重症病人譫妄的群組照護

Bundle Care of Delirium in Critically Ill Patients

譫妄是急性腦部功能障礙的症狀，一旦發生將導致病人精神狀態改變，當重症病人發生譫妄，不僅會延長住院天數，增加死亡率，甚至會增加醫療費用的支出。因此，疼痛、躁動及譫妄的臨床照護指引建議重症護理人員需定期進行疼痛、鎮靜及譫妄評估，並讓病人每日自然清醒、自然呼吸、早期活動或下床運動，以預防並治療譫妄問題。本文透過文獻查證，簡介造成譫妄原因及危險因素、譫妄評估、譫妄的治療及群組照護內容，供重症護理人員參考並運用，以期減少重症病人譫妄的發生。

Delirium is an acute brain dysfunction that incurs altered mental status. When critically ill patients develop delirium, it prolongs hospital length of stay, increases mortality rate and even health care costs. The clinical practice guideline for pain, agitation and delirium recommends nurses assess critically ill patients periodically for their pain, agitation and delirium status. The guideline also recommends nurses provide the patients with daily natural wake-up, natural breathing, early participation of activity of daily life and out of bed to prevent the risk of delirium. Through literature reviews, this article introduces the causes and risk factors of delirium, assessment tools and its treatment and bundled care. This information is used as reference and application for critical care professionals to decrease occurrence of delirium.