理解意识障碍：危重症护理护士的机遇。
Understanding Disorders of Consciousness: Opportunities for Critical Care Nurses.
机构信息
Malissa A. Mulkey is a postdoctoral research fellow at Indiana University-Purdue University, Indianapolis, Indiana, and a clinical nurse specialist at University of North Carolina-Rex Hospital.
出版信息
Crit Care Nurse. 2021 Dec 1;41(6):36-44. doi: 10.4037/ccn2021344.
BACKGROUND
Disorders of consciousness are powerful predictors of outcomes including mortality among critically ill patients. Encephalopathy, delirium, and coma are disorders of consciousness frequently encountered by critical care nurses but often classified incorrectly.
OBJECTIVE
To provide a greater understanding of disorders of consciousness and to provide standardized assessments and nursing interventions for these disorders.
METHODS
A literature search was conducted by using the terms consciousness, mental status, awareness, arousal, wakefulness, assessment, disorders of consciousness, delirium, encephalopathy, coma, vegetative state, and minimal consciousness. Articles were published in the past 10 years in CINAHL and PubMed. Articles were excluded if they were not in English or directly related to caring for patients with a disorder of consciousness. The remaining 142 articles were evaluated for inclusion; 81 articles received full review.
RESULTS
A disorder of consciousness signifies that the threshold for compensation has been surpassed with potentially irreversible damage. Altered thalamocortical interactions and reduced cortical activity impair communication networks across the various parts of the brain, causing a disturbance in consciousness.
DISCUSSION
The cue-response theory is a model that describes the process and impact of nursing care on recovery from acute brain injury. Appropriate standardized assessments and interventions must be used to manage altered levels of consciousness in critically ill patients.
CONCLUSIONS
Paying close attention to neurological changes and monitoring them with standardized assessments are critical to implementing early measures to prevent complications.
背景
意识障碍是重症患者死亡率等预后的有力预测因素。脑病、谵妄和昏迷是重症监护护士经常遇到但经常分类错误的意识障碍。
目的
提高对意识障碍的认识，并为这些障碍提供标准化评估和护理干预。
方法
通过使用术语意识、精神状态、意识、觉醒、清醒、评估、意识障碍、谵妄、脑病、昏迷、植物状态和最小意识来进行文献检索。在 CINAHL 和 PubMed 中搜索过去 10 年发表的文章。如果文章不是英文的或与护理意识障碍患者无关，则将其排除在外。对剩余的 142 篇文章进行评估以纳入；81 篇文章进行了全面审查。
结果
意识障碍表示补偿阈值已经超过，可能存在不可逆转的损伤。丘脑皮质相互作用改变和皮质活动减少会损害大脑各个部位之间的通讯网络，导致意识障碍。
讨论
线索-反应理论是一种描述护理对急性脑损伤恢复过程和影响的模型。必须使用适当的标准化评估和干预措施来管理重症患者的意识改变。
结论
密切关注神经变化并使用标准化评估进行监测对于实施早期预防并发症的措施至关重要。
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