In anticipation of the upcoming Nurses’ PodCrawl about Delirium, I am re-releasing one of my most impactful episodes of all time with thought leader, Kali Dayton.
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.
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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%
- 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