icu psychosis

15
ICU SYNDROME/ICU PSYCHOSIS Presented by Basil Kuriakose

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Page 1: Icu psychosis

ICU SYNDROME/ICU PSYCHOSIS

Presented by

Basil Kuriakose

Page 2: Icu psychosis

INTRODUCTION

Advances in medical science and technology have prompted the establishment of many highly specialized units (ICUs) providing intensive patient care.

ICU psychosis /Delirium in the intensive care unit is a serious problem that has recently attracted much attention.

As the number of intensive care units and the number of people in them grow, ICU psychosis is perforce increasing as a problem.

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DEFINITION

Eisendrath defined "ICU Syndrome" /"ICU psychosis" as an acute organic brain syndrome involving impaired intellectual functioning and occurring in patients treated within a critical care unit.

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INCIDENCE It is commonly found in the critically ill with a

reported incidence of15-80% By some estimates, 80% of elderly intensive-care

patients develop the condition, which frequently leads to nursing home stays and a hastened death.

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ETIOLOGY AND PRE DISPOSING FACTORS

Sensory overload Sleep deprivation Immobilization Severe emotional stress Unfamiliar environment Dehydration Low Hemoglobin level Hypoxemia Pain Infection Drugs Prolonged stay in ICU and advancing age

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CLINICAL MANIFESTATIONS

Sudden onset of impairment in cognition Disorganized thinking Difficulty in concentrating Problems with orientation in time and/or

place and/or person Altered affect, often with emotional liability Altered perception of external stimuli Impairment of memory Changes in sleep–wake cycle Hallucinations Agitation or change in activity levels

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DIAGNOSTIC EVALUATION

Confusion Assessment Method Mini mental status examination Explore other organic causes

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MANAGEMENT

The management strategy is to “wait and watch”.Non Drug Management Continuity of health care personal Clear concise communication Repeated verbal reminders of time, place

and person. Clock, calendar, TV, newspaper, radio readily

accessible as a means of orientating in time

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Simplify the environment, single room when available, reduce noise levels, remove unnecessary equipment

Adjust lighting according to day and night cycle.

Keep familiar objects Flexible visiting hours Allow maximum periods of uninterrupted

sleep Encourage mobilisation and increase activity

levels Relaxation techniques like music therapy and

massage may also help.

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PHARMACOLOGICAL MANAGEMENT

Antipsychotic agents such as haloperidol is commonly used.

Olanzapine and respiridone have been used as they are less sedating and have fewer side effects

Benzodiazepine would be beneficial, and lorazepam is the drug of choice.

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OTHER THERAPEUTIC MEASURES

Adequate pain management Avoid offending drugs Correct fluid and electrolytes Treat infection Administer oxygen Correct hypoglycemia Treat underlying cardiac problems

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ASSIGNMENT

Do a concealed observation of your ICU and find out things and factors that can be avoided to prevent ICU syndrome also suggest some measures to prevent ICU syndrome.

Formulate a scale to assess ICU syndrome

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REFERENCES

Lewis, Heitkemper, Dirksen O’Brien, Bucher. Medical Surgical Nursing. Seventh edition. Nodia: Elsevier publication; 2007.p no-1576-78,1736-37.

Mark Borthwick. Richard Bourne. Mark Craig. Annette Egan. Prevention and Treatment of Delirium in Critically Ill Patients. United Kingdom Clinical Pharmacy Association. June. 2006.

Granberg. Malmros. Bergbom. Lundberg. Intensive Care Unit Syndrome/Delirium Is Associated With Anemia, Drug Therapy And Duration Of Ventilation Treatment. Acta Anaesthesiol Scand 2002; 46: 726–731

Sandeep Jauhar .When A Stay in Intensive Care Unhinges the Mind. The New York Times. December 8, 1998.

Richard C. Monks. Intensive Care Unit Psychosis. Canadian Family Physician. Vol. 30: February 1984, P No- 383-389