Delirium is acute brain failure, it is missed in most cases, and the miss almost always happens with the quiet patient. Run each Confusion Assessment Method feature on three people — you must actually perform the attention test, not guess it — and score them against the rule 1 and 2 and (3 or 4). Then sweep one patient for the cause, because a positive screen is the beginning of the work, not the end of it.
Run the CAM
The five-minute sweep — Mrs Okafor, 412
82 years old, day 2 after hip fracture repair. She lives alone, manages her own medications, and has no history of dementia. Her CAM is positive. Work the sweep: every item here is within nursing scope, and most ward delirium is found before a single laboratory result returns.
Now triage her medication list. For each drug given or due in the last 48 hours, decide whether it is a high-risk delirium precipitant you would raise with the provider.
The CAM rule, drawn
Not yet scoredTest each feature, mark it present or absent, then score. Feature 2 is mandatory — a CAM cannot be positive without demonstrated inattention.
Establishing feature 1 needs collateral history. You cannot call something an acute change without knowing the baseline, which means telephoning the daughter or the care home and asking a specific question: “Two weeks ago, was he doing his own medications and his own shopping? Was he like this yesterday morning?”
Sweep findings
0 checks done · 0 findings.PINCH ME is the frontline nursing sweep: Pain, Infection, Nutrition, Constipation, Hydration, Medication, Environment. The letters above light as you find them.
The treatment for delirium is the cause. Medication is for one narrow indication only — severe distress or agitation posing imminent danger that has not responded to non-pharmacological measures. It does not treat delirium, does not shorten it, and is never indicated for the hypoactive form.
Benzodiazepines worsen delirium and are contraindicated except in three situations: alcohol or benzodiazepine withdrawal, neuroleptic malignant syndrome, and catatonia. In alcohol withdrawal delirium they are the treatment, guided by a CIWA-Ar protocol — and thiamine is given before any glucose load.
Physical restraint is not a treatment. It increases agitation, injury, aspiration, deconditioning, delirium duration and death, and it re-enacts trauma for anyone with an assault history. A raised side rail used to stop a person leaving the bed is a restraint, whatever the order set calls it.