What is ICU psychosis?

ICU psychosis is a disorder in which patients in an intensive care unit (ICU) or a similar setting experience a cluster of serious psychiatric symptoms. Another term that may be used interchangeably for ICU psychosis is ICU syndrome. ICU psychosis is also a form of delirium, or acute brain failure.

What causes ICU psychosis?

Environmental Causes Sensory deprivation: A patient being put in a room that often has no windows, and is away from family, friends, and all that is familiar and comforting. Sleep disturbance and deprivation: The constant disturbance and noise with the hospital staff coming at all hours to check vital signs, give medications, etc. Continuous light levels: Continuous disruption of the normalbiorhythms with lights on continually (no reference to day or night). Stress: Patients in an ICU frequently feel the almost total loss of control over their life. Lack of orientation: A patient's loss of time and date. Medical monitoring: The continuous monitoring of the patient's vital signs, and the noise monitoring devices produce can be disturbing and create sensory overload. Medical Causes Pain which may not be adequately controlled in an ICU Critical illness: The pathophysiology of the disease, illness or traumatic event - the stress on the body during an illness can cause a variety of symptoms. Medication (drug) reaction or side effects: The administration of medications typically given to the patient in the hospital setting that they have not taken before. Infection creating fever and toxins in the body. Metabolic disturbances: electrolyte imbalance, hypoxia (low blood oxygen levels), and elevated liver enzymes. Heart failure (inadequate cardiac output) Cumulative analgesia (the inability to feel pain while still conscious) Dehydration

What are the symptoms of ICU psychosis?

The cluster of psychiatric symptoms of ICU psychosis include:
extreme excitement, anxiety, restlessness, hearing voices, clouding of consciousness, hallucinations, nightmares, paranoia, disorientation,

 agitation, delusions, abnormal behavior, fluctuating level of consciousness which include aggressive or passive behavior.

In short, patients become temporarily psychotic. The symptoms vary greatly from patient to patient. The onset of ICU psychosis is usually rapid, and is upsetting and frightening to the patient and family members.

How is ICU diagnosed?

The diagnosis of ICU psychosis can be made only in the absence of a known underlying medical condition that can mimic the symptoms of ICU psychosis. A medical assessment of the patient is important to search for other causes of mental status abnormality such as:
stroke, low blood sugar, drug or alcohol withdrawal, and any other medical condition that may require treatment.

The patient's safety must be considered at all times.

How is ICU psychosis treated?

The treatment of ICU psychosis clearly depends on the cause(s). Many times the actual cause of the psychosis involves many factors, and many issues will need to be addressed to relieve the symptoms. A first step is a review of the patient's medications. The physician in charge of the patient along with the pharmacist can review each of the patient's medications to determine if they may be influencing the delirium. Family members, familiar objects, and calm words may help. Sleep deprivation may be a major contributing factor. Therefore, providing a quiet restful environment to allow the patient optimal sleep is important. Controlling the amount of time visitors are allowed to stimulate the patient can also help. Dehydration is remedied by administering fluids. Heart failure requires treatment with digitalis. Infections must be diagnosed and treated. Sedation with antipsychotic agents may help. A common medication used in the hospital setting to treat ICU psychosis is haloperidol. It should be understood that in saving a life in the critical environment, ICU psychosis sometimes may be a small price to pay for cutting edge, precise medical life-saving measures.

Can ICU psychosis be prevented?

The primary goal is to correct any imbalance, restore the patient's health, and return the patient to normal activities as quickly as possible. To help prevent ICU psychosis, many critical care units are now:
using more liberal visiting policies, providing periods for sleep, protecting the patient from unnecessary excitement,

 minimizing shift changes in the nursing staff caring for a patient, orienting the patient to the date and time, reviewing all medical procedures with an explanation about what to expect, asking the patient if there are any questions or concerns, talking with the family to obtain information regarding religious and cultural beliefs, and even coordinating the lighting with the normal day-night cycle, etc.

How long does ICU psychosis last?

