Case 20 of 40
Assess discomfort and treatable causes of delirium in palliative care
Example case for staff education
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Ms MacDonald, 67, has advanced cancer and develops delirium in hospice.
Read the case transcript
Page 1
Panel 1
Ms MacDonald, 67, has advanced cancer and develops delirium in hospice.
Daughter: She was talking with me yesterday. This is new.
Panel 2
Her recorded wishes prioritise comfort and treatment with little burden.
Nurse Okafor: We will assess what may be troubling her.
Panel 3
The doctor checks for pain, retention, constipation and medicine effects.
Palliative doctor: Some problems may be treatable even with advanced illness.
Panel 4
Relieving urinary retention eases discomfort. Confusion remains.
Nurse Okafor: She looks less uncomfortable, but still needs reassurance.
Panel 5
Further investigations are considered against her wishes and likely benefit.
Palliative doctor: Which tests would help us improve her care?
Panel 6
That evening she becomes frightened again.
Ms MacDonald: Please stay. I do not know this place.
Panel 7
The palliative team reviews continuing distress and treatment.
Palliative doctor: We will adjust care and review how she responds.
Panel 8
Staff explain the changes and support her daughter.
Nurse Okafor: We will keep checking her comfort and tell you what changes.
Panel 9
Overnight care continues, with clear plans for review.
Nurse Okafor: Please call for medical review if distress is not relieved.
Commentary
In palliative care, assess distress and possible treatable causes of delirium. Consider the person’s wishes and the likely benefits and burdens of investigations and treatment. Continue care for comfort and specialist review.