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Icu psychosis

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  • 1. ICU SYNDROME/ICUPSYCHOSISPresented byBasil Kuriakose
  • 2. INTRODUCTION Advances in medical science and technology haveprompted the establishment of many highlyspecialized units (ICUs) providing intensive patientcare. ICU psychosis /Delirium in the intensive care unit isa serious problem that has recently attracted muchattention. As the number of intensive care units and thenumber of people in them grow, ICU psychosis isperforce increasing as a problem.
  • 3. DEFINITION Eisendrath defined "ICU Syndrome" /"ICUpsychosis" as an acute organic brain syndromeinvolving impaired intellectual functioning andoccurring in patients treated within a critical careunit.
  • 4. INCIDENCE It is commonly found in the critically ill with a reportedincidence of15-80% By some estimates, 80% of elderly intensive-carepatients develop the condition, which frequently leads tonursing home stays and a hastened death.
  • 5. 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
  • 6. CLINICAL MANIFESTATIONSSudden onset of impairment in cognition Disorganized thinking Difficulty in concentrating Problems with orientation in time and/or placeand/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
  • 7. DIAGNOSTIC EVALUATION Confusion Assessment Method Mini mental status examination Explore other organic causes
  • 8. 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 andperson. Clock, calendar, TV, newspaper, radio readilyaccessible as a means of orientating in time
  • 9.  Simplify the environment, single room whenavailable, reduce noise levels, remove unnecessaryequipment 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 andmassage may also help.
  • 10. PHARMACOLOGICAL MANAGEMENT Antipsychotic agents such as haloperidol iscommonly used. Olanzapine and respiridone have been used asthey are less sedating and have fewer side effects Benzodiazepine would be beneficial, andlorazepam is the drug of choice.
  • 11. OTHER THERAPEUTIC MEASURES Adequate pain management Avoid offending drugs Correct fluid and electrolytes Treat infection Administer oxygen Correct hypoglycemia Treat underlying cardiac problems
  • 12. ASSIGNMENT Do a concealed observation of your ICU and find outthings and factors that can be avoided to preventICU syndrome also suggest some measures toprevent ICU syndrome. Formulate a scale to assess ICU syndrome
  • 13. REFERENCES Lewis, Heitkemper, Dirksen O’Brien, Bucher. MedicalSurgical Nursing. Seventh edition. Nodia: Elsevierpublication; 2007.p no-1576-78,1736-37. Mark Borthwick. Richard Bourne. Mark Craig. AnnetteEgan. Prevention and Treatment of Delirium in CriticallyIll Patients. United Kingdom Clinical PharmacyAssociation. June. 2006. Granberg. Malmros. Bergbom. Lundberg. Intensive CareUnit 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 CareUnhinges the Mind. The New York Times. December 8,1998. Richard C. Monks. Intensive Care Unit Psychosis.Canadian Family Physician. Vol. 30: February 1984, PNo- 383-389