1.Causes of ICU syndrome
1. 1 Personal factors, such as gender, age and disease status, are all factors that affect the occurrence of ICU syndrome, especially those who are introverted or have mental and nervous system diseases, brain trauma and cerebrovascular diseases. When they are in ICU, patients are prone to emotional changes, which leads to ICU syndrome. Elderly patients are more likely to be monitored in ICU. Most critically ill patients, due to the lack of psychological preparation for sudden illness, think that their serious illness will endanger their lives and have a very obvious sense of fear and threat. Patients with mental illness, brain trauma or cerebrovascular disease, sleeping pills poisoning or long-term dependence on certain drugs are prone to this syndrome when they are in ICU.
1.2 pharmaceutical factors lidocaine is used to treat arrhythmia. When the intravenous drip speed reaches 4mg/min, most patients may have mental symptoms such as delirium. H2 receptor blockers (cimetidine), opioids, benzodiazepines, theophylline, corticosteroids and sodium nitroprusside can also cause mental symptoms. Anti-infective drugs have different degrees of neuropsychiatric side effects, especially after combined use of adrenocortical hormone, which will increase the incidence of neuropsychiatric side effects.
1.3 interpersonal factors limit the self-care ability of ICU patients. In addition, complicated instruments and monitoring measures make patients bear great psychological pressure, and the use of binding bands increases patients' irritability and uncooperative. The visiting time and times are limited, so patients can only talk and get along with their relatives and friends in a short time, which makes them relatively isolated from the outside world, and patients will feel uneasy, inferior and lonely. Some patients need artificial airway because of their illness, so they can't express their feelings and discomfort through language, let alone vent their emotions, which is also one of the reasons for this disease.
1.4 patients with environmental factors have been bedridden for a long time, and continuous illumination makes them lose their sense of direction during the day and night. The ICU medical staff are busy with their work, and the ward is noisy. What patients see all day is intensive monitoring and treatment equipment, monitoring light signals, all-weather lighting and the busy work of medical staff, especially witnessing the death of patients in the same room, which makes patients feel bound and depressed. These tense atmospheres have caused the visual overload of patients, and at the same time, the alarm sounds of monitors, aspirators, instruments and ventilators emit irregular sounds and frequent alarm sounds for a long time, which makes patients feel a single stimulus, increasing their psychological burden, complicated treatment and nursing operations, pain caused by various treatments, expectoration, discomfort after changing body position, anxiety and shyness caused by full exposure of various parts of the body, etc., all of which make patients feel bound.
2. The main clinical manifestations of 2.ICU syndrome
(1) Delirium is the most common symptom, which shows that the ability to respond to external stimuli is obviously reduced, such as irritability, speech disorders, auditory hallucinations or hallucinations, and feeling that people are floating in the air.
(2) Behavior and movement disorders are abnormal, and there are various behaviors, such as shouting, tearing clothes and smashing things, hitting people and swearing.
(3) Emotional disorder, confusion, disorientation and judgment disorder are mostly manifested as emotional depression, and in severe cases, they may be manifested as fear, anxiety, guilt and suicidal thoughts and behaviors.
(4) There are two main forms of thinking disorder: one is association process disorder, such as thinking fracture; Another form is delusion.
(5) Dementia in elderly patients with mental retardation during (or after) ICU monitoring belongs to the category of mental retardation and is also one of its internal manifestations.
(6) inattention, memory difficulty, irrelevant answer, etc.
(7) Fatigue, lethargy, depression, apathy, withdrawal, sadness, fear, murder and hostile thoughts.
(8) Other symptoms such as insomnia, headache, low back pain, constipation or diarrhea, abnormal skin sensation, etc.
3 How to alleviate ICU syndrome of critically ill patients?
(1) Improve the internal environment of ICU, keep the room clean, tidy, comfortable and quiet, use soft lighting, and set windows and clocks in the patient's field of vision. Properly arrange the treatment operation time, try to keep patients awake during the day and sleep at night, and create a good rest environment for patients. At night, the best comfortable lying position and local massage can be adjusted according to the condition to help them fall asleep. Insomnia and nervous patients can be given appropriate sedatives to ensure adequate sleep. When talking, walking and performing surgery, medical staff should move gently to minimize the influence of the alarm sound of ECG monitoring, ventilator and other instruments on patients. When there is a machine alarm, they should react quickly and calmly. When rescuing patients, be busy and orderly to avoid causing tension.
(2) To eliminate the adverse effects of language, medical staff should communicate with patients more, give them humanized attention, listen carefully to their troubles, questions and feelings, and explain their illness, treatment process and methods in a language that patients can understand. Do a good job in explaining patients and use nonverbal communication for patients with language communication difficulties, so medical staff should master some nonverbal communication skills and communicate with patients through body language. If conditions permit, visual information transmission can be increased to grasp its physiological and psychological dynamics, enhance patients' response to external stimuli, and promote the recovery of brain function. Avoid anxiety, depression, hallucinations, etc.
(3) Reduce patients' loneliness, care for patients, explain patiently, and meet patients' requirements as much as possible, so as to eliminate patients' loneliness, fear and loneliness caused by the absence of relatives, do a good job in patients' psychological care, explain the importance and necessity of intensive care, and make patients have good psychological preparation to avoid nervousness, anxiety and fear.
(4) Comfortable nursing Pay attention to protecting patients' privacy when doing surgery, so that patients feel respected. Try to avoid the times and time of patients' exposure, and keep them covered at any time when doing exposure operations such as enema and catheterization. Try to reduce the times and time of binding patients, because long-term use of binding tape will make patients have obvious psychological reactions, such as excitement, resistance, loss of dignity, fear and other related complex changes. For patients who particularly need restraint, we should observe at any time, repeatedly evaluate the necessity of restraint, and at the same time relax the restraint belt regularly, and the bound limbs must move passively at regular intervals.
(5) Health education should be given to patients entering ICU. Nurses should explain relevant medical knowledge to patients in easy-to-understand language, help patients to look at their illness objectively, and let patients know that they are entering ICU for better treatment and care. All kinds of instruments around them are designed to help monitor the changes of heart rate, blood pressure, breathing and body temperature, so that patients can naturally relieve their psychological pressure and have a correct understanding of their illness.
(7) Other music is a special language, and the melodious and appropriate melody can achieve the effect that people can't achieve when relaxing and communicating with others. The application of music therapy in ICU stress environment can alleviate the excessive tension of sympathetic nerves, promote emotional calm, inhibit various stress reactions, and reduce and prevent the emergence of ICU syndrome.
In short, nurses should care for patients with love, carefulness, patience and compassion, and use warm smiles, appropriate language and skilled technology to ensure that patients maintain the best psychological and physical state when receiving treatment.