An older woman is recovering from a bowel resection in the intensive care unit but remains intubated and on a mechanical ventilator. Which of the following should the nurse implement to help prevent delirium in this woman?

Question

a. Assess cognition with MMSE-2.
b. Provide uninterrupted periods of rest and sleep.
c. Maintain adequate sedation and pain management.
d. Cover the patient's eyes with protective ophthalmic ointment.

Answer 1

B
Providing uninterrupted periods of rest and sleep is a challenge for the nurse in intensive care. Because of the nature of the patients' illnesses, nurses administer medications and treatments and perform invasive procedures on a 24-hour basis, leaving patients little time for rest. Many patients become delirious in the intensive care unit because the noise, activity, brightness, and disturbance tend to persist around the clock, which contribute to delirium. Patients lose their sources for maintaining orientation and stability; that is, bright lighting at all times, as well as unfamiliar and abrupt increases in noise, can lead to a disruption in the circadian rhythm. In addition, patients in intensive care are more likely to receive multiple medications, and medications that are potentially harmful can aggravate the patient's cognitive difficulties.
Because this patient is intubated and on mechanical ventilation, the nurse cannot apply the MMSE-2; the patient is unable to perform adequately. Besides, assessing for dementia is not a prophylactic measure. Sedation and pain management, although often needed in the intensive care unit, can contribute to delirium. Covering the eyes of a patient in intensive care with oint-ment can be necessary to prevent corneal damage; however, it is likely to contribute to delirium because the patient will be unable to see clearly.