Archive for June, 2011
Have you ever had a loved one, who had no previous mental problems, or only slight dementia, go into the hospital or ICU? Once there, did their entire personality and behavior take a 180 degree turn for the worse? Did their grasp on reality go out the window? Normally polite and mild mannered, did the person begin yelling at you and the staff? Did they try to rip out their IV line, climb out of bed or think bugs were crawling all over them? If you are nodding your head to any of this, more than likely your loved one had an episode of “Hospital Psychosis”….
First of all, what is hospital psychosis and how can the hospital or ICU cause it? We all know the hospital is a stressful place to be. It feels foreign. It’s noisy. Different and unfamiliar people are coming and going at all times of the day and night. It is impossible to get a good nights sleep in the hospital. So you have extreme stress exacerbated by sleep deprivation very early on. Adding sedatives or anesthesia into the mix can also make the person more vulnerable.
Other possible causes:
Constant light from machines and staff entering in and out can disrupt normal biorhythms Stress from being ill, away from home, loss of control of normal life Unfamiliar people coming and going at all times Away from loved ones or usual caregiver Pain, metabolic disturbances and dehydration can be huge factors Disorientated to time, day and what is going on in the world
Hospital psychosis is related to the length of stay in the hospital. Family members may comment that the person seemed “not quite himself” the first day or two. But by day three there was hallucinating, his speech was slurred with profound memory loss. Some people develop the psychosis more abruptly. Within hours of being admitted they may begin talking gibberish or try to climb over the rails out of bed. They may continuously brush at the bed thinking there are bugs everywhere.
Hospital psychosis is real and it can be very dangerous when it’s severe. Especially ICU psychosis where there are no windows, very limited contact with family and noisy machines. These agitated patients have been known to begin ripping out vital tubes and IV catheters with disastrous results. So it’s important to remember that hospital psychosis can be life threatening.
Hospitals, doctors and nurses should first and foremost be aware of what hospital psychosis is and just as importantly what it isn’t. In the past there seems to have been some reluctance on the part of the medical establishment to acknowledge that hospital psychosis exists. Many times it remains untreated. This is unacceptable! Frustrated and scared family members are told that its just medication reactions, or the person has dementia, etc.
Hospital staff should understand that in most cases, the person has no history of dementia or mental problems. The patient and family can be helped tremendously by a staff that:
Watches for and is alert to symptoms of possible hospital psychosis Knows importance of taking immediate action, Is capable of explaining it fully to everyone involved, including patient All staff informed and committed to managing and treating early on Can empower family members by informing them what they can and should do, as well as behaviors to avoid Offer reassurance that the condition is temporary, will subside once the person goes home, and should fully resolve.
If you are in the medical field, can you imagine the peace of mind you can give by having this conversation with a patient or family member? If you work in an ALF or Nursing Home your client has to go to the hospital, take it upon yourself to educate the patient and family. This prepares them and reassures them. If you are a patient’s primary doctor and have to admit him-take the time to educate your patient and family about hospital psychosis and the possibility it could occur.
What things can be done to prevent hospital psychosis?
Encourage family and friends to conduct very frequent low key visits! The patient needs to be surrounded by familiar faces. If the person had a caregiver assisting them at home, make sure their caregiver continues to come and be with the patient as MUCH as possible-talking, reading, just sitting together. Clients who utilize their caregiver when the family can’t be there have smoother sailing! Protect the patient from unnecessary excitement, noise, chaos or arguments Insist staff do all they can to coordinate lighting with day and night Insist your loved one have blocks of dark, quiet uninterrupted sleep each night. Disorientation worsens symptoms so make sure patient has his glasses to see, his hearing aid to hear Having their caregiver there to answer simple questions, without waking the patient, when staff comes in to ask endless questions . Doctor may use anti-psychotic or antidepressants to treat symptoms but w/ extreme caution-it’s possible their side effects could worsen the situation.
Hospital acquired infections can increase the length of a patient’s stay, be costly and increase morbidity, according to The World Health Organization. There are some simple steps hospitals can take to decrease hospital infections.
All staff should be trained in hospital infection control polices and follow all guidelines. Training staff properly and ensuring they follow guidelines is the first step in reducing hospital acquired infections.
Hand washing is a simple practice which plays a large role in hospital infection control. Washing hands prior to working with a patient and after care is completed reduces transference of infections among patients. In addition, using protective equipment, such as gloves and gowns, reduces transmission of infections among patients.
Having an alcohol based foam or gel in each patient’s room is a simple step hospitals can take. This makes cleaning hands easy and quick for staff.
Proper sterilization and cleaning of equipment helps cut the risk of hospital acquired infections. Cleaning medical devices, such as stethoscopes and blood pressure cuffs, between patients greatly reduces infections.
Special precautions should be taken when patients have devices in place which increase the chances for infection. Notably, catheters, breathing tubes and IV ports are used in areas where infections may develop frequently.
Developing infection control polices for patients with indwelling devices is essential. For instance, IV port infection protection should include using all sterile techniques. In addition to wearing gloves, staff should wipe the tip of the port with an alcohol swab prior to putting in medication or connecting additional tubing. For information about hospital infection control visit to our site at http://www.iveramed.com
Each year the number of U.S. veterans increases as soldiers returning from America’s most recent wars come home. However, as the survivors are welcomed home after pursuing a dutiful career serving their country, a new generation of men and women suffering from mild- to severe-traumatic brain injuries (TBI) are greeted with battled medical budgets and flawed TBI technologies, which don’t provide the necessary services and treatments required to improve their newly developed disabilities.
