Podcast
Questions and Answers
Which factor is most likely to contribute to ICU delirium due to the ICU environment itself rather than patient-specific conditions?
Which factor is most likely to contribute to ICU delirium due to the ICU environment itself rather than patient-specific conditions?
- Use of benzodiazepines for sedation. (correct)
- Severity of the patient's illness upon admission.
- History of alcohol abuse.
- Pre-existing dementia.
A patient in the ICU exhibits lethargy, decreased psychomotor activity, and reduced alertness. Which type of delirium is the patient most likely experiencing?
A patient in the ICU exhibits lethargy, decreased psychomotor activity, and reduced alertness. Which type of delirium is the patient most likely experiencing?
- Mixed delirium.
- Hyperactive delirium.
- Normoactive delirium.
- Hypoactive delirium. (correct)
Why is regular screening for delirium using tools like CAM-ICU important for ICU patients?
Why is regular screening for delirium using tools like CAM-ICU important for ICU patients?
- To identify delirium early, enabling prompt intervention and management. (correct)
- To ensure patients receive adequate pain medication, preventing discomfort.
- To promote social interaction and reduce feelings of isolation.
- To minimize the use of invasive devices, reducing the risk of infection.
Which of the following non-pharmacological interventions is LEAST likely to prevent or manage delirium in ICU patients?
Which of the following non-pharmacological interventions is LEAST likely to prevent or manage delirium in ICU patients?
An elderly patient with a history of mild cognitive impairment is admitted to the ICU after surgery. Which of the following preventative measures is MOST important to include in their care plan to reduce the risk of delirium?
An elderly patient with a history of mild cognitive impairment is admitted to the ICU after surgery. Which of the following preventative measures is MOST important to include in their care plan to reduce the risk of delirium?
A patient in the ICU is diagnosed with delirium. Their family is concerned and asks what might have contributed to this condition. Which of the following factors could be playing a role?
A patient in the ICU is diagnosed with delirium. Their family is concerned and asks what might have contributed to this condition. Which of the following factors could be playing a role?
Which of the following assessment findings would be LEAST indicative of delirium in an ICU patient?
Which of the following assessment findings would be LEAST indicative of delirium in an ICU patient?
Which of the following statements best describes the relationship between inflammation and ICU delirium?
Which of the following statements best describes the relationship between inflammation and ICU delirium?
What is the PRIMARY reason for prioritizing non-pharmacological interventions over pharmacological interventions in the prevention and management of ICU delirium?
What is the PRIMARY reason for prioritizing non-pharmacological interventions over pharmacological interventions in the prevention and management of ICU delirium?
Which of the following strategies is MOST likely to promote a healthy sleep-wake cycle and reduce the risk of delirium in an ICU patient?
Which of the following strategies is MOST likely to promote a healthy sleep-wake cycle and reduce the risk of delirium in an ICU patient?
Flashcards
ICU Delirium
ICU Delirium
Acute disturbance in attention and awareness with disorganized thinking, fluctuating in severity, common in ICU patients.
Hyperactive Delirium
Hyperactive Delirium
Increased psychomotor activity, agitation, and restlessness.
Hypoactive Delirium
Hypoactive Delirium
Decreased psychomotor activity, lethargy, and reduced alertness.
Age as a Risk Factor
Age as a Risk Factor
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Cognitive Impairment
Cognitive Impairment
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Substance Abuse History
Substance Abuse History
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Sedative/Analgesic Use
Sedative/Analgesic Use
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Sleep Disruption
Sleep Disruption
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Reorientation
Reorientation
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CAM-ICU
CAM-ICU
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Study Notes
- ICU delirium involves an acute disturbance in attention and awareness
- Disorganized thinking or altered consciousness levels often accompany it
- Delirium develops rapidly and varies in severity
- It's a common issue for ICU patients
Types of Delirium
- Hyperactive delirium shows as increased psychomotor activity, agitation, and restlessness
- Hypoactive delirium shows as decreased psychomotor activity, lethargy, and reduced alertness, often undiagnosed
- Mixed delirium includes both hyperactive and hypoactive features, fluctuating between the two
Diagnostic Criteria
- Key signs are disturbance in attention and awareness
- It develops quickly, hours to days, marking a change from the patient's normal state
- The disturbance varies throughout the day
- Cognition is also disturbed, affecting memory, orientation, language, visuospatial skills, or perception
- These disturbances aren't due to other neurocognitive disorders
- Evidence from medical history, exams, or lab results confirms it's a direct result of a medical condition, substance use, or toxin exposure
Risk Factors for ICU Delirium
- Patient-related risks:
- Older age significantly raises the risk
- Existing cognitive issues like dementia are major factors
- Alcohol or substance abuse history increases risk
- Severity of illness is a key indicator
- Existing medical conditions like infections or neurological diseases
- ICU environment and management risks:
- Certain medications, like sedatives and opioids
- Physical restraints can worsen delirium
- Invasive devices, such as catheters and mechanical ventilation
- Sleep deprivation and disrupted sleep cycles due to ICU conditions
- Immobility or limited activity
- Social isolation and minimal interaction
- Inflammatory biomarkers link to delirium
- Genetic factors can increase susceptibility
- Dehydration and electrolyte imbalances contribute
- Poorly managed pain can lead to delirium
- Urinary retention or fecal impaction also contribute
- Sensory impairments like vision or hearing deficits
- ICU admission itself is a risk due to the environment and procedures
Prevention Strategies
- Non-drug interventions are the first choice
- Regularly remind the patient of the time, place, and their identity
- Offer cognitive stimulation through talks, reading, and puzzles
- Involve family for support and familiarity
- Control pain with non-opioid options when possible
- Reduce the use of high-risk medications like benzodiazepines
- Use minimal sedation when needed, considering daily interruptions
- Encourage early movement and physical therapy
- Improve sleep by managing noise and light, and coordinating care activities
- Correct sensory issues with aids like glasses or hearing aids
- Ensure proper hydration and nutrition
- Medication is for when non-drug methods aren't enough
- Antipsychotics can manage agitation and psychosis from delirium
- Medications address withdrawal symptoms from substance dependence
- Drugs should target symptoms and causes, reducing side effects
Monitoring and Assessment
- Regular screening using assessment tools is important
- CAM-ICU is a common tool for diagnosing delirium in ICU
- ICDSC is another validated tool
- Monitor at least once per nursing shift, or more often for high-risk patients
- Full assessment includes cognitive tests, medication review, and identifying potential causes
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