Clinical examples
Illustrated cases
Forty cases exploring delirium, from the first change in someone’s thinking to assessment, treatment and recovery. Open a case to read the comic, commentary and transcript.
The 12 illustrated 4AT cases form a separate collection.
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40 cases
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Case 1New drowsiness and withdrawal may be delirium
Assess a person who has become drowsy or withdrawn and look for possible causes.
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Case 2Lucidity in the morning does not rule out delirium overnight
Ask about recent changes even when the person answers clearly during your assessment.
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Case 3A sudden change in someone with dementia may be delirium
Find out how the person usually is and assess any sudden change in attention or alertness.
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Case 4Delirium after hip surgery may have several causes
Treat possible causes, continue daily care and reassess symptoms that persist.
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Case 5Fear returning after a period of calm
Continue support, reassess possible causes of distress and seek senior review if severe distress persists.
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Case 6Check recent medicine changes when assessing delirium
Review medicines and other possible causes, then check the effects of any treatment changes.
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Case 7Check the person can hear you during a delirium assessment
Help the person hear and communicate, then continue the full assessment for delirium.
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Case 8Assess delirium even when a relative is not yet available
Use staff observations and earlier records while seeking more information about the person.
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Case 9Check Parkinson’s medicine timings when delirium develops
Assess possible causes, give Parkinson’s medicines at the usual times and seek specialist advice.
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Case 10Plan support and follow-up when delirium persists at discharge
Check safety, confirm the help available and explain when to seek urgent medical help.
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Case 11New confusion with worsening breathing needs urgent assessment
Assess and treat the acute illness urgently, then continue delirium assessment and care.
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Case 12Check for constipation when assessing delirium
Ask about bowel movements and discomfort, and continue to look for other possible causes.
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Case 13Bacteria in urine do not by themselves confirm a urinary infection
In a stable older person without signs of urinary or systemic infection, assess other causes and observe carefully.
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Case 14Severe alcohol withdrawal with delirium needs urgent treatment
Assess urgently, follow the withdrawal protocol, monitor closely and assess other causes and thiamine needs.
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Case 15Use the person’s preferred language when assessing delirium
Support communication and assess a new change without attributing it to a language barrier.
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Case 16Frightening memories may persist after delirium in intensive care
Assess current thinking and distress, explain delirium and arrange appropriate support and follow-up.
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Case 17New confusion after a fall needs urgent assessment for head injury
Assess urgently and seek prompt help for possible head injury or neurological deterioration.
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Case 18Help people mobilise safely while they recover from delirium
Assess movement and daily activities, adapt instructions and respond to changes in alertness.
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Case 19Persistent delirium needs reassessment before drawing conclusions about dementia
Review possible causes and arrange further assessment of thinking and daily function.
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Case 20Assess discomfort and treatable causes of delirium in palliative care
Consider the person’s wishes and the benefits and burdens of treatment while continuing comfort care.
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Case 21Delirium and care needs can continue after hip surgery
Reassess pain, medicines and urinary retention, and continue rehabilitation while delirium persists.
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Case 22Delirium may persist after pneumonia in someone with dementia
Assess continuing delirium and changes in daily abilities after the infection improves.
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Case 23Eating, drinking and movement need continuing monitoring during delirium
Help with daily care, assess swallowing problems and investigate new illness during delirium.
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Case 24Treat dehydration carefully when delirium occurs with kidney injury and heart failure
Review fluids, kidney function, medicines and breathing together while continuing delirium care.
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Case 25New drowsiness after discharge with delirium needs reassessment
Plan continuing support, assess new illness promptly and review care needs as they change.
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Case 26Improvement can occur after delirium has lasted for weeks
Continue assessment and rehabilitation, and review care arrangements when abilities change.
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Case 27Someone with delirium may still be frightened after they stop calling out
Ask about fear and discomfort even when agitation has reduced, and assess distress separately from attention.
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Case 28Check for harm when medication reduces agitation during delirium
Reassess drowsiness, stiffness and swallowing difficulties after medication, as well as any benefit.
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Case 29Pause and assess when a person newly resists personal care
Check for delirium, pain, hearing difficulties and fear before trying care again.
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Case 30Reassess new drowsiness in a person with Parkinson’s disease and delirium
Check for new illness and confirm that Parkinson’s medicines are being given at the right times.
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Case 31Assess continuing delirium even when blood tests improve and depression is present
Assess recent changes in attention and daily abilities alongside mood, physical illness and medicines.
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Case 32New confusion after surgery may appear before fever or circulatory deterioration
Assess new confusion promptly and continue delirium care after treatment of the surgical complication.
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Case 33Persistent confusion during alcohol withdrawal needs assessment for other causes
Treat withdrawal and nutritional problems while reassessing infection, medicine effects and continuing delirium.
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Case 34Check for withdrawal when a regular medicine has been unintentionally stopped
Find out which medicines were actually taken and when, then plan supervised treatment if withdrawal is suspected.
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Case 35Treat delirium and distress according to the person’s wishes in advanced cancer
Assess treatable problems, review benefits and burdens of treatment, and continue comfort care as illness progresses.
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Case 36Assess delirium, weakness and frightening memories separately after intensive care
Continue physical and cognitive assessment, explain the admission and support discussion of distressing memories.
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Case 37Investigate new neurological signs even when infection may explain delirium
Assess possible brain injury alongside pneumonia and continue delirium care after treatment.
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Case 38Repeated similar episodes during delirium may be seizures
Record each episode carefully and seek neurological assessment when its features suggest seizures.
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Case 39Memory changes over weeks and focal seizures need assessment for encephalitis
Investigate the wider neurological illness when correcting low sodium does not explain continuing symptoms.
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Case 40Unusual posture and repeated speech during delirium need assessment for catatonia
Assess catatonia and delirium separately, and monitor both benefit and harm from treatment.
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