COGNITIVE ISSUES IN CRITICAL CARE NURSING

Learning Outcome
By the end of this session students should be able to:

1. Identify issues affecting cognitive function of patients admitted to CCU

2. Institute simple remedies in reducing factors affecting patients

normal cognitive functions and general health
 Cognitive Issues
 Patients in CCU may feel overwhelmed by equipment's around him

 Although equipment's essential for patient care, it may create an

environment foreign to patient which can result in disturbed cognition
(thought related function)

 Disease processes can affect cognitive function in a critically ill patient;

 For example:
 Patient with metabolic disturbances or hypoxia can experience confusion
and changes in sensorium (mental clarity)
 Cognitive Issues

 Many factors affect a patients cognitive

function while in CCU including:
1. Medication
2. Sensory input
3. Invasion of personal space
4. Emotional status
5. Medical diagnosis
6. Spiritual status
 MEDICATIONS
Some medications that can cause adverse CNS reactions & affect cognitive function
include:
Drugs Effects
Inotropic such as: Agitation, hallucination, malaise, dizziness,
Digoxin (Lanoxin) vertigo and paresthesia
Corticosteroids such as: Euphoria, psychotic behaviour, insomnia,
Prednisolone (Sterapred) vertigo, headache, paresthesia & seizure
Benzodiazepines such as: Drowsiness, sedation, disorientation,
Lorazepam (Ativan) amnesia, unsteadiness and agitation
Opioid Analgesics such as: Sedation, clouded sensorium, euphoria,
Oxycodone (Oxytocin) dizziness, lightheadedness and somnolence
 Sensory Input
 Sensory stimulation in any environment maybe perceived
as pleasant or unpleasant & comfortable or painful.
The CC environment tends to stimulate all five senses

1. Auditory -referring to hearing

2. Visual -referring to seeing
3. Gustatory -referring to sense of taste
4. Olfactory -referring to smell
5. Tactile -sensation of touch
 Sensory Input
Patients on ICU don’t have control over the environmental stimulation around
them. They may experience sensory deprivation, sensory overload or both

Sensory deprivation can result from: Sensory overload results from an

A reduction in the quantity and
quality of normal & familiar sensory
input such as:
The normal sights and sounds
encountered at home
increase in:
The amount of unfamiliar sounds &
sights in CC environment such as:
Beeping cardiac monitors, ringing
telephones, overhead paging systems
and voices.
 Sensory Input
 When environmental stimuli accede the patients ability to cope
with the stimulation, the patient may experience anxiety,
confusion and panic

 Sensory deprivation or overload can lead to such problem as:

1.Sleep disturbances,
2.Reality disturbances and
3.Delirium
 Sensory deprivation or overload
1. Sleep disturbance
Noisiness of CC environment is a major cause

 Other factors that interfere with sleep on the CCU include;

Nursing interventions, pain and fear

Sleep deprivation can cause –anxiety, restlessness, disorientation

depression, irritability, confusion,
combativeness & hallucinations
 Sensory deprivation or overload
Sleep Deprivation can cause further medical problems such as:
 Immunosuppression
 Decreased pain tolerances
 Decreased muscle strength

In other words sleep deprivation can impede the recovery process and contribute
to new problems

TO PROMOTE REST –the CC nurse can take steps to provide a quieter

environment:
reduce light
reduce noise by communicating quietly
 2. Reality disturbance

• Integration of the senses is necessary for the person to process

environmental information.
• Disturbance in reality occur when a patients ability to interpret the
environment is altered.
• Examples of reality disturbances are:

 Disorientation to time
 Inability to decipher whether its night or day
 Misinterpretation of environmental stimuli,
 For example: thoughts that alarms and noises from
equipment's are phones ringing for the patient
 2. Reality disturbance

• Hearing or vision lost or loss of consciousness (caused for example

by a head injury) can make a patient especially vulnerable to reality
disturbance

• Lack of one or more sensory mechanisms that are necessary to

function make it hard for the patient to adapt to the CC
environment
 3. Delirium
• Delirium (acute confusion) is an altered state of consciousness, consisting of :
confusion, distractibility, disorientation, delusional thinking,
defective perception and agitation.

• When it occurs in a CC environment, its commonly called ICU Psychosis

• It has a rapid onset and is generally reversible

The nurse can assist the patient suffering from ICU Psychosis by:
*promoting rest, *controlling pain, *monitoring the effects of new medications
*decreasing noise & light in the room, *encouraging mobility when possible,
*providing orientation to the patient
 Invasion of personal space

• Personal space is the unmarked boundary or territory around a person

• Several factors such as:

cultural background & social situation influence a patients interpretation

of personal space

A patients personal space is limited in many ways by CC environment. For

example; due to the confines of bed, rest, lack of privacy and use of invasive
equipment
 Invasion of personal space

• Nurses can try to increase patients sense of personal space even with in the
CC environment by simply remembering to show common courtesy such
as:
• Asking permission to perform a procedure or look at a wound or dressing
• Pulling curtain over or closing the door
• Knocking before entering the patients room
 SUMMARY
1. Name some factors that affect patients cognitive function while admitted to a CCU
Medication/ Sensory input/ Invasion of personal space/ Emotional status/ Medical diagnosis/
Spiritual status

2. Name 1 drug that can cause adverse CNS reaction & affect cognitive function
Inotrope –digoxin/ corticosteroids –prednisolone/ Benzodiazepines –lorazepam/ Opioid analgesic –
oxycodone

3. Name some problems caused by sensory deprivation or overload

Sleep disturbances/ Reality disturbances and Delirium

4. What can the nurse do to promote rest in CCU?

Reduce light/ reduce noise by communicating quietly

5. Invasion of personal space is also a factor affecting cognitive function of a patient in CCU. How best
can a nurse increase patients sense of personal space
• show common courtesy such as:
asking permission to perform a procedure or look at a wound or dressing.
Pulling curtain over or closing the door/ Knocking before entering the patients room