Critical care nursing quarterly
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Case Reports
Intensive care unit psychosis revisited: understanding and managing delirium in the critical care setting.
Delirium occurs frequently in critically ill patients, yet this syndrome is often unrecognized and poorly understood. Health professionals must recognize delirium and patients at risk because delirium can lead to higher morbidity rates and longer lengths of stay. Various disease states and pathophysiologic disorders cause delirium, as do many commonly used drugs. ⋯ Treatment of delirium focuses on finding the cause and managing the symptoms, often with the use of pharmacologic agents. Critical care nurses need to perform cognitive assessments so that deficits can be recognized and specific interventions for prevention of cognitive impairment can be used. Appropriate nursing care can lessen the severity of delirium, shorten its course, and decrease the morbidity associated with the syndrome.
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Penetrating head injuries are a significant public health problem in the United States, with an estimated 33,000 gun-related deaths and many more nonfatal shootings per year. Initial treatment for a penetrating head injury is similar to that of a closed head injury. That is, all efforts must be made to prevent any secondary insults, hypoxia, or ischemia. ⋯ Others have said that patients with a low coma score and transventricular gunshot wounds should not be treated because of the high mortality. If the patient survives a penetrating head injury, he or she generally goes on to experience a relatively good functional outcome. Only if all components of a good treatment regimen are in place will patients and their families obtain the best possible outcome.