Critical care nursing quarterly
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Review Case Reports
Delirium in the intensive care unit: are we helping the patient?
The intensive care unit (ICU) represents a dynamic interaction between patient factors and interventional factors. The complexity of this situation can generate an impaired consciousness in the patients. The critical care provider is faced with deducing the etiology and treatment of delirium in the ICU. ⋯ Withdrawal syndromes, delirium tremens in particular, are known to cause delirium. By a combination of appropriate selection of medications and an awareness of delirium as a side effect, the patient in the ICU may be treated in a manner to minimize the clouding of consciousness. An understanding of the proposed pathophysiology of various types of delirium will allow appropriate clinical measures to be taken.
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Goals in the care of the mechanically ventilated patient are sedation, analgesia, anxiolysis, and muscle relaxation. Causes of distress in these patients include: pain, sleep deprivation, anxiety, psychosis, agitation, and delirium. ⋯ When caring for the agitated patient on the mechanical ventilator, physiologic, mechanical, and emotional causes must all be investigated. Finally, nonpharmacologic therapy is of utmost importance in the care of these patients.
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Drugs are among the most commonly administered therapeutic interventions received. In the intensive care unit (ICU), patients routinely receive more therapies than on general medical or surgical wards, and practitioners caring for these patients are presented with the challenge of monitoring each of these therapies for efficacy and toxicity. The goal of this article is to describe a conceptual approach that practitioners can use to monitor for drug efficacy and predictable and unpredictable adverse drug effects. Although therapeutic drug monitoring (TDM) assumes a relatively small role in the overall monitoring scheme, TDM is discussed because it serves an important function for a select group of agents.