Page 48 - Critical Care Notes

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BASICS

Pain Assessment Scales
Pain Visual Analog Scale (VAS)
no pain 0 worst pain 10
no anxiety 5 severe anxiety
■ Nonverbal Adult Pain Assessment Scale (NVPS)
■ Behavioral Pain Scale (BPS)
■ Critical Care Pain Observation Tool (CPOT) for nonverbal adults
■ Faces Pain Scale
Pain Management
■ Continuous IV narcotic
■ Patient controlled analgesia
■ Epidural analgesia
Delirium
Delirium has been associated with poor patient outcomes. Patients with deliri-
um have higher ICU and hospital stays along with a higher risk of death. Usually
reversible. More common in elderly patients, patients with compromised men-
tal status, and mechanically ventilated patients. AACN recommends the THINK
mnemonic in determining the cause of delirium in ICU patients:
■ Toxic situations
■ HF, shock, dehydration
■ Deliriogenic meds (tight titration of sedatives)
■ New organ failure (e.g., liver, kidney)
■ Hypoxemia
■ Infection/sepsis (nosocomial)
■ Immobilization
■ Nonpharmacological interventions (Are these being neglected?)
■ Hearing aids, glasses, sleep protocols, music, noise control, ambulation
■ K + or electrolyte problems
May also be precipitated by hypertension, head trauma, and metabolic distur-
bances.
Delirium is characterized by an acute onset of mental status changes that
develop over a short period of time, usually hours to days. It may fluctuate over
the course of a day. It may be combined with inattention and disorganized think-
ing or altered level of consciousness. The DSM-IV TR describes three clinical
subtypes: hyperactive, hypoactive, and mixed. Hyperactive delirium may be
confused with anxiety and agitation.
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