医学研究report代写 -基于证据的护理研究-护理学代写

EVIDENCE-BASED NURSING RESEARCH

基于证据的护理研究

By [Name]

Course

Professor's Name

Institution

Location of Institution

Date

医学研究report代写 Lars may be suffering from delirium as he appears withdrawn, apathetic, avoiding conversations, and eye contact. In general..

 

Evidence-Based Nursing Research

Lars may be suffering from delirium as he appears withdrawn, apathetic, avoiding conversations, and eye contact. In general, delirium is a sudden change in the brain’s normal functioning causing mental confusion and emotional disturbances (Maldonado 2018). People with delirium often show reduced awareness of the surrounding,

as seen in Lars. Treating delirium is costly because physicians often detect the condition when it is too late (Leslie & Inouye 2011; Weinrebe et al. 2016). As a result, patients who develop delirium are always at an increased risk of morbidity and mortality (Mistraletti et al. 2012). The purpose of this essay is to examine a case study of a patient (Lars) with delirium and determine what risk factors predisposed him to the disease,

how it could have been prevented, and how to manage the disease.

译文：循证护理研究

拉斯可能会出现del妄，因为他显得孤僻，精神萎靡，避免交谈和目光交流。 一般而言，ir妄是大脑正常功能的突然变化，导致精神错乱和情绪障碍（Maldonado 2018）。 患有ir妄症的人通常对周围环境的意识降低，

如拉斯所示。 治疗del妄是昂贵的，因为医师通常会在病情太迟时发现病情（Leslie＆Inouye 2011; Weinrebe et al。2016）。 结果，发生del妄的患者总是处于发病和死亡风险增加的状态（Mistraletti等，2012）。 本文的目的是研究一个患有ir妄的患者（Lars）的案例研究，并确定哪些易患该疾病的风险因素，

如何预防它，以及如何控制这种疾病。医学研究report代写

---

Delirium Risk Factors for Mr De Jong

People 65 and older are at a high risk of developing delirium (De Lange et al. 2013). Lars falls within this bracket as he is 67 years old. Ageing comes with several complications that require frequent hospitalisation, like hypotension and breathing difficulties. During hospitalisation, the onset of delirium has been documented widely,

especially in I.C.U. and post-operative settings (Maldonado 2018). Other risk factors of delirium associated with the patient include being male, poor or deceased mobility, and depression. Before his hospitalisation, Lars had become depressed due to the increased burden of being the only carer of his sick wife. His hospitalisation also decreased his mobility, which is likely to continue with an increased hospital stay.

Together, these factors increased his risk of developing delirium.

译文：德钟先生的妄危险因素

65岁及65岁以上的人群罹患del妄的风险很高（De Lange et al.2013）。 拉斯（Lars）享年67岁。 衰老伴有多种并发症，需要经常住院，例如低血压和呼吸困难。 在住院期间，widely妄的发作已被广泛记录，

特别是在I.C.U. 和术后设置（Maldonado 2018）。 与患者相关的ir妄的其他危险因素包括男性，行动不便或死者以及抑郁症。 在住院之前，拉尔斯由于成为生病的妻子的唯一照顾者而增加了负担，因此变得沮丧。 他的住院治疗也降低了他的行动能力，这可能会随着住院时间的增加而继续下去。

这些因素加在一起，增加了他发生del妄的风险。

---

How May Delirium Have Been Prevented In This Case?

The nursing staff in charge of Lars' treatment suspected that he had delirium and implemented nonpharmacological protocols to reassure Lars and re-orientate to the environment. Immediately starting a treatment intervention without conducting tests to verify whether Lars has delirium shows that the nurses do not have adequate delirium testing and management training.

Preventing at-risk patients such as Lars from developing delirium at the bedside requires nurses to be proactive in their nursing practises. According to the Nursing and Midwifery Board of Australia (N.M.B.A.), nurses should “demonstrate proactive leadership to positively influence the direction of nursing” (N.M.B.A 2014).

By being proactive, nurses must regularly perform complete screening and examination of patients in need of critical care using appropriate tools to develop an accurate picture of their health needs and how they can be met (Levett-Jones et al. 2010). Thus, nurses need to be trained on using appropriate delirium assessment,especially on various delirium assessment tools such as the CAM-ICU.

