Emergence Delirium: A Nursing Perspective - AORN

More documents

Recommendations

Info

MARCH 2009, VOL 89, NO 3Hudekmembers. 2,4 Emergence delirium can increase patientcosts because of the increased length oftime spent in the PACU, extra pharmaceuticalsused to try to resolve the emergence delirium orto protect the patient, repair of any physicaldamage the patient may cause to himself or herself,and the cost for an increased number ofstaff members to care for the patient. 2,4 It is importantthat nurses, physicians, and anesthesiacare providers work together to recognize patientsat risk for emergence delirium, reduce itsoccurrence whenever possible, and successfullytreat it when it occurs.CONCLUSIONThe final diagnosis for Abby was an “adversereaction to anesthesia.” She returned tothe admitting hospital for follow up twoweeks after her transfer. She was in good spiritsand was having no notable ill effects fromher experience. She had no recollection ofwhat had happened in the PACU. Abby recalledjoking with the anesthesia care providerin the preoperative holding area and thenwaking up in the facility to which she wastransferred. For the patient, it did not appearto be a traumatic experience; however, it is animportant part of her medical history thatshould be taken into consideration in any futuresurgical experiences.REFERENCES1. Burns SM. Delirium during emergence fromanesthesia: a case study. CritCare Nurse. 2003;23(1):66-69.2. Lepousé C, Lautner CA, Liu L, Gomis P, Leon A.Emergence delirium in adults in the post-anesthesiacare unit. Br J Anaesth. 2006;96(6):747-753.3. Mason LJ. Pitfalls of pediatric anesthesia. Societyfor Pediatric Anesthesia. http://www.pedsanesthesia.org/meetings/2004winter/pdfs/mason_Pitfalls.pdf.Accessed January 28, 2009.4. Neugeborn I. Emergence delirium. DownstateAnesthesia. http://downstateanesthesia.org/Education/Optimized%20Files/Emergence%20Delirium.ppt. Accessed January 10, 2009.5. Wells LT, Rasch DK. Emergence “delirium” aftersevoflurane anesthesia: a paranoid delusion? AnesthAnalg. 1999;88(6):1308-1310.6. Kain Z, Caldwell-Andrews A, Maranets I, et al.Preoperative anxiety and emergence delirium andpostoperative maladaptive behaviors. Anesth Analg.2004;99(6):1648-1654.7. Riker RR, Fraser GL, Simmons LE, Wilkins ML.Validating the sedation-agitation scale with theBispectral Index and Visual Analog Scale in adultICU patients after cardiac surgery. Intensive CareMed. 2001;27(5):853-858.8. Riker RR, Fraser GL. Monitoring sedation, agitation,analgesia, neuromuscular blockade, and deliriumin adult ICU patients. Semin Respir Crit Care Med.2001;22(2):189-198.9. Sessler CN, Gosnell MS, Grap MJ, et al. TheRichmond Agitation-Sedation Scale: validity andreliability in adult intensive care unit patients. AmJ Respir Crit Care Med. 2002;166(10):1338-1344.Kim Hudek, RN, BScN, MEd, CNOR, is aperioperative nurse at Western Arizona RegionalMedical Center, Bullhead City, AZ.Ms Hudek has no declared affiliation that couldbe perceived as a potential conflict of interest inpublishing this article.516 • AORN JOURNAL
Examination 1.8Emergence Delirium: A Nursing PerspectivePURPOSE/GOALTo educate perioperative nurses about caring for patients at risk for or experiencing emergencedelirium.BEHAVIORAL OBJECTIVESAfter reading and studying the article on emergence delirium, nurses will be able to1. describe the symptoms of emergence delirium,2. discuss perioperative patient populations in which emergence delirium is most likely to occur,3. identify risk factors that are thought to predispose patients to emergence delirium, and4. discuss ways perioperative nurses can reduce the incidence of emergence delirium.QUESTIONS1. Emergence delirium in children has beendescribed as a dissociated state of consciousnessin which the child is inconsolableor uncooperative.a. trueb. false2. The patient populations most likely to experienceemergence delirium are1. older adults.2. middle aged women.3. children.4. men between the ages of 20 and 25.a. 1 and 3b. 2 and 4c. 2, 3, and 4d. 1, 2, 3, and 43. Emergence delirium is most often notedin the immediate postoperative periodand usually occurs during the first ____minutes after surgery.a. 5 to 10b. 10 to 15c. 15 to 30d. 30 to 454. Most patients with emergence deliriumpresent with periods of excitement thatalternate with periods of lethargy.© AORN, Inc, 2009a. trueb. false5. The following agents have been associatedwith emergence delirium:1. most inhalation agents2. most IV agents including midazolam,remifentanyl, and propofol3. atropine and ketamine4. droperidol5. barbituratesa. 1 and 2b. 1, 2, and 4c. 3, 4, and 5d. 1, 2, 3, 4, and 56. The following conditions increase thelikelihood of emergence delirium occurringin an older adult patient:1. depression2. drug dependency3. stroke4. organic brain disease5. allergiesa. 1 and 3b. 1, 2, and 4c. 1, 3, and 5d. 1, 2, 3, 4, and 57. In the literature, the factor that appears toMARCH 2009, VOL 89, NO 3 • AORN JOURNAL • 517
Page 2 and 3: MARCH 2009, VOL 89, NO 3HudekIn old
Page 4 and 5: MARCH 2009, VOL 89, NO 3HudekDocume
Page 6 and 7: MARCH 2009, VOL 89, NO 3HudekTABLE
Page 10 and 11: MARCH 2009, VOL 89, NO 3Examination
Page 12: 1.8Learner EvaluationEmergence Deli

Emergence Delirium: A Nursing Perspective - AORN

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?