors argue that beyond qualitative studies there is insufficient practical research on the impact and burden of delirium on nurses in practice (Mc Donnell & Timmins, 2012). This argument outlines the premise behind the research. It is not a research question, but a statement of belief upon which they draw in framing the purpose and focus of their research. The authors articulate their recognition of the fact that many researchers have only focused on the diagnosis, treatment, and prevention for delirium. In addition, they also recognized that nurses often lack knowledge and understanding

The aim of the study was to explore family members’ experiences with the use of a diary when a sick relative did not survive the stay in the ICU. The overall study findings revealed that the diary was experienced as a medium for interpersonal communication, where it was perceived as a social medium maintaining communication and the relationship with the patient. But the diary was also a common interest affecting writers and readers in different ways, thus sharing information, emotions and thoughts enabled relationships, which grew. Not only relationships developed but also participants as humans due to the course of events and finally the death of the patient. The experience was compared to taken on a journey but in an existential way by the participants. To understand the unfamiliar in a way different from the way in which it has been understood so far, also include a way to understand him/herself in a new way (Gadamer, 1989).

Does the compliance with a sedation protocol improve after nurses receive a sedation competency over a three month period? The available data supported the hypothesis that nursing education and competency can lead to consistent best practices and positive outcomes for patients. The answers to this research question can help develop interventions that support best practices for patients who are mechanically ventilated and receiving intravenous sedation.

Delirium is one of the most cognitive, most fatal, and most life threatening disorders of the mind (Laura,2015). This disorder is explained by the small alternating changes in the mental status, with random thoughts, and strange levels of consciousness (Laura,2015). People with delirium can have high levels of confusion, small losses of memory, and will also have no idea where they are or what is happening around them. It is even possible for patients to be able to hear certain things that aren’t really there, but it could seem extremely real to them, like random sounds in walls or tables; it is almost impossible for them to think clearly (Laura,2015). Immediately getting treatment is the most important thing for someone with delirium in order