译文：在这种情况下如何预防Deli妄？ 医学研究report代写

负责Lars治疗的护理人员怀疑他患有del妄症，并实施了非药物治疗方案，以使Lars放心并重新适应环境。立即开始治疗干预而未进行测试以验证Lars是否有ir妄，这表明护士没有进行足够的ir妄测试和管理培训。

要防止高危患者（如Lars）在床边出现requires妄，需要护士积极主动地进行护理。根据澳大利亚护理和助产委员会（N.M.B.A.）的说法，护士应“展现积极主动的领导才能对护理方向产生积极影响”（N.M.B.A 2014）。

积极主动，护士必须定期使用适当的工具对需要重症监护的患者进行全面筛查和检查，以准确了解他们的健康需求以及如何满足他们的需求（Levett-Jones等人，2010年）。因此，需要对护士进行适当appropriate妄评估的培训，尤其是在各种del妄评估工具（例如CAM-ICU）方面。

---

In this way, nurses will be able to detect the condition early and prevent it from escalating.

Hospitals also need to update their procedures and guidelines concerning vulnerable patient management. Principally, it should be standard practise to conduct specific tests on specific patient populations who are known to be at risk of developing particular diseases. For example,

a policy requiring nurses to test for delirium in male patients above 65 years admitted to the hospital can help detect the disease at an early stage. Early detection means early treatment.

Lastly, preventing delirium, in this case, requires nurses to use intervention approaches that target the correctable risk factors that predispose the patient to the diseases. Mainly, nurses should modify all risk factors associated with hospital-induced delirium. Nurses should ensure that all elderly patients with critical care needs are placed in the same wards.

译文：这样，护士将能够及早发现病情并防止病情恶化。

医院还需要更新有关弱势患者管理的程序和指南。 原则上，应该对已知有患特定疾病风险的特定患者人群进行特定测试，这是标准做法。 例如，

一项要求护士对入院的65岁以上男性患者进行del妄测试的政策可以帮助及早发现该疾病。 早期发现意味着早期治疗。

最后，在这种情况下，预防preventing妄需要护士使用针对可导致患者易患疾病的可纠正风险因素的干预方法。 主要是，护士应修改与医院引起的ir妄有关的所有危险因素。 护士应确保将所有有重症监护需求的老年患者放在同一病房中。

---

The wards should be free of unsettling noises and disturbances

such as frequent room changes. Such conditions will enable the patient to have adequate rest and sleep, which can help reduce the effects of delirium (De Lange et al. 2013). Invasive procedures have also been linked with delirium risk; hence reducing them could have prevented the disease in this case.

译文：病房应没有令人不安的噪音和干扰  医学研究report代写

例如频繁的房间更换。 这样的条件将使患者有充足的休息和睡眠，这可以帮助减少del妄的影响（De Lange et al.2013）。 侵入性手术也与ir妄风险有关。 因此减少它们可以预防这种情况下的疾病。

---

How To Manage Delirium In The Case

The nursing staff implemented nonpharmacological approaches to manage the patient’s delirium. These comprised encouraging communication and repeated reorientation, ensuring visible daylight, nursing staff consistency, mobilisation activities, and range of motion exercises, common interventions for all patients with delirium (Hipp & Ely 2012).

Communication with the patient should be clear and precise, accompanied by meaningful eye contact. Most importantly, nursing should display empathy and compassion when communicating with Lars. To help with mobilisation, the patient should not be under any physical restraint since this can lead to nervousness (Yevchak et al. 2012).  

