ICU Psychosis Case Study

This paper addresses the effects of nursing interventions on the prevention and management of intensive care unit (ICU) psychosis. ICU psychosis (or ICU delirium) is a sudden onset of confusion, lethargy, hallucinations, and distress during an ICU stay. ICU psychosis is distressing to the patient, family, and nursing staff, and can result in detrimental health outcomes. ICU psychosis is relatively unstudied and untreated, yet highly prevalent in the ICU (Idemoto, 2007). With the implementation of the Confusion Assessment Method in the ICU (CAM-ICU), it is now estimated that 87% of all ICU patients experience delirium (Dimensions of Critical Care Nursing). ICU psychosis can impact the patient’s psychological and cognitive health and complicate

She analyzes the benefits of identifying and diagnosing delirium, the short term and long term effects of delirium on a patient, and nursing interventions to prevent and manage delirium (Volland, 2015). At Johns Hopkins, using the acronym DELIRIUM allows ICU nurses to identify risk factors including, “dementia; electrolyte disorders; lung, liver, heart, kidney, brain; infection; rx (prescription) drugs; injury, pain, stress; unfamiliar environment; metabolic” (Volland, 2015). With ICU nurses better trained in identifying these risks, they can alert the medical team and interventions can be implemented to decrease the effects and length of psychosis. Effective interventions studied were: addressing any underlying medical issues; creating a more relaxed environment that is conducive to sleep and decreased anxiety; distinguishing between night and day by adjusting the lights and announcing the day and time to the patient; and conversing with the patient (Volland,

This involved 21 hospitals over the course of one year and required a multidisciplinary team to improve the hospital’s system of identifying and treating delirium in the ICU (Adams, 2015). A patient centered, evidence-based plan was created to decrease incidences and decrease cost to the hospital system. A multidisciplinary team of nurses, physicians, and physical therapists were enlisted to develop the plan CAM-ICU became a part of the electronic medical administrative record flow chart and nurses were trained accordingly. CAM-ICU evaluated several aspects of delirium: “(i) acute change in mental status… (ii) inattention, (iii) disorganized thinking, and (iv) altered level of consciousness” (Adams, 2015). Patients were screened once in the morning and once in the afternoon so that their sleep schedule was not interrupted. Any positive CAM-ICU reports were sent to the physician and the physician and care team were encouraged to discuss delirium during daily rounds (Adams, 2015). If a patient had a positive CAM-ICU, nursing interventions were implemented to minimize the effects of the delirium. Reports show improved adherence to diagnostic tools, decreased usage of benzodiazepines, and increased implementation of nursing