What’s the Big Deal With Delirium? An Interview with Sarah from the Rapid Response RN Podcast

by | Apr 24, 2023 | Critical Care | 0 comments

This podcast is available on Apple Podcasts, Stitcher, PlayerFM, iHeartRadio, Libsyn, Spotify, and Amazon Music.

Who You’ll Hear

Kati Kleber, MSN RN– Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.

Sarah Lorenzini, MSN, RN, CCRN, CEN – Rapid Response Nurse and host of the Rapid Response RN Podcast

What You’ll Learn

In this episode, I interview Sarah Lorenzini from the Rapid Response RN Podcast about delirium. We discuss a powerful experience Sarah had with delirium in the ICU, common mistakes new nurses make regarding delirium, and tidbits about new nurses working with RRT nurses. This episode is part of a Nurse Podcrawl focused on the topic of delirium. Head here to check out all of the other amazing podcasts too.

Sarah’s Story

Summary: Elderly non-English speaking patient post massive MI in ICU with delirium. Interpretation services not working well, family at bedside. Made an effort to maintain sleep hygiene, increase communication with a communication board specific to his language, and got him outside on the helipad for sunlight. Once extubated, him and his family were enormously thankful to Sarah for helping him stay sane during that scary time.

Common Mistakes New Nurses Make Regarding Delirium

  • Unnecessary use of benzos
  • Disrupted sleep-wake cycle
  • Delayed PT/OT
    • Do you have any talking points for a patient who doesn’t want to get out of bed?
      • “You will not eat in your bed” / “blame the doctor”
      • “Because I care so much about you… because the literature shows that patients who are more mobile get better faster!” start off with care/compassion and justify w/ the literature.
  • Not identifying it

Interesting Delirium Facts

  • 80% of intubated patients develop delirium
  • Delirium doubles the risk of dying the hospital
  • Delirium doubles the nursing hours required for care, so sedation actually doesn’t make your job easier
    • ABCDEF Bundle reduces readmission to ICU by 46%
  • Deep sedation exceptions:
    • Intracranial HTN
    • Status epilepticus
    • Inability to oxygenate with movement (severe ARDS, cardiogenic shock)
  • Sedation isn’t sleep: Propofol and benzos disrupts REM cycle
  • Family engagement decreases rates of delirium by 88%; they are a potent non-pharmacological intervention
    • No evidence to support visitor restrictions
  • If we sedate deeply in response to agitation, an agitation is the top cause of delirium we end up with patients who are sedated because they’re intubated and intubated because they’re sedated

Soapboxes for New Nurses

  • RRT response to calls; the goal isn’t to take over because you can’t handle it. The goal is to teach and empower you to be able to handle it yourself the next time.
  • Reconsider posting memes, Reels or TikToks making light of intubated, sedated and restrained patients

Trying to build your confidence as a new ICU nurse?

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Breakthrough ICU from FreshRN is a 6-week, online course specifically crafted for brand new ICU nurses who want to get ahead of the game. So that instead of merely surviving orientation, they’re confidently thriving all the way through. With Breakthrough ICU, it’s like we took all of the highlighted info from the nursing textbooks, mixed in our own experience, wisdom, and expertise, and packaged it in a way that it’s tangible, easy to digest and understand, and can be applied to your very next shift. You can start your ICU journey with your head held high (but not too high!) and your heart calm. 

More Resources For ICU Nurses

Picture of Kati Kleber, founder of FRESHRN

Hi, I’m Kati.

Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

Connect with her on YouTube, Pinterest, TikTok, Instagram, and Facebook, and sign-up for her free email newsletter for new nurses.

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