The nursing staff should create an environment that fully supports the patient’s path recovery. As suggested previously, this can be done by limiting ward changes that can be disruptive for the patient. Patients’ wards should also be fully equipped with everything that they may need. These can include more comfortable access to water,

译文：如何在这种情况下处理Deli妄

护理人员实施了非药理学方法来管理患者的ir妄。这些措施包括鼓励交流和反复调整方向，确保可见的日光，护理人员的一致性，动员活动和运动范围，对所有with妄患者的常见干预措施（Hipp＆Ely 2012）。

与患者的沟通应清晰准确，并伴有有意义的目光接触。最重要的是，与Lars交流时，护理人员应表现出同理心和同情心。为了帮助运动，患者不应受到任何身体约束，因为这会导致神经紧张（Yevchak等，2012）。

护理人员应该创建一个完全支持患者的路径恢复的环境。如前所述，这可以通过限制可能对患者造成破坏的病房变更来完成。患者病房还应充分配备他们可能需要的一切。这些可以包括更舒适的饮水，

---

food, fruits, books, personal diary,

and many others. The bedside should also be fitted with an alarm system that the patient can press when needed or in discomfort. According to Hipp and Ely (2012), these measures will reduce constant patient movements that can lead to falls that are not good for delirium individuals.

Moving to pharmacological interventions should only be considered if nonpharmacological approaches prove to be ineffective. The main drugs used to treat severe cases of delirium are neuroleptics, such as Haloperidol. The efficacy of Haloperidol has been demonstrated in many clinical trials (Agar et al. 2017).

Haloperidol also exists in parenteral form, which means that it can be administered through injection or infusion (Girard et al. 2018). The patient can, therefore, benefit from this type of medication. Moreover, it reduces suicide ideation in patients who are more likely to harm themselves (Agar et al., 2017).

译文：食物，水果，书籍，个人日记

和许多其他。 床头还应配备警报系统，患者在需要或不适时可以按一下。 根据希普（Hipp）和伊利（Ely）（2012）的观点，这些措施将减少患者持续不断的运动，从而导致跌倒，这对del妄个体不利。

仅在非药理学方法证明无效的情况下，才应考虑采用药理学干预措施。 用于治疗重症of妄的主要药物是抗精神病药，例如氟哌啶醇。 氟哌啶醇的功效已在许多临床试验中得到证明（Agar等人，2017）。

氟哌啶醇也以肠胃外形式存在，这意味着它可以通过注射或输注给药（Girard等人2018）。 因此，患者可以从这种药物中受益。 此外，它减少了更有可能伤害自己的患者的自杀念头（Agar等人，2017）。 医学研究report代写

---

However 医学研究report代写

some patients may experience Haloperidol's side effects, such as a high rate of extrapyramidal symptoms and acute dystonias (Zivkovic et al. 2013). When a patient develops reactions to the drug, the nurse can consider using alternative drugs for treating delirium. These may include other uncommon antipsychotics like risperidone,

olanzapine, and quetiapine (Johnsen et al. 2010). Although they may not be as effective as Haloperidol, the drugs have shown promising results when treating patients with acute delirium (Johnsen et al. 2010). These alternatives have nearly the same side effects as Haloperidol. As such, the selection of a specific drug will depend on how the patient responds to it.

Parenteral Haloperidol and uncommon antipsychotics also increase stroke risk when used regularly, although this risk is higher among patients with dementia. While Lars has not been diagnosed with dementia, he remains at risk as there is evidence to suggest that the disease can co-exist with delirium both in older patients (Jackson et al. 2017).

In sum, despite being the most effective solutions, pharmacological interventions carry more risks than nonpharmacological interventions. In this context, for the best treatment outcomes, nurses should combine both intervention styles when managing patients with delirium. It is imperative to note that these drugs can affect the patient’s mental status and block efforts to monitor the development of the mental status change.

译文：然而  医学研究report代写

一些患者可能会出现氟哌啶醇的副作用，例如锥体外系症状的高发生率和急性肌张力障碍（Zivkovic等人，2013）。当患者对药物产生反应时，护士可以考虑使用替代药物治疗ir妄。这些可能包括其他罕见的抗精神病药，如利培酮，

奥氮平和喹硫平（Johnsen等人，2010年）。尽管它们可能不如氟哌啶醇有效，但在治疗急性ir妄患者时已显示出令人鼓舞的结果（Johnsen等人，2010年）。这些替代品具有与氟哌啶醇几乎相同的副作用。这样，具体药物的选择将取决于患者对它的反应。

定期使用肠胃外氟哌啶醇和罕见的抗精神病药也会增加中风的风险，尽管痴呆患者的这种风险较高。虽然拉斯没有被诊断出患有痴呆症，但他仍然处于危险之中，因为有证据表明该疾病可以在老年患者中与del妄共存（Jackson et al.2017）。

总之，尽管是最有效的解决方案，但药理学干预比非药理学干预具有更大的风险。在这种情况下，为了获得最佳治疗效果，护士在处理managing妄患者时应结合两种干预方式。必须注意，这些药物会影响患者的精神状态并阻碍监测精神状态变化发展的努力。

---

Thus, the nursing staff needs to avoid this option if possible.

