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Longer duration of delirium is linked to poorer health outcomes among older adults, underscoring the need for early detection and intervention. As a nurse, you can play a key role in identifying risk factors, detecting symptoms early, implementing nonpharmacologic interventions promptly, and educating family members about the disorder.

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Both CAM forms and their instructions are available from Hospital Elder Life Program for Prevention of Delirium at

Sudden onset and inattention, plus either disorganized thinking or an altered level of consciousness, indicate a positive screen on CAM.

When his wife visits at lunch time, she tells Jessica her husband is picking at the bedding and complaining of feeling cold. When you respond, he states, “I can’t figure out how to get my TV on.” You remind him you explained how to use the TV remote yesterday, and ask if he has trouble remembering things.

Jessica has the nursing assistant give him a warm blanket. He states he didn’t have trouble until he came to the hospital.

Other factors that place older adults at risk include dementia, alcohol abuse, impaired physical function, sensory impairment, sleep deprivation, poor oxygenation, uncontrolled pain, and taking four or more medications. Jeffries in our case scenario has some of these risk factors.

Factors that can cause or contribute to delirium include: To detect a change in the patient’s cognition, you need to know his or her baseline status.

Patients with a positive screen require further evaluation by a physician or an advanced practice nurse to identify the cause and initiate appropriate interventions. Jeffries for delirium, based on her observation of excessive drowsiness, his wife’s report of him picking at his bedding, and his complaint of pain despite his medication. These results indicate a positive screen for delirium, so she immediately contacts the physician to ensure a more thorough evaluation.

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