All posts by Imelda's blog

Delirium in the ICU

On a daily basis, 30,000 to 40,000 ICU patients in the United States suffer from delirium. Delirium is an acute brain dysfunction. It is believed the problem will only get bigger due to the increased age of our population. The article written by Maniou states multiple studies concluded delirium in mechanically ventilated patients is seen in 60-80% of ICU patients. The article also states that each day a patient spends in a state of delirium their risk of death is increased by 10%. Hypoactive delirium may be difficult to diagnose but it is important to recognize it because it may be an early sign of a serious medical condition, such as sepsis, pneumonia, MI, or PE. Delirium may also be linked to longer hospital stays and increased cognitive impairment on discharge. Risk factors associated with delirium include: increased age, severity of disease, use of medications such as psychoactive drugs, opiates and benzodiazepines. Other risks include the patient’s loss of control, loss of personal space, and loss of their ability to communicate. For these reasons it is important for nursing staff to be aware of this medical problem. Nurses must know how to recognize it and how to treat it, as delirium is harmful to patients and costly to hospitals. The Confusion Assessment Method-Intensive Care Unit is the most commonly used method to diagnose delirium, other tools include the delirium check list and The Intensive Care Delirium Screening Checklist. Nurses should be educated on effective methods to identify patients at increased risk for delirium, how to asses for delirium and appropriate interventions to manage the medical problem.

I do agree with the article. Medicine has many new advances and people are living longer than before. The older population is more fragile and sensitive, thus increasing their risk for delirium. It also seems that patients admitted to the hospital are more fragile and sick then in past years. It is important for all nurses to identity patients at risk, assess and implement nursing interventions to prevent complications. I think the next step needed to bring about awareness of this issue is staff education. As this is a big problem, nursing staff especially nurses caring for patients in ICU should be educated on the issue. I think nurse education is the most important step to identify and treat these patients. Nurses are the primary caregivers and we are the ones who interact with the patients the most. We are in the perfect position to assess and identify patients at increased risk for delirium. We are also in the perfect position to intervene to prevent long term complications.

As a nurse working in med/surg and acute rehabilitation I often encounter older patients who become disoriented when taking narcotics, sleeping and psychoactive medications. I believe that it is important to for all nursing staff not just ICU staff to get educated on delirium. Often the patients change in LOC is not associated or linked to these medications and it is important to recognize it and to be aware of the possible causes to prevent its reoccurrence. As nurses we are the doctor’s eyes and we are also the patient’s advocate and it is our responsibility to monitor, prevent and intervene in these situations. We must prevent long term complications and limit hospital costs.


Maniou, M. (2012). Delirium: A distressing and disturbing clinical event in a intensive care unit. Health Science Journal, 6(2) 587-597.


Digital Technology and Healthcare Blog

Digital Technology and Healthcare

Digital technology will eventually serve healthcare providers and clients as a communication abridge allowing consumers to get healthcare when and where they need it regardless of distance. Digital technology will help increase the client’s participation in their healthcare by closing communication gaps between clients and providers. Digital technology will help healthcare providers focus on the needs of the client while improving care and ultimately reducing cost. Digital technology can be intimidating but the benefits are great for client care and increase satisfaction allowing clients to better manage their own health. Digital technology will give clients more autonomy to manage their health while still having the support and guidance of experienced healthcare providers. New mobile health technology is emerging so quickly that client privacy and security are of great concern to both clients and healthcare providers. It is imperative these concerns be resolved before the implementation of new technology.

Many healthcare professionals believe digital technology has impacted the nursing profession in many ways and will continue to bring about changes in the delivery of care. Digital technology impacts the future of nursing because healthcare providers such as nurses must keep up with the new technological advances if they want to continue to practice in the healthcare profession. Technology may drive older nurses who are not technology driven into another profession or early retirement. Adaptation to new technology may be challenging and intimidating cause anxiety and fear in healthcare providers. The healthcare system is rapidly moving towards a technology driven era. In the near future healthcare providers will be forced to use more technology than in the past years or even months.

Technology relates to assessment in multiple ways. With modern technology it will be possible to monitor clients at home for longer periods of time without having to admit them into a clinic or hospital. Technology will change the form and location client assessment is performed. Having the ability to monitor the clients in the home sitting can provide better and more accurate information for the diagnosis and treatment of curtain medical conditions. For instance in clients with A-fib, 30 day EKG monitoring can be useful for the detection of this condition. Early detection of health problems may decrease the cost of care and suffering for clients. With the new technological advances it is realistic to consider mobile technology as part of the client’s plan of care. Technology will surely impact the way healthcare providers manage the clients care at home. The use of text messages for negative test results, electronic prescribing and electronic patient records will improve care, allowing health professionals to spend more time with each client, thus saving money. One meta-analysis reviewed several trials and reported overall modest evidence that text messaging has a positive impact on self-management and outcomes in conditions such as diabetes, asthma, and hypertension (Dicianno, Parmanto, Fairman, Crytzer, Yu, Parmana, Coughenour, Petrazzi, 2015).

