In many intensive care units and nursing homes nurses have a "PRN" or "when necessary" order for Haldol, the antipsychotic medication also known as by its generic name haloperidol. Using too much Haldol, however, may cause as many problems as it treats.
Haldol, or its generic equivalent haloperidol, is a standard medication in many long-term care facilities. Often doctors prescribe Haldol PRN ("pro Re nata," or "as needed") for difficult patients who need ongoing care. More specifically, Haldol is used to treat delirium, which is associated with a variety of morbidities and mortalities, that is, delirium can foreshadow worsening condition or death.
What Is Delirium?
Delirium is a short-term, usually reversible, form of brain dysfunction. Sometimes delirium is mistaken for depression. Delirious patients may become sad and withdrawn. They express feelings of hopelessness. They may become suicidal.
In other situations, delirium causes grandiosity. Patients may believe they possess superpowers. Alternatively, patients may believe they are being persecuted. The nurse or the doctor or the hospital or some nefarious individual or organization is out to kill them. The condition may cause hallucinations, such as seeing puppies floating in the air, or delusions, such as the idea that an IV line is a snake sucking blood out of a vein.
The sleep cycle may be reversed, with sleepiness during the day and wakefulness at night. Usually there is also a problem with attention span, so delirious people do not cause harm to themselves or to others, but sometimes delirious patients attempt to elope from care, so that their beds and their bodies have to be fitted with alarms. There may be a bed alarm, which sounds a loud alarm when the patient gets out of bed, or a body alarm, which locks doors when the patient approaches.
Delirium Has Warning Signs
Usually delirium does not come on immediately upon admission to an intensive care unit or nursing home. There may be at first just an unusually large number of requests for assistance. The patient may report vivid dreams, or hallucinations that are recognized as hallucinations. Anxiety almost always accompanies delirium. There may also be increased blood pressure, heart rate, respiration, and urination, and difficulty with short-term memory and concentration.
Prevention of Delirium
Some very simple interventions can greatly reduce the risk of delirium. Patients who are in a room with others, with twenty-four hour noise and light and interruptions for vital signs and blood work, quickly wear out and become delirious. One study found that noise reduction with nothing more than ear plugs reduced the rate of delirium by 53 percent. Patients who are in private rooms are far less likely to develop delirium. Patients who are not awakened in the middle of the night for blood draws so the doctor can have lab results early in the morning are less likely to develop delirium.
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Why is preventing delirium so important? A friend of mine recounts the story of his father's pulling out his IV lines, blood spurting all over the bed and the floor, when he became delirious. Patients in a state of delirium may become violent. They may make sexual overtures they would never make when psychologically well, and ruin relationships and their self-esteem for the rest of their lives. Delirious patients may pull stitches and damage vital organs after surgery, and some delirious patients die as the result of leaving their beds too soon. Rister also tells the story of a man in ICU who decided he would go out for a hamburger several hours after brain surgery, who fell in the floor and died.