CAM_ICU

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Assessing using CAM-ICU

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Assessing for Delirium: a basic guide for the RN:

Assessing for Delirium: a basic guide for the RN Janet Atarthi -Dugan

Objectives::

Objectives: Characterize the signs and symptoms of delirium . Describe the impact delirium has on patient outcomes Identify baseline risk factors or "predisposing factors" for delirium Review screening tools for delirium with emphasis on CAM-ICU

What is Delirium?:

What is Delirium? “A disturbance of consciousness characterized by acute onset and fluctuating course of inattention accompanied by either a change in cognition or a perceptual disturbance, so that a patient’s ability to receive, process, store, and recall information is impaired .” LOL---let’s keep it simple! Think : rapid onset, inattention, clouded consciousness (bewildered ) that fluctuates

ANOTHER ASSESSMENT?????:

ANOTHER ASSESSMENT????? YES! Another assessment…… The CAM is considered the gold standard for assessing delirium Assessing using CAM-ICU verbiage standardizes language among providers and nurses Gives the facility an Evidenced Based Tool to validate the resources we dedicate to confused & agitated patients ( cough cough—get reimbursed!)

WHY do we even care????:

WHY do we even care???? ICU delirium is a predictor of Increased : mortality length of stay time on vent costs re-intubation long-term cognitive impairment

Identification of causes as the 1st step in delirium management (T-H-I-N-K) :

Identification of causes as the 1st step in delirium management (T-H-I-N-K) T: Toxic situations • CHF, shock, dehydration • New organ failure (eg, liver, kidney) H: Hypoxemia I: Infection/sepsis N: Nonpharmacologic interventions ( Are these being neglected?) • Hearing aids, glasses, noise control K: K + or electrolyte problems

Risk factors:

Risk factors Hx of dementia (3x) Sensory deficits **visual impairment(3x) ** hearing impairment advanced age alcohol dependence multiple meds

How do we detect it?:

How do we detect it? Cognitive assessment is considered “ a vital sign” particularly in the ICU Bedside assessment tool is a formal tool: CAM-ICU

So where do I find it?:

So where do I find it? Click on I-view Under neuro assessment (right above CIWA) NOTE: THIS ASSESSMENT IS A 2 STEP PROCESS!

STEP 1: Arousal/LOC Assessment (using RASS):

STEP 1: Arousal/LOC Assessment (using RASS) STEP 1: Get a RASS SCORE. This is done on every ICU patient every shift anyways right? **If score is -3 or greater: proceed to CAM-ICU

Step 2: Assess Content of Consciousness (Delirium):

Step 2: Assess Content of Consciousness (Delirium)

So your patient is CAM-ICU positive---what next???? :

So your patient is CAM-ICU positive---what next???? Treat underlying cause! Frequent reorientation Minimize caregiver changes Provide hearing aids, glasses QUIET at night—avoid VS, meds, etc . Avoid Restraints when you can:usually makes it worse! Watch Those Meds! Avoid benzodiazepines Careful with opiods Suggest to MD? Haldol or Seroquel

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