A mechanically ventilated patient continues to exhibit distress despite the fact that all life-threatening causes of patient disturbance have been determined and alleviated. Why should the therapist next consider this disturbance to be neuropsychiatric?

A. because the pain-induced stress response may lead to a hypercoagulable state
B. because uncontrolled disturbances can lead to complications of the gastrointestinal tract
C. because the optimal management of pain, delirium, and, anxiety is not the same
D. because inappropriate treatment may lead to nosocomial infections

?ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: The first step in management of patient distress is to rule out any life-threatening abnormalities, particularly of the cardiac, pulmonary, and central nervous systems. Acute onset of patient distress may be a sign of myocardial ischemia, hypoxia, hypercarbia, pneumothorax, cerebral hemorrhage or infarction, an acute abdomen, or
hypoglycemia. Once life-threatening causes are excluded, the next step should be the determination of the underlying cause for the neuropsychiatric disturbance, as the optimal management of pain, delirium, and anxiety is not the same. Attempting to simply medicate for agitation can potentially aggravate the problem if the wrong therapy is administered. Or, it may merely mask the signs without providing effective treatment, which can lead to further complication.
D. Incorrect response: See explanation C.