#25 The Awake and Walking ICU

Propofol and Ativan are a nurses best friend, right? WRONG. Kali Dayton, RN, DNP from the podcast Walking Home from the ICU challenges us to rethink delirium in a way that not only produce better patient outcomes but substantially decrease the nurses workload in the long run.

Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00) or here for detailed instructions.

Claim free CEs | Listen on Apple Podcasts | Listen on Spotify

Types of Delirium

Delirium is not always hyperactive. In fact, it is usually not. According to Kumar et al, the types and frequency of delirium are:

  • Hypoactive 44.5%
  • Hyperactive 33.3%
  • Mixed 22.2%

Important Statistics

  • For every 1mg of Lorazapam given, the risk of delirium goes up by 20% in within the following 24 hours (Pandharipande, 2013)
  • Patient’s who become delirious are
    • 2x as likely to die during admission (Salluh, 2015
    • 3x as likely to die within 6 months after discharge
    • More likely to die 1 year after discharge (Ely, 2004)

Kali’s Call to Action for Nurses

  • Fight for safe staffing ratios with this information. Play out the domino effect and the ultimate $$$ COST of the these consequences
  • Involve families
  • Facilitate physical and occupational therapy
  • Encourage mobility, foleys out, utilize commode/toilet, chair during the day (chair and bed exercises, even with family, are far more effect than inspiratory spirometer)
  • Maintain proper circadian rhythms 
  • AVOID medications like Ativan like the plague
  • Mobility and melatonin at night 
  • Talk patient through it- allow them to discuss their delirium- make sure everyone understands where they are