Podcast
Questions and Answers
What does the acronym THINK stand for?
What does the acronym THINK stand for?
Toxic Situations, Hypoxia, Infection, Nonpharmacologic -being ignored, K+ or electrolyte problems
Which of the following is NOT considered a risk factor for ICU delirium?
Which of the following is NOT considered a risk factor for ICU delirium?
Which of the following is considered a nonpharmacologic risk factor for ICU delirium?
Which of the following is considered a nonpharmacologic risk factor for ICU delirium?
What is the main pathophysiological mechanism that can lead to ICU delirium?
What is the main pathophysiological mechanism that can lead to ICU delirium?
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The RASS scale is used to assess pain levels.
The RASS scale is used to assess pain levels.
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The CAM-ICU tool is used to assess pain levels in patients in the ICU.
The CAM-ICU tool is used to assess pain levels in patients in the ICU.
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Which of the following is NOT a feature of hyperactive delirium?
Which of the following is NOT a feature of hyperactive delirium?
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What is the recommended level of sedation for ICU patients based on the RASS scale?
What is the recommended level of sedation for ICU patients based on the RASS scale?
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Which of the following is a priority for intervention in a patient with delirium?
Which of the following is a priority for intervention in a patient with delirium?
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Which of the following is an example of a non-opioid pain medication?
Which of the following is an example of a non-opioid pain medication?
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The use of benzodiazepines for sedation is generally recommended for ICU patients.
The use of benzodiazepines for sedation is generally recommended for ICU patients.
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A spontaneous breathing trial is part of the ABCDEF bundle.
A spontaneous breathing trial is part of the ABCDEF bundle.
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Which of the following interventions is NOT recommended for a patient with delirium?
Which of the following interventions is NOT recommended for a patient with delirium?
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What is the goal of progressive mobility for ICU patients?
What is the goal of progressive mobility for ICU patients?
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What is the primary objective of Family engagement and empowerment for a patient with delirium?
What is the primary objective of Family engagement and empowerment for a patient with delirium?
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Which of the following is NOT a common medication used to treat delirium?
Which of the following is NOT a common medication used to treat delirium?
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The use of physical restraints is often considered an effective strategy for managing delirium.
The use of physical restraints is often considered an effective strategy for managing delirium.
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Study Notes
Upcoming Assignments and Deadlines
- Psychosis Discussion Board due this Sunday
- Davis Post Class Quiz: Psychosis due this Sunday
- Saunders: Psychosis & Mobility due this Sunday
- CJE Remediation due this Sunday
- Next week: CJE- MS2 Benchmark Exam, Review Day, Plan of Care, Final Evals
Psychosis and ICU Delirium
- Psychosis is defined as abnormalities in five domains: delusions, hallucinations, disorganized thought, disorganized/abnormal motor behavior, and negative symptoms.
- ICU delirium is an acute onset of cerebral dysfunction with three key features: change or fluctuation in baseline mental status, inattention, and either disorganized thinking or altered level of consciousness.
- Risk factors for ICU delirium include older age, drugs, sensory deficits (eyes, ears), low oxygen, infection, retention, intracranial events (rare), underhydration, and metabolic issues involving electrolytes.
- Pathophysiology of ICU delirium involves neurotransmitter dysregulation, systemic inflammation, mitochondrial dysfunction, and hypoxia.
Learning Objectives
- Review the introduction to psychosis, including anatomy, physiology, pathophysiology, and risk factors.
- Outline the pathophysiology of psychosis related to ICU delirium, including polypharmacy, infection, illness, and sensory changes during ICU admission.
- Document assessment findings for patients with ICU delirium (using tools like RASS and CAM-ICU).
- Plan safe, evidence-based care for psychosis in the ICU setting.
- Apply pharmacology to treat psychosis, specifically in the ICU setting.
- Collaborate with the healthcare team to manage ICU delirium.
- Apply pathophysiology knowledge to reduce potentially life-threatening complications related to psychosis in ICU delirium.
- Provide health teaching for patients & families about psychosis and ICU delirium.
- Evaluate the effectiveness of nursing care in the setting of hospital-induced psychosis or delirium.
Diagnostic Tests
- CAM-ICU, pCAM-ICU, psCAM-ICU, ICDSC
Classification of Delirium
- Hyperactive: Agitation, restlessness, hallucinations, emotional changes.
- Hypoactive: Confusion, lethargy, sedation, slowed motor function.
- Mixed: Combination of hyperactive and hypoactive symptoms.
ICU Day #2 Case Study
- 72-year-old female with a right hip fracture in the ICU.
- Vital signs and other details provided.
- Patient receiving fentanyl, propofol, and is mechanically ventilated.
- Patient has not left the bed since admission to the emergency department.
Key Nursing Management for Delirium
- Assess and manage pain routinely.
- Conduct both awakening and breathing trials.
- Select sedation and analgesia medications carefully.
- Assess for delirium.
- Promote early progressive mobility.
- Engage and empower family members.
Other Non-Pharmaceutical Strategies
- Promote sleep/wake cycles.
- Reorient the patient.
- Minimize or disguise lines/tubes.
- Avoid restraints.
Medications
- Haloperidol, Risperidone, Olanzapine, Quetiapine are examples of antipsychotic medications.
- Dexmedetomidine or Propofol are often used instead of benzodiazepines for sedation.
- The lightest level of sedation needed (RASS -2 or higher)
Assessing Sedation Effectiveness
- Evaluate for asynchrony with the vent.
- Use a validated tool such as RASS.
- Ask the family for feedback about the patient's comfort.
- Monitor brain waves with BIS.
Patient Priority Intervention (Case Study)
- Start a low-dose antipsychotic (haloperidol).
- Begin intermittent bolus doses of benzodiazepines.
- Discontinue dexmedetomidine and fentanyl.
- Ensure ABCDEF bundle implementation.
Interrelated Concepts
- Communication, Health Care Systems, Psychosis, Health Promotion, Patient Education.
Extending Learning
- Build a plan of care (POC) using a class template.
- Compare/contrast Alzheimer's and ICU Delirium.
- Review classmates' discussion posts, provide comments, or ask questions.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
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Description
Test your knowledge on psychosis and ICU delirium with this quiz. Explore key concepts including definitions, risk factors, and the pathophysiology related to these conditions. Prepare for your upcoming assignments and deepen your understanding of psychiatric assessments in critical care.
