Download - Delirium Assessment and Management
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Delirium Assessment and Management Presented by: Jonna Bobeck BSN, RN, CEN
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IntroductionAcute change in consciousnessHyperactive deliriumHypoactive deliriumAssociated with increased length
of stayOften goes undetected
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Supporting EvidenceNeed for standardized assessment toolsTools
◦Confusion Assessment Method (CAM-ICU)◦ Intensive Care Delirium Screening Checklist
(ICDSC)Also implementing the ABCDE bundle
◦A - awakening◦B - breathing◦C- coordination◦C- choice◦D - delirium
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Supporting EvidenceUnderstudied and underreportedPre-existing dementia,
hypertension, alcoholism, and severity of illness
Recent studies conclude early mobility improves cognitive function
Decrease sedative use and modify iatrogenic risk factors
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Managing ICU DeliriumThe FDA has not approved a drug
to treat deliriumFDA has issued an alert regarding
antipsychotic medicationAll patients receiving
antipsychotic medications should be closely monitored
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Managing ICU DeliriumUse the THINK mnemonic
◦T- toxic situations◦H – hypoxemia◦I – infection/sepsis◦I – immobilization◦K – electrolyte abnormalities
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Delirium ScreeningPatients admitted to Intermediate
or Advanced ICU with be screened for delirium on admission and at least every 12 hours thereafter
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Process for UtilizationAdd the Delirium Screening to
interventionsComplete the screeningImplement the ABCDE bundle
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Process for Utilization: Patient Positive for DeliriumOrientationEnvironmentClinical paramaters
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Process for Utilization: Patient Positive for DeliriumPharmacologic
◦Use THINK mnemonic◦T – toxic situations◦H – hypoxemia◦I – infection/sepsis◦N – non-phamrocologic interventions◦K – postassium or electrolyte
problem
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Early MobilizationPatients will be progressively
ambulated and mobilizedObjective assessment every 12
hours
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Process for Utilization Step 1: baseline mobility
◦Passive ROM twice a day◦Turn every 2 hours◦Increase sensory stimulation during
day◦Allow rest at night◦Involve families
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Process for UtilizationAssess mobility progression
criteria◦Responds to verbal stimuli with eye
opening◦Oxygen demands are stable◦No unstable fractures◦No increased titration of
vasopressors for 12 hours
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Process for Utilization: Progressive MobilizationStep 2: bed to chair positionStep 3: life to chairStep 4: dangle on edge of bedStep 5: transfer to chairStep 6: standing at bedsideStep 7: ambulate at bedside
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Process for UtilizationAssess tolerance of activity by:
◦Unexpected change in vs◦Symptomatic decrease in SBP◦Decrease in Scvo2◦Increase in FiO2◦Desaturation less than 90%◦Ventilator dysyncrony◦Sustained increase in secretions
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Key PointsO2 may not be increased during
mobilizationNotify provider if FiO2 does not
return to baselineRT may adjust ventilator to
support increased requirementsAdvance only 1 step per day
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Summary: Putting it all TogetherABCDE bundle
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ReferencesPullman Regional Hospital,(2012).
Delirium screening protocol Retrieved from \\prhs5\groups\Policies and Procedures\Patient Care
Pullman Regional Hospital, (2012). Early mobilization of ventilator patients protocol Retrieved from \\prhs5\groups\Policies and Procedures\Patient Care