Neuro 101 Toolkit-Delirium Case Study

Delirium Case Study
Pdf Summary
The presentation explains that delirium is an acute, fluctuating decline in attention and cognition—a medical emergency that is common in older adults after surgery and in intensive care. It is associated with longer hospital stays, loss of independence, cognitive decline, complications, and increased mortality. Postoperative delirium may be preventable in many patients.<br /><br />Risk factors include older age, pre-existing cognitive impairment, severe illness, sensory impairment, infection, uncontrolled pain, sleep disruption, dehydration, poor nutrition, electrolyte abnormalities, immobility, urinary catheters, and polypharmacy. Some medications, including benzodiazepines and drugs with anticholinergic effects, can contribute.<br /><br />Because delirium is often missed, clinicians should establish a patient’s usual cognitive function, obtain information from family or other knowledgeable people, and screen for acute changes—including less-obvious hypoactive symptoms such as withdrawal and reduced movement. The Confusion Assessment Method (CAM) is a widely used tool: delirium is suggested when acute or fluctuating symptoms and inattention occur alongside disorganized thinking or altered consciousness. A positive screen should prompt a full assessment for reversible causes, such as infection, metabolic disturbances, medication effects, or hypoxia.<br /><br />Prevention and care emphasize non-drug measures: reorientation, appropriate lighting and cues, family contact, adequate nutrition and hydration, early mobility, access to glasses and hearing aids, better sleep, infection prevention, pain control, and assessment of oxygenation, constipation, and urinary retention. Medication-based prevention is not well supported. Antipsychotics should be reserved for severe distress or danger when other approaches fail; benzodiazepines are generally avoided except for specific indications such as withdrawal.<br /><br />In the case study, an 82-year-old man developed signs including withdrawal, poor intake, reduced movement, and hyponatremia after neurosurgery. Care included CAM screening, restoring access to his glasses, tube feeding, management of sodium levels, and therapy services. During COVID-related visitation restrictions, the presentation also recommends structured day–night routines, mobility, sensory aids, and facilitating family communication.
Keywords
delirium
postoperative delirium
older adults
CAM screening
inattention
hypoactive delirium
risk factors
nonpharmacologic prevention
antipsychotics
cognitive decline