Category: Critical Care Nursing When agitation or delirium develops, a rapid assessment should be performed to rule out life-threatening problems (hypoxia, pneumothorax, hypotension), or other acutely reversible causes (hypoglycemia, metabolic acidosis, stroke, seizure, pain).
Category: Critical Care Nursing Hypoactive delirium, which is the most prevalent form of delirium, is characterized by decreased physical and mental activity and inattention. In contrast, hyperactive delirium is characterized by combativeness and agitation.
Category: Critical Care Nursing Agitation may be caused by various factors: metabolic disorders (hyponatremia and hypernatremia), hyperthermia, hypoxia, hypotension, use of sedative drugs and/or analgesics, sepsis, alcohol withdrawal and long-term psychoactive drug use.
Category: Critical Care Nursing A new or sudden change in the neurologic condition of a critically ill patient necessitates a neurologic examination, review of the clinical course, medications, laboratory data, and appropriate imaging or neurophysiologic studies.
Category: Critical Care Nursing New-onset seizures in general medical-surgical intensive care unit patients are typically caused by narcotic withdrawal, hyponatremia, drug toxicities or previously unrecognized structural abnormalities.
Category: Fundamentals Therapeutic oral doses of barbiturates produce mild decreases in pulse and blood pressure, similar to sleep. With toxic doses, hypotension occurs from depression of the myocardium along with pooling of blood in a dilated venous system.
Category: Fundamentals Barbiturates act directly on the medulla to produce respiratory depression. In therapeutic doses, this respiratory depression mimics that of normal sleep. With toxicity, the neurogenic, chemical and hypoxic respiratory drives are suppressed.
Category: Fundamentals Barbiturates produce dose-related depressive effects ranging from mild sedation to coma and respiratory arrest. In the early stages of intoxication, some patients experience euphoria. Barbiturates have no analgesic effect.
Category: Fundamentals Barbiturates can be addictive, producing physical dependence. Whereas tolerance to the mood-altering effects of barbiturates develops rapidly with repeated use, tolerance to the lethal effects develops more slowly.
Category: Fundamentals Naloxone is ineffective orally because its bioavailability is minimal due to first-pass metabolism. It is effective via intravenous, subcutaneous, intramuscular, inhalational and endotracheal routes.
Category: Fundamentals Naloxone is a competitive opioid antagonist that rapidly reverses the effects of opioid intoxication. Because of the rapid clinical response, it can also aid in the diagnosis of opioid overdose.
Category: Fundamentals Acute lung injury can be seen in opioid overdose and pulmonary edema can cause a failure of oxygenation. This manifests as desaturations on pulse oximetry, despite an adequate respiratory rate and rales on lung examination.
Category: Fundamentals The hallmarks of the opioid toxidrome are central nervous system depression, respiratory depression and miosis. Miosis is caused by stimulation of µ receptors in the Edinger-Westphal nuclei of the third cranial nerve.
Category: Fundamentals Along with the usual complications of amphetamines, MDMA can precipitate a life-threatening hyponatremia. MDMA alters the release of stores of vasopressin, which in the setting of high free water intake results in free water retention.
Category: Fundamentals Cocaine induces coronary vasoconstriction while increasing myocardial oxygen demand. Platelet aggregation is enhanced through thrombogenic/antifibrinolytic pathways. These cumulative effects can cause coronary insufficiency.