It is also important to provide the selected drug in small doses as the patient’s progress is monitored.Providing Lars with patient education on delirium and his role in preventing the disease's occurrence is also an effective method of managing it. Patient education is important because it empowers the patient to take charge of their treatment and builds independent behaviours (Yeh et al. 2018).

Patient education can be incorporated with psychotherapy interventions such as C.B.T. to teach the patient how to manage stressful situations. The role of family support should also be emphasised as a part of this process since it lacks it during his wife’s care that took a toll on Lars, causing depression and other problems.

Finally, Lars may need access to coordinated care once he is discharged to prevent recurring dementia and other conditions. Care coordination may involve all the wider health care system components, encompassing hospitals, speciality care, rehabilitation centres, home healthcare, and community supports services. (Oliver et al., 2014).

Patients with multiple conditions like Lars have complex needs that may prolong their primary conditions (i.e., dementia), which underscores the need for a wide range of health services offered by different healthcare professionals and institutions. Additionally, they require home and community-based services to help them become independent and overcome functional limitations.

Overall, critically ill patients' variety of services demands structured and robust care coordination. Their lack thereof can cause operational silos, as in divergent care goals, and disjointed care that may hinder the patient’s full recovery chances.

译文：因此，如果可能的话，护理人员需要避免这种选择

监测患者的病情进展时，以小剂量提供所选药物也很重要。向Lars提供有关patient妄的患者教育及其在预防疾病发生中的作用也是一种有效的治疗方法。患者教育很重要，因为它使患者能够掌控自己的治疗并建立独立的行为（Yeh等人2018）。

可以将患者教育与心理疗法（例如C.B.T.教患者如何处理压力大的情况。在此过程中，还应强调家庭支持的作用，因为在妻子的照料过程中缺乏家庭支持，这对拉尔斯造成了伤害，并导致抑郁和其他问题。

最后，Lars出院后可能需要获得协调治疗，以防止痴呆复发和其他情况。护理协调可能涉及所有更广泛的医疗体系，包括医院，专科护理，康复中心，家庭保健和社区支持服务。 （Oliver et al。，2014）。

患有Lars等多种疾病的患者有复杂的需求，可能会延长其原发性疾病（即痴呆），这突显了对不同医疗保健专业人员和机构所提供的广泛医疗服务的需求。此外，他们需要基于家庭和社区的服务来帮助他们变得独立并克服功能限制。

总体而言，重症患者的各种服务需要结构化且稳健的护理协调。他们的缺乏可能会导致手术孤岛，如在不同的护理目标中出现，以及脱节的护理可能会阻碍患者的完全康复机会。 医学研究report代写

---

Conclusion

Delirium is preventable and treatable. However, it remains to be a leading cause of morbidity and mortality among older patients. This paper has shown that preventing delirium is cost-effective compared to treating it. To prevent delirium, the essay has suggested that nurses must be proactive in their approaches.

They must be aware of the risk factors of delirium and the appropriate measures that can be adopted to eliminate those risks. More importantly, nurses must be trained on delirium management, particularly on the disease assessment and management of affected patients.

译文：结论

妄是可以预防和治疗的。 但是，它仍然是老年患者发病和死亡的主要原因。 本文表明，与治疗it妄相比，预防del妄具有成本效益。 为了防止del妄，文章建议护士必须积极主动地采取措施。

他们必须了解of妄的危险因素以及可以采取的消除这些危险的适当措施。 更重要的是，必须对护士进行ir妄管理方面的培训，特别是有关疾病评估和患病患者管理方面的培训。

---

教育学代写

医学代写

护理学代写

References

Agar, M.R., Lawlor, P.G., Quinn, S., Draper, B., Caplan, G.A., Rowett, D., Sanderson, C., Hardy, J., Le, B., Eckermann, S. and McCaffrey, N., 2017. Efficacy of oral risperidone, Haloperidol, or placebo for symptoms of delirium among patients in palliative care: a randomised clinical trial. J.A.M.A. internal medicine, 177(1), pp.34-42.