ICU psychosis often vanishes magically with the coming of morning or the arrival of some sleep. However, it may last 24 hours or even up to two weeks with fluctuations of the level of consciousness and behavior patterns. Although it may linger through the day, agitation frequently is worst at night. (This phenomenon, called sundowning, is also common in nursing homes). Fortunately, ICU psychosis usually resolves completely when the patient leaves the ICU.

How common is ICU psychosis?

Some estimate that one patient in every three who spends more than five days in an ICU experiences some form of psychotic reaction. As the number of intensive care units and the patient population in them grow, the number of individuals affected by this disorder will correspondingly increase. With patients being transferred out of the ICU more rapidly than in years past; ICU psychosis may be more common in other areas such as the regular medical floor of the hospital or sometimes may even occur after discharge from the hospital.

What is an advance directive?

A witnessed document or oral statement in which instructions are given by a person to express desires related to health care decisions. Directive may include, but it not limited to, the designation of a health care surrogate, a living will, or an anatomical gift. A witnessed written document or oral statement voluntarily executed by a person that expressed the person's instructions concerning life-prolonging procdures. Informed consent, refusal of consent, or withdrawal of consent for healthcare, unless stated in an advance directive. Patient is physically or mentally unable to communicate a willful and knowing health care decision. Consent voluntarily given after sufficient explanation and disclosure of information. A competent adult who has not been expressly designated to make health care decisions for an incapacitated person, but is authorized by state statute to make health care decisions for the person. A competent adult designated by a person to make health care decisions should that person become incapacitated.

What is a living will?

What is health care decision?

What is incapacity or incompetent?

What is informed consent?

What is a proxy?

What is a surrogate?

What is terminal condition?

A condition in which there is no reasonable medical probability of recovery and can be expected to cause death without treatment. A permanent, irreversible unconsciousness condition that demonstrates an absence of voluntary action or cognitive behavior, or an inability to communicate or interact purposefully with the environment. Complete and irreversible cessation of brain function.

What is a persistant vegetative state?

What is brain death?

Nutritional Support in Critical Care

By Andrea Lott, eHow Contributor

In critical care, a patient receives treatment for a serious illness or injury. The goal of critical care is to eventually discharge the patient into an ambulatory care unit and eventually from the hospital entirely. To improve the effectiveness of the medicine and therapies given to the patient, staff members may provide nutritional support to the patient. Nutritional support in critical care gives the patient's body strength and resiliency for healing and recovery.

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Significance
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After experiencing the extreme trauma of an injury or acute illness, the body's metabolism can overextend, resulting in a loss of lean muscle and fat. Such a patient loses muscle and fat because of his body's overproduction of regulatory hormones when responding to the trauma, despite consuming what would otherwise be a healthy diet. Critical care nutrition regulates the body's use of sugar, protein and other fuels to best aid in the patient's recovery.

Types
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Health care professionals deliver nutritional support to patients in one of two ways if the patient is unable to consume adequate nutrition by mouth. One way is enteral feeding, which uses a feeding tube to deliver nutrition to the patient's digestive system. The other is parenteral feeding, which delivers nutrients to the patient intravenously. In general, doctors prefer enteral feeding whenever possible because it is less expensive and is less likely to cause low blood sugar, which can set the patient's recovery back. Doctors use parenteral feeding when enteral feeding is impossible due to digestive system problems or if there is a high likelihood of a patient aspirating the nutrition while on a ventilator.
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Benefits
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Doctors prescribe nutrition to their critical care patients that specifically addresses particular recovery needs. For instance, in a multi-center study cited in the Journal of Trauma (October 1994), researchers discovered that trauma patients experienced fewer incidents of multiple-organ failure when fed immune-enhancing nutritional formula. Immune-enhancing nutrition contains various proteins and omega-3 fatty acids to boost the patient's immune system and fight infection and sepsis. Other formulas support healthy respiratory, liver and kidney functions.

