Professional Documents
Culture Documents
Journal Critique On Confusion Running Head: Journal Critique On Confusion 1
Journal Critique On Confusion Running Head: Journal Critique On Confusion 1
[Course]
.
Journal Critique on Confusion 2
What a Nurse Can Do without Doctor’s Help for a Patient Experiencing Confusion
Since the times of Florence Nightingale, “the lady with the lamp”, people have an unshaken
belief in the abilities of nurses. Most of the people think that, if permitted by the law, nurses
are assigned duties of doctors they usually have the desired level of skill, compassion,
commitment to patient care, diligence and thoughtful knowledge and dedication to carry out
Summary of the Article - Truman, B., Ely, W. E. Monitoring Delirium in Critically Ill
Patients: Using the Confusion Assessment Method for the Intensive Care Unit. Critical Care
Critical care nurses should be well aware that various patients in ICUs experience some
degree of cognitive impairment, ranging from coma to delirium. Before surgery and
providing lifesaving, supportive care, patients are normally given some potent psychoactive
For many nurses, this is expected and of little consequence. But recent studies show that
delirium, one of the repeated problems in the ICU, is actually an autonomous risk factor for
extended length of stay and that various patients who experience delirium may have extended
memory deficits even after discharge from the hospital. Studies have shown that delirium
goes under-recognized two thirds of the time. In this review the author has discussed the key
features of delirium, its etiology, its risk factors and interventions to minimize this
complication. Delirium requires early recognition. Once delirium is detected, efforts should
Nonpharmacological Interventions
Despite primary prevention some degree of delirium is expected in the ICU. Even though, not
the data present mainly focuses on reducing risk factors. A few of the most prevalent
activities many times a day, following a nonpharmacological nap procedure, using activities
involving mental presence, making patient(s) use eye glasses and magnifying lenses, making
patients use hearing aids and encouraging their removing earwax, correcting dehydration as
early as possible, and curtailing preventable noise and stimuli. According to a study, regular
execution of these interventions may result in a 40% decrease in the development of delirium.
Involving patients’ families can be helpful in reorienting and comforting delirious patients.
Pharmacological Interventions
The first to do is to determine if any of the current medications used by patient may be adding
to the delirium. Unsuitable drug treatment for sedation or analgesia may exaggerate delirium.
Patients who are delirious may become more unresponsive and confused when treated with
sedatives. Benzodiazepines which are often used in the ICU to treat "confusion" (delirium)
actually aggravate the problem. Currently, no drugs have been approved by the Food and
Drug Administration for the treatment of delirium. The guidelines of the Society of Critical
Critical care nurses can do a lot to improve patients’ quality of care by recognizing delirium
early on, finding out the causes, and dispensing educated care. ICU nurses as the front line
health care personnel can do a lot for assessing and observing delirium. Precise diagnosis and
immediate adjustment of the risk factors, that augment patient’s risk for delirium, may thwart
many undesirable outcomes associated with this phenomenon. Similarly, proper interventions
may help in decreasing the seriousness and/or duration of delirium. Prompt assessment of
delirium is the way to lessening the toll of delirium and increasing patients’ comfort in the
Journal Critique on Confusion 4
ICU. More studies are needed on the topic and especially on the use of delirium recognition
Reference
Truman, B., Ely, W. E. Monitoring Delirium in Critically Ill Patients: Using the Confusion
Assessment Method for the Intensive Care Unit. Critical Care Nurse April 2003;
http://ccn.aacnjournals.org/cgi/content/full/23/2/25