Health care is growing increasingly complex, and most clinical research focuses on new approaches to diagnosis and treatment. In contrast, little effort has been targeted at the perfection of operational systems, client and medical safety. If medicine is to achieve major gains in quality, it must be transformed, and technology will play a key part, especially with respect to patient safety. Patient safety should be assured by extensive testing before implementation or placement into practice. Patient safety will continue to be assured with the reporting of glitches and continued testing of newly implemented technology.

The current research addressing the impact of mobile technology in client care focuses on healthcare outcomes, cost efficiency and accessibility. One of the biggest benefits reported by research of mobile health is time management. Physicians using mobile technology to treat clients, are finding more time in their day to help additional clients by limiting in-person office visits for when they’re absolutely necessary. The use of mobile health also allows instant access to a client’s Electronic Health Records. In selected facilities physicians are utilizing a mobile app, called eVisit, to facilitate online interactions with clients. Once a client has signed in to the hospital’s client portal and completed a questionnaire concerning their complaints, physicians can respond within minutes to provide care. If a prescription is required, the order can be submitted electronically to the client’s pharmacy.

Pros for using mobile technology include the ability of healthcare professionals to have access to multiple sources of data, including their clients’ activities over extended time periods. Mobile technology strives to be able to change the quality of public health care in general. For example, mobile tools can be used by diabetics in the management of their disease, thus changing the outcome and improving health. Better management of the disease can result in lower hospitalization rates for diabetic clients. Another benefit of mobile health is financial. Analysts suggest that the new mobile technology could save the health industry and its clients billions of dollars annually. Digital medical records allows healthcare providers to view the clients past medical history electronically. Digital medical records allows healthcare providers to monitor and trend labs, vitals, and visits to other healthcare providers, thus providing the client with better services and ultimately resulting in better outcomes. Mobile technology may soon become more available for use making it more affordable and convenient to both healthcare professionals and clients. Cons to the use of mobile technology include healthcare providers concern regarding overwhelming amounts of data to be assessed. A major concern for both clients and healthcare professional includes the loss of security and privacy of client information as well as the accuracy of the data obtained. Another major obstacle and concern will be the integration of technology into provider systems and its correct utilization.

Technology is being integrated into the hospitals and is being used daily to provide clients with health education. Hospitals utilize electronic discharge orders and education of admitting diagnosis and medications. Electronic technology is also being used to send medication orders directly to client’s pharmacy. Health technology is all around. Most smart phones can now be used to download applications related to healthcare. The provided article discussed some of the recent medical advances in digital technology including ambulatory EKG monitoring, PATRICIA and ear bud innovation for exercise. Mobile health applications promise both improvements in the quality of medical services and financial savings. Mobile health is still in the developmental stages, and it has some glitches to overcome. The integration of mobile health technology is inevitable, it is only a matter of when it will be implemented. Healthcare providers would be wise to embrace the new technology as it promises to facilitate and optimize client health.


Dicianno, E, B., Parmanto, B., Fairman, D. A., Crytzer, M. T., Yu, X. D., Parmana, G., Coughenour, D., Petrazzi, A. A. (2015). Perspectives on the evolution of mobile (mHealth) technologies and application to rehabilitation. American Physical Therapy Association. 95(3). DOI: 10.2522/ptj.201 30534



Imelda’s Introduction


My name is Imelda Magdaleno. I graduated from Ventura College in 2008. After passing my boards I was hired to work for Saint John’s Regional Medical Center in the Medical/Surgical department. I worked there for about five years until overstaffing and layoffs forced me to move to Acute Rehabilitation. I have been in acute Rehab for about two years. Rehab is not the department where I want to be but it is perfect now that I am in the process of obtaining my BSN. The BSN program has been a difficult experience but I am very fortunate to have made some great friends along the way. Hugo, Margaret and Cassandra have helped make this journey exciting and fun. When I have free time I love to spend time with my two and a half year old son Fernando. We like to go to the park and take walks on the beach because they help mommy relax!!  The little guy at the bottom is my son Fernando :-)