I'm Not A Nurse - But I Have A Question

[sugarbear]

Sorry to bother you all - and perhaps this is not the place to ask this question - so I apologize in advance.

This isn't a medical question, per se...but mostly just asking about your experience.

My father is just recovering from post-operative back surgery, in which he had a small(?) heart attack in the recovery room and then immediately an angiogram/angioplasty on his right coronary artery...it has been 6 days now since the surgery(s). On day 4, he started having what I would (non-professionally) called dimensia. He imagines that silverware is sitting in front of him on the sheets and tries to pick them up. He sees medicine floating in the air. ...and most disturbing to my mom is how he will be having a conversation with us and then *instantly* - even eyes open - start rambling incoherantly from parts of old conversations with people he hasn't talked to in years, or statements back to back that might makes sense as a single sentence but when strung together have no relationship, "Danny time to get a haircut. I need to grade those papers. Ooops, I cut a wire." At first we thought it was the pain killers...but now he hasn't been on them for a couple days and it is still happening.

The doctor said the brain tests came back "excellent"...so supposedly no detectable damage from the heart attack.

Do you see this kinda thing happen a lot after surgery? Cardiac surgery? Can anesthesia cause strangeness like this so long after surgery?

Again, I am not asking for medical advice or anything...just wondering if in your field - in the field - you see alot of this...

Thanks so much if you can give me some feedback.

--PAUL

[TazziRN, RN]

Different forms of psychosis can be seen after cardiac surgeries where the pt is place on a bypass machine, but your father didn't have that. Perhaps you should insist on a referral to a neurologist for your dad.

[ZASHAGALKA, RN]

I can't speak to you father's situation, because I don't know it.

I would say that dementia is a process and doesn't happen overnight. So I doubt the sudden appearance of confusion is 'dementia'. The correct word, if you are looking such things up, is 'delirium' (literally: off track).

But, people, expecially older people, that are tossed out of their routine can become confused and display the symptoms that you describe.

There's something about lying in bed that can throw even young people for a loop after a few days. We humans just aren't designed to be inactive; and even a few days of it is a MAJOR stress to our systems.

In critical care, we have a term for this: "ICU psychosis". You might look that term up online. "ICU psychosis" is a form of delirium, and not necessarily limited to the "ICU".

Assuming this is the case and not an acute physical change (CVA - but you said the doctors did a CT scan to look for such and didn't find it) the 'cure' is:

Getting appropriate sleep

Weaning off meds that he's not used to that might have sedative effects (but again, some of those meds might be needed for pain management, to PROMOTE the sleep that might help with this and some might be to REDUCE the effect of the behavior. This is a DOCTOR'S domain. I don't suggest to change medicine routines; I'm suggesting that, at a later point, when/if these type of meds are no longer needed, their elimination might have an overall improved effect.)

Reorientation devices in his room (calendars, clocks he can see, windows open during the day, personal devices in reach - like HIS watch, short wheel chair trips OUTSIDE if appropriate, etc. etc.) This is VERY important. We are creatures of VISUAL/TACTICAL cues. Remove those cues, and its easy to become confused. So, work on RESTORING those cues.

To the extent possible, activity out of bed (be 'worn' out being up during the day so can sleep at night. OOB and walking to the extent allowed by orders.)

DAY/NIGHT reorientation (it's easy to get days and nights messed up in the hospital and we instinctually apply our personal chemicals and hormones in conjuction with our day/night schedules: the result of such confusion - your body never knows when to 'gear up' for daytime and 'gear down' for nightime - and all those chemicals/hormones that DO THAT; well they are being applied randomly, or not at all.)

You can read about it more.

Most times, these situations mostly resolve as someone returns their routines and to their 'lives'.

But again, there is a world of difference between asking a 'general' question and a 'specific' one. I answered a 'general' question and not one 'specifically' related to your father.

Good luck.

~faith,

Timothy.

[Beary-nice]

My dad got really weird after coming home from his 3-way bypass. Mom left the house to walk downtown...2 blocks to get something from the store. When she returned, she couldn't find him anywhere. She heard noises in the basement. There was dad, working on something in the air and saying he had to get the knobs turned. Mom had difficulty getting him back upstairs because he thought he was clearly on a mission of some sort and it took some time for him to come back to reality. This was on his 5-6th post op day and he had been home for about 48 hours. He was also taking darvocet two of them pretty regularly for pain from his incisions. The darvocet was stopped and he started taking tylenol only and surprisingly no more hallucinations or weird doings. My dad was 56 when he had his surgery. Not saying this is what is going on with your dad but this was our experience with mine. So it was either the darvocet pain pills or a coincidence. Agree with Tazzi that further investigation is in order.

[sugarbear]

Wow...that ICU psychosis...*really* sounds like it fits with what Dad has going on. He certainly is not getting good sleep for weeks now...even before he got into the ICU he hasn't be able to sleep because of pain...and now all of the disturbances in the hospital...it sure sounds like it fits.

It seems to fit too with the fact that as soon as a new person comes to visit him he is fine...but when the new/interesting stimulii goes away he more easily slips into this delirium.

I really appreciate it. Thank you all...I hope that we have a name for our issue now.

--PAUL

[maddynrs]

I agree with Zashagalka. The ICU psychosis thing is verrry prevalent in my unit. I see elderly and sometimes not-so-elderly patients totally out of their minds with confusion and insistent upon going about their normal daily rituals in the middle of their rooms with feces running down their legs and total delerium in their eyes. It's not a pretty sight for the family or the nurses. Fortunately, I've also seen people come out of this state with no signs of residual damage or confusion. A lot of it does have to do with the meds, but mostlyj it's the change in routine and the chemicals that our bodies produce.

So Bravo to you for a very enlightened answer Kash, as I have also learned more in this posting.

Hope your father gets back to normal soon SugarBear.

M.