Icu Delririum Increases Hospital Length of Stay Essay Example

It was suggested that nurses and other healthcare professionals need comprehensive education on delirium, along with reliable and understandable assessment tools, and keen clinical observation skills (Litton, 2003). The author further concluded that implementing these measures would result in appropriate patient management, ultimately reducing morbidity and improving long-term outcomes. The concept of ICU delirium is intricate and challenging to define; it can be described as acute confusion and agitation in critically ill patients. Delirium is typically characterized by a fluctuating course, deficits in attention concentration, impaired cognition, disorganized thinking, and an altered level of consciousness, occurring alongside an underlying organic cause such as medical illness or drug use/withdrawal (American Psychiatric Association, 1994; Litton, 2003).

While there may be varying definitions of delirium, there is a consensus about the symptoms commonly seen in ICU delirium, such as delusions, hallucinations, disorientation, and paranoia (Arend & Christensen, 2009). In the literature review, several terms were found to describe ICU delirium, including sundown syndrome, ICU psychosis, acute confusion, ICU syndrome, encephalopathies, and cognitive impairments (Marshall & Soucy, 2003). Other terms used to refer to ICU delirium include aggression and agitation and acute brain failure. Various defining characteristics of ICU delirium were identified throughout the literature.

The precise identification and management of ICU delirium, along with nurses' recognition and education for family members, is crucial. Delirium in the ICU is frequently overlooked or misdiagnosed but is a common issue. Accurate diagnosis is important to reduce hospital stay length and complications. To achieve positive outcomes in delirium cases, it's vital to evaluate its underlying cause and provide appropriate treatment (Litton, 2003). Once an accurate diagnosis is made, treatment plans can restore the patient's

previous cognitive state.

When addressing delirium, the initial step is to diagnose and treat the root physical cause. This may entail modifying or discontinuing medications that triggered the delirium, establishing a calm environment to promote sleep, and offering pain relief. For critical care nurses who dedicate significant time to patient care, it is imperative to possess the ability to identify and evaluate ICU delirium. By possessing adept assessment skills and utilizing appropriate tools, nurses can promptly detect cases of delirium.

The intensive care delirium checklist (Litton, 2003) is the most widely used tool for nurses to identify delirium. Nurses are usually the first to notice significant changes in a patient's behavior and mental state, and they communicate these observations to other healthcare professionals (Litton, 2003). Educating families is important when caring for patients with ICU delirium. The sudden onset of delirium can be disruptive and distressing for loved ones who knew the patient as coherent and rational just hours earlier (Litton, 2003). Families require education and reassurance about the cause of the delirium and the fact that the patient will return to their normal mental state once the cause is identified and treated.

Case Examples: This writer defines ICU delirium as acute confusion experienced by critically ill patients. The treatment of these patients should involve accurate diagnosis and early treatment, early recognition of delirium by nursing staff, and educating the patient's family.

Model Case: A patient admitted to the intensive care unit (ICU) develops complications following a cholecystectomy. After spending two days in the ICU, the patient starts displaying symptoms of acute confusion. He become convinced that he is in prison, complains about bugs crawling on the walls, and

experiences difficulty sleeping.

The nurse uses the intensive care delirium checklist and quickly determines that the patient is experiencing delirium. The nurse educates the family about ICU delirium and reassures them that the confusion is temporary and can be treated. The nurse informs the physician about this assessment and it is discovered, after reviewing the patient's chart, that pain medication is causing the confusion. The medication is stopped and two days later the patient is alert and oriented and no longer experiencing delirium. This case is exemplary because an accurate and early diagnosis was made, treatment was initiated promptly, and the nurse ensured the family received proper education.

Borderline Case A patient is admitted to the intensive care unit (ICU) after developing complications post hip replacement. After two days in the ICU, the patient exhibits acute confusion, mistaking the environment for a hotel, expressing fear of someone attempting to harm her, and experiencing difficulty sleeping. The nurse attending to her utilizes the intensive care delirium checklist and promptly recognizes that the patient is suffering from delirium. The nurse educates the patient's family about ICU delirium and provides reassurance that the confusion is transient and treatable.

The nurse notifies the physician about her assessment and is instructed to consult a psychiatrist. Throughout the day, the patient's confusion worsens and she becomes aggressive. The following day, the psychiatrist evaluates the patient and attributes her confusion to lack of sleep. A prescription for a sleep aid is given to the patient, and within three days, she wakes up, regains awareness, and no longer experiences delirium. This case is considered borderline as although the patient received appropriate diagnosis and treatment,

there was a delay in providing care. On another note, there is another scenario involving a patient who encounters complications after surgery and requires admission to the intensive care unit.

After spending two days in the intensive care unit, the patient shows signs of acute confusion, mistaking his surroundings for his own home and expressing worry about intruders. He also has trouble sleeping. The nurse quickly informs the doctor and requests medication to help relieve the patient's distress. Once given the medication, the nurse successfully helps the patient rest peacefully during the afternoon.

The patient displays ongoing confusion and combative behavior upon waking up. The nurse informs the family that this is common for patients in the patient's age group following surgery. To aid in managing the situation, additional medication is given to induce sleep. However, despite this, the patient remains confused throughout the night and subsequent days. After three days, a psychiatrist is consulted as requested by the family.

After examining the patient's medical records, it has been determined that the patient is having a negative reaction to a recently prescribed medication. As a result, the medication has been discontinued and this has led to an improvement in the patient's mental condition and a cessation of delirium symptoms. This particular case is notable due to the delayed diagnosis, which resulted in delayed treatment and an extended hospitalization. In terms of nursing significance, delirium is a common condition in ICU settings that can lead to higher rates of illness and death as well as longer hospital stays (Marshall & Soucy, 2003). Therefore, nurses have a crucial role in assessing and identifying cases of delirium in ICU settings.

The presence

of nurses at the bedside enables them to notice even slight changes in a patient's behavior, as stated by Arend ; Christensen (2009). It is mentioned by the authors that ICU delirium can result in financial implications for the National Health Services, including greater usage of ventilators and extended hospital stays. This is supported by information from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (Washington), published by the American Psychiatric Association.

C.: American Psychiatric Association. 1994 Arend, E., & Christensen, M.

The article titled "Delirium in the intensive care unit: a review" by Litton (2009) provides an overview of delirium in the critical care setting. The article was published in Nursing in Critical Care, volume 14, issue 3, pages 145-154.

(2003) Marshall, M. and Soucy, M. published an article titled "Delirium in the critical care patient: what the professional staff needs to know" in Critical Care Nursing Quarterly, volume 26, issue 3, pages 208-213.

The article "Delirium in the intensive care unit" was published in the Critical Care Nursing Quarterly in 2003. It was written by McNicoll, L., Pisani, M., and Zhang, Y. The article can be found on pages 172 to 178 of volume 26 (issue 3) of the journal.The article titled "Delirium in the Intensive Care Unit: Occurrence and Clinical Course in Older Patients" by Ely, E., Siegel, M., & Inouye, S. (2003) was published in the Journal of the American Geriatrics Society. It focuses on delirium and its occurrence and clinical course specifically in older patients within the intensive care unit setting. The article can be found on pages 591-598.The article "Dealing with ICU delirium" by Pierson (2007) can be found in Critical

Care Alert, volume 14(12), pages 89-91.