De Lange, E., Verhaak, P.F.M. and Van Der Meer, K., 2013. Prevalence, presentation and prognosis of delirium in older people in the population, at home and in long term care: a review. International journal of geriatric psychiatry, 28(2), pp.127-134.

Girard, T.D., Exline, M.C., Carson, S.S., Hough, C.L., Rock, P., Gong, M.N., Douglas, I.S., Malhotra, A., Owens, R.L., Feinstein, D.J. and Khan, B., 2018. Haloperidol and ziprasidone for treatment of delirium in critical illness. New England Journal of Medicine, 379(26), pp.2506-2516.

Hipp, D.M. and Ely, E.W., 2012.

Pharmacological and nonpharmacological management of delirium in critically ill patients. Neurotherapeutics, 9(1), pp.158-175.

Jackson, T.A., Gladman, J.R., Harwood, R.H., MacLullich, A.M., Sampson, E.L., Sheehan, B. and Davis, D.H., 2017. Challenges and opportunities in understanding dementia and delirium in the acute hospital. PLoS medicine, 14(3), p.e1002247.

Johnsen, E., Kroken, R.A., Wentzel-Larsen, T. and Jørgensen, H.A., 2010. Effectiveness of second-generation antipsychotics: a naturalistic, randomised comparison of olanzapine, quetiapine, risperidone, and ziprasidone. B.M.C. psychiatry, 10(1), p.26.

Leslie, D.L. and Inouye, S.K., 2011. The importance of delirium: economic and societal costs. Journal of the American Geriatrics Society, 59, pp. S241-S243.

Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S.Y.S., Noble, D., Norton, C.A., Roche, J. and Hickey, N., 2010. The ‘five rights’ of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk patients. Nurse education today, 30(6), pp.515-520.

Maldonado, J.R., 2018.

Delirium pathophysiology: An updated hypothesis of the aetiology of acute brain failure. International journal of geriatric psychiatry, 33(11), pp.1428-1457.

Mistraletti, G., Pelosi, P., Mantovani, E.S., Berardino, M. and Gregoretti, C., 2012. Delirium: clinical approach and prevention. Best Practice & Research Clinical Anaesthesiology, 26(3), pp.311-326.

Nursing and Midwifery Board of Australia - Nurse practitioner standards for practice (2014). Retrieved November 18, 2020, from Nursingmidwiferyboard.gov.au website: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/nurse-practitioner-standards-of-practice.aspx

Oliver, D., Foot, C. and Humphries, R., 2014. Making our health and care systems fit for an ageing population. London: U.K.: King's Fund.

Weinrebe, W., Johannsdottir, E., Karaman, M. and Füsgen, I., 2016. What does delirium cost? Zeitschrift für Gerontologie und Geriatrie, 49(1), pp.52-58.

Yeh, M.Y., Wu, S.C. and Tung, T.H., 2018. The relation between patient education, patient empowerment and patient satisfaction: A cross-sectional-comparison study. Applied Nursing Research, 39, pp.11-17.

Yevchak, A., Steis, M., Diehl, T., Hill, N., Kolanowski, A. and Fick, D., 2012. Managing delirium in the acute care setting: a pilot focus group study. International journal of older people nursing, 7(2), pp.152-162.

Zivkovic, M., Mihaljevic-Peles, A., Bozina, N., Sagud, M., Nikolac-Perkovic, M., Vuksan-Cusa, B. and Muck-Seler, D., 2013. The association study of polymorphisms in D.A.T., DRD2, and C.O.M.T. genes and acute extrapyramidal adverse effects in male schizophrenic patients treated with Haloperidol. Journal of clinical psychopharmacology, 33(5), pp.593-599.