The Rational Clinical Examination
David L. Simel, Drummond Rennie
Delirium
Camilla L. Wong, Jayna Holroyd-Leduc, David L. Simel, Sharon E. Straus
Sections:
Clinical Scenario, Methods, Results, Comment, Scenario Resolution, References
Topics Discussed:
delirium
Excerpt:
"An 85-year-old man with non–small cell lung cancer was
admitted yesterday to the oncology ward for treatment of pneumonia.
He started antibiotics and supplemental oxygen. Prior to hospitalization,
he lived independently in the community. An overnight nursing report
indicates that he did not sleep and was pacing up and down the ward.
During morning rounds, he was easily startled and noted to be picking
at the bed sheets. The patient's daughter says, "This is
not my father. Right now, he's in his own little world. He never
behaves this way!" What instruments could the nurse and
physician use to determine if these changes and observations are
indicative of a delirium?Patients with delirium have a reduced ability to focus, to sustain
or shift attention with an associated change in cognition, or they
develop a perceptual disturbance that occurs over a short period of
time and tends to fluctuate over the course of the day. There is
usually evidence of a medical cause from history, physical examination,
or investigations.1 Many hospitalized older patients
become delirious and delirium is an independent marker for increased
mortality during the 12 months after hospital admission.2 In
addition to death, developing delirium has been associated with
longer length of hospital stay, increased hospital-acquired complications,
persistent cognitive deficits, and increased discharge rates to
long-term care.3-6..."
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