Confused Connie — Delirium vs Dementia & Restraint Alternatives
Sudden confusion that fluctuates hour to hour is delirium until proven otherwise — and it usually has a treatable cause
Connie's daughter says her mother was sharp and independent last week, but tonight Connie doesn't recognize the hospital room and insists she needs to leave for a job she retired from decades ago.
Connie is admitted for a urinary tract infection and, within a day, becomes acutely disoriented, pulling at her IV line one hour and lucid the next. Delirium has a sudden onset and fluctuating course, unlike dementia's slow, steady decline, and it is almost always caused by an underlying medical problem such as infection, hypoxia or medication effect. Treating the underlying cause resolves delirium, while restraints and sedatives only worsen it. Non-pharmacologic strategies and frequent reorientation are the safest first-line approach.
Read Confused Connie's full story →The story arc
The setup
Connie, age 82, is admitted with a urinary tract infection and mild dehydration; her baseline cognition per family is intact.
The turn
By evening she is agitated, picking at her IV tubing, and cannot state where she is; by morning she seems clear again, only to worsen once more by afternoon.
The crisis
Connie tries to climb out of bed at 2 a.m., pulls at her Foley catheter, and becomes combative when a sitter tries to redirect her.
The save
The nurse checks vital signs, oxygen saturation and blood glucose, reviews the medication list for culprits, ensures the UTI is being treated, reorients Connie frequently, keeps the room well-lit in the day and dark at night, and uses a bed alarm and sitter instead of physical restraints.
NCLEX study section — Delirium vs Dementia & Restraint Alternatives
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Mental Health
Take this chapter into practice questions on the same topic.