With an average of 1.4 million Americans undergoing some form of TBI, the number of scientists and researchers striving to cure these individuals should be ever increasing, however, dwindling budgets continue to compress and squeeze war-related brain injury funding. In 2006, the U.S. House and Senate slashed the allocated funding for the Defense and Veterans Brain Injury Center (DVBIC) in half from the previous year.
Traumatic brain injury has been deemed the “signature” injury of the Iraq war, according to military doctors and experts. It is imperative for struggling soldiers to find assistance with their TBI-related disability.
What is TBI?
Traumatic brain injury is defined as an injury that occurs after an abrupt trauma causes damage to the brain, according to the National Institute of Neurological Disorders and Stroke (NINDS). War-related TBI can occur in many ways and individuals suffering from this and related side effects will find symptoms vary on a case-by-case diagnosis.
Researchers and scientists are, however, finding several repetitive conditions and symptoms among TBI victims. The common signs and symptoms of these war-related conditions are as followed, according to a studies published in the medical journals of Neuropsychology and Brain Injury:
* cognitive issues *decreased attention span, including focused, selective and sustained attention problems *language difficulties
* lack of motivation *inability to efficiently process information
* irritability *depression and anxiety
* increased fatigue *headaches *memory loss or disturbance
* behavioral issues
* disrupted sleep
* post traumatic stress disorder
In May 2006, the co-founder of the DVBIC testified to a Senate subcommittee that while “body armor may save troops caught in blasts it leaves many with brain damage,” according to a USA Today news report. Additionally, the article cited several disturbing statistics on the state of TBI and war veterans.
* 10 percent of all troops in Iraq suffer from concussions during combat. * 20 percent of all frontline infantry troops suffer from concussions during combat.
*Scientists believe the Pentagon must screen all troops returning from Iraq.
*The Pentagon has declined screenings for all returning troops and only screen a small population of soldiers.
*If left untreated or untested, multiple head injuries and concussions can cause permanent brain injury.
Also, several equally disturbing statistics have been reported from several specialized journals including Brain Injury, Internal Medicine, Soldiers Magazine, MIT’s Technology Review and Perspectives in Psychiatric Care. These statistics area as follow:
*Nearly 25 percent of all military veterans of the Iraq war are diagnosed with a mental illness.
* War-related TBI patients often manifest distinct personality changes.
* Of the 35,000 soldiers screened for TBI, approximately 11 percent have had symptoms of mild TBI.
* No treatments currently exist to cure long-lasting symptoms of TBI.
Flawed Brain Injury Technology
Unfortunately, as budgets are cut, the quality of care and technology also decreases. Most recently the Government Accountability Office (GAO) reviewed nine Veterans Affairs (VA) medical centers and found that the TBI-screening test’s validity and reliability may be flawed.
Additionally, the report found that soldiers with TBI may be receiving inadequate or unnecessary care for their brain injuries, according to an Associated Press article from January 2008. The report found that:
* Although the VA has implemented TBI screening tools, the validity and reliability of the tool has not yet been established.
* The VA has implemented a protocol to ensure soldiers testing positive for TBI are adequately treated; however, many of the VA’s medical facilities either did not follow the protocol or had difficulty doing so.
* Culturally, the VA has found that Iraq veterans feel the VA and its facilities cater to elderly veterans and do not want to treat young veterans.
* The VA is struggling with poor rural access to medical centers as well as poor turnout rates for injured vets who in some cases must drive 100 miles plus to reach a nearby VA hospital.
Living With TBI
Veterans who are currently living with TBI will find that not only does TBI affect them, but the ripple effect among an injured veteran’s family and friends is quite extensive. There are an array of clinical trials that a TBI victim can become involved in to improve the living conditions as well as to treat the symptoms of TBI. Some of these clinical trials can be found through the following organizations Web sites:
* National Institute of Neurological Disorders and Stroke – Brain Resources and Information Network (BRAIN)
* Acoustic Neuroma Association Brain Trauma Foundation
* Brain Injury Association of America Family Caregiver Alliance/National Center on Caregiving National Rehabilitation Information Center (NARIC)
* National Stroke Association
* National Institute on Disability and Rehabilitation Research (NIDRR)
Finding Brain Injury Assistance
There are several organizations available to offer assistance specifically to those with war-related ailments. The following are several of the leading organizations/hospitals:
* Walter Reed Army Medical Center Defense and Veterans Brain Injury Center
* Defense Center of Excellence for Psychological Health and Traumatic Brain Injury
* National Intrepid Center of Excellence Deployment Health Clinical Center
*Center for Study of Traumatic Stress Center for Deployment Psychology
* The Department of Defense (DoD) also offers a search component through their Web site to assist veterans in finding a veteran hospital in their geographic area.
Additionally, individuals enduring the pain of a war-related brain injury are encouraged to locate an experienced traumatic brain injury lawyer who can provide assistance with developing a brain injury lawsuit. Because of the nature of these injuries, there should be no reason why monetary compensation is not rewarded to an injured party.
TBI medical bills can be extremely expensive, and this potential for awarded compensation can provide relief from the stress associated with medical expenses.