Name: Liam Henry

NUR 360 – Nursing Care of Older Adults

Delirium: The Under-recognized Medical Emergency Post Viewing Report

Delirium: The Under-recognized Medical Emergency:

1. What percentage of delirium is commonly missed by nurses? More than

50%, sometimes 60%

2. The first patient in the video, Mrs. Bonds, had some dramatic differences
in her behavior throughout the segment. What are some possible reasons
for this change in behavior?
Some possible reasons for this change in behavior is that Mrs. Bonds
might have mixed delirium, so she often fluctuations between being hyperactive state,
hypoactive state of delirium and normal mental status. She also came in with some of
the risk factors for developing delirium without actually having it upon admission,
but then began to develop and experience delirium throughout the day. Also, some of
her medications could have an effect on her level of delirium.

3. Identify the 5 triggers of delirium that were identified in the video:

1. Medications
2. Infections
3. Other Acute Illnesses
4. Foley Catheters
5. Other Environmental Factors

4. Why is it important to address delirium early?

It is important to address delirium early because it can be a medical
emergency such as an MI or pulmonary embolism which need to be addressed
quick because deterioration of the patient will happen fast. Other deliriums are
more subtle, but still need to be addressed immediately in order to treat the
cause. The quicker the delirium is recognized, the shorter the course and
intensity of the delirium is experienced.

5. Identify the three types of delirium identified in the video and give an
example of each
Three types of delirium identified in the video are hyperactive delirium,
hypoactive delirium and mixed delirium. An example of hyperactive delirium
is a patient that is trying to constantly trying to get out of bed, accusing people
of stealing things, etc. An example of hypoactive delirium is if a patient is a
very quiet patient, but they never speak because they don’t know what’s going
on and doesn’t want anyone to know that. An example of mixed delirium is
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Name: Liam Henry

when a patient fluctuates between hyperactive states, hypoactive states and

normal mental status.

6. Patients with a diagnosis of dementia have a greater risk of developing

delirium than older adults who do not have dementia
True

7. Why is determining a patient’s baseline cognitive status a challenge for

hospital nurses? What are some ways the nurse could conduct this
assessment?
Determining a patient’s baseline cognitive status is a challenge for
hospital nurses because many times this is their first time encountering the patient so
they might not have the knowledge of that the patient’s baseline is prior to
hospitalization. The challenge is to get that information. Some ways the nurse could
conduct this assessment is she could look in the patient’s chart to find any
documentation, or maybe try to ask the family or others that are familiar with the
patient about what the patients baseline is.

8. You are assigned to a patient with dementia. You have assessed several
signs and symptoms of delirium. You inform the patient’s physician that
you suspect the patient is experiencing delirium and report the assessment
data you have collected that supports your claim. The physician tells you
that those behaviors are normal because the patient has dementia and that
there is nothing that can be done. How would you respond to the
physician?
I would respond to the physician by telling him that you can’t just assume
that delirium is just a part of the dementia because it isn’t until the terminal
stages of dementia that people can show these symptoms. Also, sometimes
when patients who already have dementia and are diagnosed with delirium it
can sometimes be the breaking point for them, signaling that they need further
institutionalization and can’t support themselves independently in the
community as they are a risk for falls, etc.