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Journal Critique on Confusion 1


Journal Critique on Confusion

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Journal Critique on Confusion 2

Journal Critique on Confusion

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

the task at hand.

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

Nurse April 2003; Volume 23, Number 2, p 25-35.

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

drugs like benzodiazepines and opiates resulting in an increase in cognitive abnormalities.

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

focus on determining the cause and minimizing the effects of delirium.

Nonpharmacological Interventions

Despite primary prevention some degree of delirium is expected in the ICU. Even though, not

much data is available on primary prevention or use of non-pharmacological interventions,
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the data present mainly focuses on reducing risk factors. A few of the most prevalent

strategies are: frequently reorienting patient(s), supplying cognitively thought-provoking

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

Care Medicine recommend haloperidol for the treatment of delirium.

Personal Views about the Article

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
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ICU. More studies are needed on the topic and especially on the use of delirium recognition

tools in typical bedside evaluations.
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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;

Volume 23, Number 2, p 25-35. Retrieved October 28, 2008 at