All posts by Lisa

Delirium in ICU

Individuals that are admitted to the Intensive Care Unit (ICU) are already critically ill, and now, according to the article by Rattray will be faced with a longer recovery time that could be weeks, months and in some cases years to return to pre-ICU health status. 25-76% of these patient suffer from muscle wasting, weakness, and fatigue from prolonged bed-rest and immobility, and the severity increases with the more critically ill the person is. She further states that these patients suffer psychological problems from their stay in ICU. Due to their perceived experience they suffer from anxiety, depression (28%), PTSD (20%), and cognitive problems including delirium (20-80%), that negatively affect their health status. The characteristics of patients most likely to suffer from delirium are those that are already cognitively impaired, respiratory disease, older age, smokers, and alcohol abuse. Additionally, the illness that this is most prevalent are sepsis, dehydration, prolonged stay in the ICU, and biochemical abnormalities. Environmental precipitants include but are not limited to physical restraints, noise, sleep deprivation, isolation, as well as benzodiazepine and opioid use. Rattray states that rehabilitation should begin while the patient is still in ICU, by daily sedation reductions and early mobilization. This would need to be done with a team of multidisciplinary care providers that begin rehabilitation as soon as the patient is admitted to ICU and continue after discharge.

According to the article Intensive care delirium: the new black by Egerod, it is unclear if ICU delirium is the result of the illness or the medications. However, she does state that these patients suffer from adverse health outcomes from prolonged delirium and stay in ICU. Egerod further promotes the use of interdisciplinary team to manage pain, sleep, circadian rhythm, lighter sedation and early ambulation. Additionally, use of family to participate in care as it gives the patient comfort and familiarity and connects them to the outside world.

Both authors promote reduced sedation, decreased use of benzodiazepines, avoiding sleep disruption and increased physical therapy and activity. Due to the high rate of patients suffering from delirium and other adverse effects from their stay in ICU that have developed standardized tests in which to assess their functioning and delirium. Further research is needed to understand these mechanisms so as to provide better treatment that will provide better health outcomes for the critically ill population.

Egerod, I. (2013). Intensive care delirium: the new black. Nursing in Critical Care, 18(4), 164-165.
Rattray, J. (2014). Life after critical illness: an overview. Journal of Clinical Nursing, 3(5/6), 623-633.

ICU Sedation Practices

The article : Changing the Sedation Status Quo in the ICU was very interesting to me because it talks about how hospitals are adopting new policies that limit the amount of time a patient is sedated in the ICU. The new treatment methods would allow patients to be awakened from sedation to assess for pain and removing them from a ventilator as soon as possible.  A growing body of research suggests that patients who are heavily sedated in the ICU are suffering from prolonged delirium. This can have long term effects on cognitive function long after the patient leaves the hospital (Landro, 2011).

Hospitals began rethinking the standard of care in the early 1990s, when patients reported suffering from depression, stress and extreme physical limitations linked to therapy they had received in the ICU (Landro, 2011). Studies conducted by Vanderbilt University show that new monitoring techniques will shorten the duration of delirium by decreasing the amount of potent sedatives a patient receives. Research from John Hopkin’s University shows that getting patients up and moving even when still on a ventilator can also prevent the muscle weakness that results when patients lose conditioning from misuse and the body becomes frail. Hospitals now plan to use milder sedation medication and to wean patients off as soon as possible and not put them back under. This will help patients to go home sooner and avoid having to go to a rehabilitation center.

I agree with this article, I think that it is not healthy to have patients sedated for a prolonged amount of time. If there is a way to get them moving sooner I think this would be beneficial for circulation, skin care, and oxygenation. However the research presented here also shows that in addition to the physical reasons there are also psychological reasons to wean patients from section sooner rather than later. Before reading this article and watching the videos, I had no idea that patients were experiencing delirium while sedated in the ICU. Furthermore it is also very concerning to see how the delirium they experienced in the ICU can affect their lives even months to years afterward. Some patients experience PTSD or depression that interferes with their daily lives. I think that if the amount of time a patient can be sedated can be shortened, and they can be ambulated sooner this will be therapeutic for the patient and will help them to recover sooner.

I think that the next step is to implement this practice in more hospitals by training ICU doctors and nurses. Educating healthcare professionals about delirium will help patients to get the support they need sooner.




Landro, L. (2011, February 15). Informed Patient: Changing the Sedation Status Quo in the ICU. Retrieved September 24, 2015, from

Digital Technology and Healthcare

Digital technology in healthcare is a very exciting idea. Two years ago I had read an article about doctors using cell phones to monitor their cardiac patients. The information was downloaded to the application and transmitted to the doctor in real time to monitor the patient’s heart health. Remote monitoring coupled with Electronic Health Records will provide the health professionals the ability to collaborate with ease and over distance. Nurses and health professionals will half to be computer literate, trained, and kept up to date as changes are made to the platform that the facility is using.

In a journal article written by Sheila M. Gephart, PhD, RN & Judith A. Effken, PhD, RN, FACMI, FAAN, it is indicated that is allows the clinicians to follow their patient when they return home and is cost effective as well. However, they do indicate that as they track and follow their patient’s chronic disease, if the information is not inputted it triggers the need for the clinician to intervene which in most cases in a phone call to remind them to input the data, such as the latest blood sugar. There are concerns about the security of the Electronic Health Records (EHR) as indicated in an article by Seth Foldy (Et al). While they have great things to say about the advancement of information tech as it relates to health care, it also approaches it with the need for serious protections and certification of the protection being used by the facility. They further explain that there are many applications used on cell phones that can give bad information and possibly cause people to delay seeking medical attention when it is needed, as well as making the information that you enter into the app accessible to other third party individuals.

Healthcare technology is growing exponentially and I as well as other nurses will be using and accessing more as time progresses. In many places health assessments done by nurses are a series of questions with check boxes and in some cases you can free-write information. In many respects this is good as it prevents areas from being missed or overlooked, however that being said it is also easy to not elaborate or be as thorough in parts of the assessment. It is up to the nurse to be as thorough as she can and if unable to elaborate in the assessment program she will need to mindful to make a narrative note so that information is not missed. While I am optimistic and excited for the future possibilities that this technology brings, it needs to be approached with caution to insure the protection of the clients information.

Gephart, S. M. (2013). Using Health Information Technology to Engage Patients in their Care. Online Journal Of Nursing Informatics, 17(3), 1-6.
Foldy, S., Grannis, S., Ross, D., & Smith, T. (2014). A Ride in the Time Machine: Information Management Capabilities Health Departments Will Need. American Journal Of Public Health, 104(9), 1592-1600. doi:10.2105/AJPH.2014.301956


Hi my name is Lisa Acquisto and I am a native of Ventura. I have three great kids. Ashlynn is 28 years old, lives in North Carolina, and is a successful beautician. She has recently returned to school to be a dietician. Anicia is 24 years old, has begun classes this fall at CSUCI as a junior studying Business. She works as a waitress at Brophy’s in Ventura and is soon to begin her second job at Farmer Boy’s in Santa Barbara. My youngest, Ben is 22 years old, and is in his final year at USC studying Public Relations in sports. He is interning with USC Athletic Marketing and Pollack PR Marketing Firm, and works for Annenberg Facilities. I also have two little dogs, which are big dogs at heart. Daphne is 8 year old, Chihuahua/Dachshund mix, and Peewee is a three year old Chihuahua/Terrier mix.