Delirium em Unidade de Terapia Intensiva: implicações para o cuidado de Enfermagem ao adulto e idoso

• Ano de defesa: 2016
• Autor(a) principal: Manhães, Karinna Aparecida Moreira
• Orientador(a): Caldas, Célia Pereira
• Banca de defesa: Almeida, Luana Ferreira de , Brum, Ana Karine Ramos
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade do Estado do Rio de Janeiro
• Programa de Pós-Graduação: Programa de Pós-Graduação em Enfermagem
• Departamento: Centro Biomédico::Faculdade de Enfermagem
• País: BR
• Palavras-chave em Português: delirium; unidade de terapia intensiva; cuidado de Enfermagem
• Palavras-chave em Inglês: delirium; intensive care unit; nursing care
• Área do conhecimento CNPq: CNPQ::CIENCIAS DA SAUDE::ENFERMAGEM
• Link de acesso: http://www.bdtd.uerj.br/handle/1/11393

Introduction: Delirium or Acute Mental Confusion refers to a syndrome with an acute onset, fluctuations in awareness and compromising of cognitive functions, attention or sleeping cycle disturbance and of the abnormally elevated (hyperactive form) or diminished (hypoactive form) of psychomotor activities. Although significantly prevalent amongst patients in Intensive Care Units (ICU s) and of the relevant impact in these patient s prognosis, it s still considerably under diagnosticated generating repercussions in morbidity/mortality rates and prolonging admission periods. In critical patients, the most common form is the hypoactive, characterized by somnolence or torpor. Research Object: Delirium in adult and elderly patients admitted into the ICU. General Objective: Investigate the occurrence of delirium in adult and elderly patients admitted in the ICU. Specific Objectives: 1) Describe the contextual reality of the ICU s nursing team s work process through direct observation; 2) Describe sociodemographic and clinical characteristics of patients admitted into the ICU; 3) Quantify the occurrence of delirium in patients admitted into the ICU by applying the Confusion Assessment Method Intensive Care Unit Flowsheet (CAM-ICU); 4) Identify the clinical variables associated to delirium. Methodology: This is a case study utilizing CAM-ICU to investigate the occurrence of delirium in patients admitted into Azevedo Lima State Hospital s ICU respecting the following inclusion criteria: patients aging equal or above 18 years; intensive admittance for at least 24 hours; capacity to communicate; absence of profound sedation. Data collection occurred between June and August 2015 with a total of 142 patients. The sample was constituted by subtracting the patients that didn t comply with the inclusion criteria and those whose data collection was lost. The project was approved by the Ethics and Research Committee of Rio de Janeiro s State University under CAAE no 46748115.5.0000.5282. Results: Out of 92 analysed patients, 16 (17.39%) were detected with delirium, totalizing 104 episodes. Age average was found at 64.5 years with a predominance of the female sex (52.7%). Average admittance time in the ICU was 37.1 days for patients with delirium and 23.6 for patients with no such diagnosis. In regards to predominant associated factors, patients with delirium were submitted to: polypharmacy (average 60.8 days); vascular catheters (average 58.5 days); IMV s (average 37 days) and mechanical restraints (average 24.8 days). Conclusion: Results indicated that professionals detected only the hyperactive form of delirium, demonstrating the necessity of implementing a protocol for its prevention in the studied ICU.