Considerations
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Doctors balance the nutrients a patient receives to best enhance the patient's bodily responses to illness. In critical care, many patients experience some time on a ventilator, or breathing machine. When fed a diet high in carbohydrates in relationship to fat, the body produces more carbon dioxide, making the patient on a ventilator work harder to eliminate the carbon dioxide and obtain oxygen. For this reason, a patient on a ventilator in critical care receives nutritional support with a higher fat-to-carbohydrate ratio than might be considered healthy in a person not on a ventilator.

Warning
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Patients receiving enteral feeding can suffer from uncomfortable symptoms such as diarrhea or constipation. Adjusting the type of nutrition the patient receives, the schedule on which she will receive the feedings or, in some cases, adjusting the placement of the tube to feed the person alleviates these symptoms in the majority of patients. Since some patients experience bowel atrophy while on parenteral feeding, causing digestive problems once oral feeding again becomes possible, doctors attempt to keep the patient on enteral feeding unless the patient aspirates large amounts of nutrition or experiences severe gut injury from the enteral feeding. Avoiding bowel atrophy helps patients make a speedier transition from IV or tube feeding back to eating.

Read more: Nutritional Support in Critical Care | eHow.com http://www.ehow.com/about_5519554_nutritional-support-critical-care.html#ixzz2D9AAtRvo

A chronic condition is a human health condition or disease that is persistent or otherwise long-lasting in its effects.[1] The term chronic is usually applied when the course of the disease lasts for more than three months.[1] Common chronic diseases include arthritis, asthma, cancer, COPD, diabetes and HIV/AIDS. A debilitating condition that interfere with an individual's way of living a normal life and dealing with the society brought about by different signs and symptoms lasting from 6 months and above.

Risk factors (Wikipedia)

While risk vary with age and gender, most of the common chronic diseases are caused by dietary, lifestyle and metabolic risk factors, that are also responsible for the resulting mortality. [4] Therefore these conditions might be prevented by behavioral changes, such as quitting smoking, adopting a healthy diet, and increasing physical activity. Social determinants are important risk factors for chronic diseases. [5] Social factors, e.g., socioeconomic status, education level, and race/ethnicity, are also a major cause for thedisparities observed in the care of chronic disease. [5] Lack of access and delay in receiving care result in worse outcomes for patients from minorities and underserved populations.[6] Those barriers to medical care complicate patients monitoring and continuity in treatment. Also, minorities and low-income populations are less likely to access and receive preventive services necessary to detect conditions at an early stage. [7]

Four Common Causes of Chronic Disease (Centers for Disease Control and Prevention )
Four modifiable health risk behaviorslack of physical activity, poor nutrition, tobacco use, and excessive alcohol consumptionare responsible for much of the illness, suffering, and early death related to chronic diseases.

More than one-third of all adults do not meet recommendations for aerobic physical activity based on the 2008
Physical Activity Guidelines for Americans, and 23% report no leisure-time physical activity at all in the preceding month.9 In 2007, less than 22% of high school students10 and only 24% of adults11 reported eating 5 or more servings of fruits and vegetables per day. More than 43 million American adults (approximately 1 in 5) smoke.12 In 2007, 20% of high school students in the United States were current cigarette smokers.13 Lung cancer is the leading cause of cancer death, and cigarette smoking causes almost all cases. Compared to nonsmokers, men who smoke are about 23 times more likely to develop lung cancer and women who smoke are about 13 times more likely. Smoking causes about 90% of lung cancer deaths in men and almost 80% in women. Smoking also causes cancer of the voicebox (larynx), mouth and throat, esophagus, bladder, kidney, pancreas, cervix, and stomach, and causes acute myeloid leukemia.14 Excessive alcohol consumption contributes to over 54 different diseases and injuries, including cancer of the mouth, throat, esophagus, liver, colon, and breast, liver diseases, and other cardiovascular, neurological, psychiatric, and gastrointestinal health problems.15 Binge drinking, the most dangerous pattern of drinking (defined as consuming more than 4 drinks on an occasion for women or 5 drinks for men) is reported by 17% of U.S. adults, averaging 8 drinks per binge.16