Example case 12 of 40
Ask about the bowels
A missed problem during delirium
Mrs Okafor, 83, is newly confused and pushes lunch away.
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Page 1
Panel 1
Mrs Okafor, 83, is newly confused and pushes lunch away.
Mrs Okafor: My stomach hurts. I do not want it.
Panel 2
The nurse takes observations and requests medical assessment.
Nurse Evans: This confusion and discomfort are new.
Panel 3
Her son helps establish her usual bowel pattern.
Son: She has not opened her bowels for five days.
Panel 4
Examination identifies constipation. The doctor checks for other problems.
Doctor Shah: I will assess the pain and review her medicines too.
Panel 5
An individual bowel treatment plan starts, with support for fluids.
Nurse Evans: I will help you get to the toilet safely.
Panel 6
After a bowel movement, discomfort eases. Confusion continues.
Mrs Okafor: That is better. Is my mother coming?
Panel 7
The team reassesses her attention, intake and possible causes.
Doctor Shah: Less pain does not mean the delirium has resolved.
Panel 8
Food, drinks, mobility and bowel care remain part of the plan.
Nurse Evans: We will check what you manage through the day.
Panel 9
Next day she eats more, but still needs reminders.
Doctor Shah: We will review her confusion and bowel care again today.
Commentary
Check bowel history and discomfort during delirium assessment. Treat constipation when identified and continue to assess other causes.
An anonymised composite case that does not describe one identifiable person and is not research evidence.