ICU syndrome refers to a group of clinical syndromes in which mental disorders are the main cause and other manifestations occur in the course of ICU care. For critically ill patients admitted to ICU wards are not only in a state of crisis physically, but also under great pressure mentally.
1. Reasons for the emergence of ICU syndrome
1.1 Personal factors The patient’s gender, age and disease condition are factors that affect the occurrence of ICU syndrome, especially for patients who are introverted or have psychoneurological diseases or traumatic brain injury or cerebrovascular diseases, the patient is prone to changes in emotional state during ICU care treatment, which leads to the occurrence of ICU syndrome. Elderly patients are more likely to occur in ICU monitoring.
Most critically ill patients, due to lack of psychological preparation for the sudden onset of their condition, believe that their condition is serious and life-threatening, creating a very pronounced sense of fear and threat. Patients with a past history of psychosis, traumatic brain injury or cerebrovascular disease, sleeping pill intoxication, or long-term dependence on certain drugs are prone to develop this sign while under ICU care.
1.2 Drug factors The use of lidocaine for arrhythmias can cause delirium and other psychiatric symptoms in most patients when the intravenous drip rate reaches 4 mg/min. H2 receptor blockers (cimetidine), opioids, benzodiazepines, theophyllines, corticosteroids, and sodium nitroprusside can also cause psychiatric symptoms. Anti-infective drugs have varying degrees of neuropsychiatric side effects, especially when combined with adrenocorticosteroids, which can increase the incidence of neuropsychiatric side effects.
1.3 Interpersonal factors The ability of ICU patients to take care of themselves is limited, and the use of complex instruments and monitoring measures puts patients under great psychological stress, and the use of restraint belts increases irritability and uncooperativeness. The time and number of visits are restricted, and patients can only talk and get along with friends and relatives for a short period of time, leaving them in a state of relative isolation from the outside world, which leads to irritability, low self-esteem, and loneliness.
Some patients are placed with artificial airways because of their condition, thus patients cannot express their feelings and discomfort through words, let alone vent their emotions, which is also one of the causes of this disease.
1.4 Environmental factors Patients are bedridden for a long time, the continuous light exposure makes patients lose their sense of orientation to day and night, ICU medical and nursing staff are busy and the ward is noisy, patients see intensive monitoring and treatment equipment, monitoring light signals, lights around the clock and the busy work of medical and nursing staff;
Especially witnessing the death of patients in the same room makes patients have a feeling of being bound and suppressed, these tense atmosphere causes visual overload of patients, while the monitor alarm sound, suction, instrument sound and ventilator, etc. long-term, monotonous irregular sound and frequent alarm sounds, and lead to a single stimulation of the patient’s sensory receptors, increasing the psychological burden of patients, treatment and care The number of operations is tedious, the pain caused by various treatment dispositions, coughing sputum;
The discomfort after changing positions, the uneasiness and shyness generated by the full exposure of various body parts, etc. all give patients a feeling of restraint and make it easier to generate fear, tension and anxiety psychological reactions.
2.The main clinical manifestations of ICU syndrome
(1) Delirium is the most common symptom, manifested as a significant decrease in responsiveness to external stimuli, such as irritability, confused speech, hallucinations or hallucinations, and the feeling that people are floating in the air
(2) Behavior and action disorder: abnormal behavior and action, such as shouting, tearing clothes and destroying things, hitting and cursing, etc.
(3) Affective disorder, disorganized consciousness, disorientation, and impaired judgment Except for a few who show high emotion and euphoria, most of them show emotional depression, and severe cases may show fear, anxiety, and guilt, and have suicidal thoughts and behaviors
(4) Thought disorder mainly manifests itself in two forms: one is association process disorder, such as thought breakdowns; the other form is delusion
(5) Intelligent disorder Dementia in elderly patients in ICU care (or after), which belongs to the category of intelligent disorder, is also one of the manifestations of this syndrome
(6)Inattentiveness, memory difficulties, and non-answer questions
(7) Fatigue, drowsiness, depression, apathy, withdrawal, sadness, fear, thoughts of victimization, hostility
(8) Other symptoms such as insomnia, headache, back pain, constipation or diarrhea, skin abnormalities, etc.
3.How to alleviate ICU syndrome in critically ill patients?
(1) Improve the environment in the ICU Keep the room clean, tidy, comfortable, quiet, light can use soft light, room with windows and clocks placed in the patient’s field of vision. Arrange the treatment operation time properly, try to keep the patient awake during the day and sleep at night to create a good recuperation environment for the patient.
The best comfortable lying position and local massage can be adjusted according to the condition at night to help them sleep, and patients with insomnia and nervousness can be given appropriate amount of sedatives to ensure sufficient sleep. Medical staff should be gentle when talking, walking and doing operations, try to reduce the impact of cardiac monitoring, ventilator and other instrument alarms on patients, and should react quickly and calmly when there are machine alarms, and when resuscitating patients, be busy but not chaotic and orderly to avoid causing tension.
(2) Eliminate the adverse effects of language Medical and nursing staff should communicate more with patients, give humane attention to patients, listen carefully to patients’ troubles, questions and feelings, use language that patients can understand, explain the condition, the process and manner of treatment.
Do a good job of explaining for patients, and use non-verbal communication for patients who have difficulty in verbal communication. Therefore, health care workers should master some non-verbal communication skills and communicate with patients through body language. Visual information transmission can be increased if the condition permits, in order to grasp their physiological and psychological dynamics, enhance the patient’s response to external stimuli, and promote the recovery of brain function. Avoid patients’ restlessness, depression, and hallucinations.
(3) Reduce patients’ loneliness Careful and considerate patients, patient explanation, meet patients’ requirements as much as possible, so as to eliminate patients’ loneliness, fear and isolation without the company of relatives, do a good job of psychological care of patients, explain the importance and necessity of intensive care, so that patients have good psychological preparation, to avoid the occurrence of tension, anxiety and fear.
(4) Comfortable care Pay attention to protecting the patient’s privacy when doing operations so that the patient feels respected. The number of times and time when the patient is naked should be avoided as much as possible, and coverings should be given at any time when doing exposed operations such as enema and catheterization. Minimize the number and duration of patient restraint, because the long-term use of restraint belt will cause patients to have obvious psychological reactions, such as agitation, rebellion, loss of dignity, fear and other related complex changes. For patients who especially need restraint, they should be observed at all times and the necessity of restraint should be repeatedly evaluated, and at the same time, the restraint belt should be loosened and untied regularly, and the restrained limbs must be moved passively at regular intervals.
(5) Health education For patients entering ICU, nurses should explain relevant medical knowledge to patients in easy-to-understand language to help them look at their condition objectively, so that they understand that entering ICU is for better treatment and care, and that the various instruments around them are to help monitor changes in heart rate, blood pressure, respiration and body temperature, so that patients can naturally reduce their psychological pressure and have a correct understanding of own condition with correct understanding.
(7) Other Music is a special language, and a melody that is relaxing and appropriate can have an effect that other communication cannot achieve. Applying music therapy in a stressful ICU environment can ease sympathetic overstimulation, promote emotional sedation, inhibit various stress reactions, and reduce and prevent the emergence of ICU syndrome.
In conclusion, nurses should provide careful patient care with love, care, patience and compassion, with a warm smile, appropriate language and skilled technique, to ensure that patients maintain the best psychological and physical state when receiving treatment.