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Biomedical subjects

M Justic

Publications and source records attributed to M Justic.

5 recordsLinked to original sources
PubMed2000

Does "ICU psychosis" really exist?

In summary, ICU psychosis does not develop in all patients. Instead, many patients are at risk for hypoactive, hyperactive, or mixed hypoactive and hyperactive delirium. Prevention of delirium should always be foremost, including recognition of patients at high risk, minimal use of causative medications, and treatment of physiological conditions that are often unrelated to a patient's admitting diagnosis. When prevention fails, early diagnosis and treatment can make a marked difference in patients' outcomes. The potential adverse outcomes of delirium are well documented. These include increased mortality; increased length of stay; reduced level of functioning in the elderly, which often leads to placement in a nursing home; and stress response syndrome after hospitalization. The value of nursing in preventing delirium is evident when nurses apply their knowledge of potential causes and develop strategies to avoid these causes in their patients. Nurses provide early detection and coordinate with other members of the healthcare team to initiate a plan of care that includes prompt treatment of delirium to reduce the signs and symptoms, duration, and potential adverse sequelae of this disorder. Nursing interventions are designed to enhance patients' cognitive status, sense of security, safety, and comfort. Nurses are instrumental in providing appropriate choices, doses, and administration of medications and in recognizing side effects. Use of medications ordered to treat delirium is often left to nurses' discretion because the orders specify that the drugs should be given as needed. Finally, nurses are the ones who recognize the need for additional assistance via psychiatric consultations or for more intensive observation and management of patients to ensure quality care.

Algorithms↗
PubMedDate not supplied

Psychopathology following cardioverter defibrillator implantation.

Previous reports have found elevated rates of psychopathology in recipients of implantable cardioverter defibrillators (ICDs). Thirty-five consecutive ICD recipients were assessed by using the Structured Clinical Interview for DSM-III-R and a semistructured questionnaire; assessments were performed within 3 days of ICD implantation (Time 1) and again 9-18 months later (Time 2). At the initial assessment, alcohol dependence in remission was the most common diagnosis, followed by mood disorders. Two cases of depression were found at follow-up assessment, but those subjects had either a lifetime history of major depression or some depressive symptoms at Time 1. No new cases of anxiety disorders were seen at Time 2. It appears that ICD recipients have rates similar to the general population at the time of implantation, and the risk for new psychopathology is largely confined to those with a lifetime history of psychopathology.

Adaptation, Psychological↗
PubMedDate not supplied

An algorithm to distinguish the need for sedative, anxiolytic, and analgesic agents.

This article discusses the use of an algorithm developed by nurses at the University of Minnesota Hospital and Clinic in Minneapolis, that can be used to distinguish the need for sedative, anxiolytic, and analgesic agents for patients in the medical intensive care unit (MICU). Many problems associated with patient sedation and analgesia exist within the critical care environment. These problems include undersedating patients with neuromuscular blockade; rapidly tapering or abruptly discontinuing high-dosage sedation, which often results in withdrawal symptoms; over-use of high-dosage continuous intravenous infusions of short-acting benzodiazepines and analgesics; failure to recognize delirium; and resistance to modifying drug regimens when patient outcomes are not satisfactory.

Adult↗