Introduction
Delirium explicated as a mental dysfunction condition comprehending with wider range of neuropsychiatric abnormalities, particularly among older individuals (Igwe et al, 2023). The present assignment will be based on Mrs. Fisher’s case study; she is a 72 years old lady who suffered from episode of delirium and frequently presented in an acute impatient care setting. The current report will be based on highlighting clinical presentation and types of delirium experienced by patient. Furthermore, risks and needs of patient that requires to be addressed will be explained along with undertaking critical discussion of best assessment tool in current case context.
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Main Body
Mrs. Fisher’s current clinical presentation, issues and brief description related to history
Literature revealed that an individual with delirium present signs and symptoms of confusion, disorganised thinking, inattention and consistent fluctuation in level of consciousness and hallucination (Nussbaum, 2022). In case of Mrs. Fisher similar signs was evident; she was agitated and confused, specifically after seeing paramedic team; she was unable to recall where she was and the patient often thought that she was on a movie set and members from paramedic team are strangers. From the case it has been evident that her level of consciousness was fluctuating and due to this she was unable to recall the reason behind pain in her head, arm and chest. Moreover, while communicating Mrs. Fisher was not able to express her thoughts and she was struggling in using accurate words for verbally expressing herself. Nevertheless; patients history depicted that she is diagnosed with rheumatoid arthritis; she had history of high blood pressure which was well managed and pain comprising with sciatica. However, there was no history related to mental health was witnessed. Thus, current clinical symptoms of Mrs. Fisher connect with sudden episode of delirium.
Type of delirium and discussing physical, psychological and social needs
The sudden onset of confusion and agitation associates with hyperactive delirium; this is explicated as that type of delirium in which patient is presented with symptoms of combinative, uncooperative behaviour, confusion and delusion (Simó, 2022). Hence, same domains were evident in Mrs, Fisher’s case; she was confused and agitated after seeing paramedic team further; patient was not able to recall her own house that reflects disorganised thinking. Mrs. Fisher was also struggling from incoherent speech and due to this she was not able to use accurate words for expressing her thoughts during that moment (Igwe et al, 2023). Hence, all of these aspects proves that Mrs. Fisher suffering from hyperactive delirium.
The physical factors of hyperactive delirium comprise with agitation in which patient faces mental distress and irritability and this promotes aggressive behaviour; same situation was evident in Mrs. Fisher case (Kaewpongsa, Jayanama and Ruangritchankul, 2025). Additionally, inappropriate behaviour by Mrs. Fisher demonstrates about mental distress experienced by her. Whereas, psychological domains comprehends with disorganised thinking; Mrs Fisher was unable to express her views as she was struggling in using accurate words. Further she had hallucination and she thought of being on a movie set; this is also identified as a psychological factor. On the other hand, social factor aligns with paranoia, fear and incoherence; Mrs Fisher was distressed after seeing other individuals and she often experienced fear for a moment and on the next moment she became aggressive (Kwak, 2021). Hence, all of these symptoms associate with hyperactive delirium.
Describing the main issues, risks and needs that must be addressed and management of issue
From the case it was evident that patient does not have any history related to mental illness and this shows that she experienced first episode of delirium. In current case context, the major issue persist with false belief of Mrs. Fisher. Due to delusion and hallucination she might develop false belief and it become difficult to gain her trust. Furthermore, due to confusion and disorganised thinking patient would not be able to express her needs appropriately (Méndez-Martínez et al, 2021). Additionally, the risk complies with safety risk; there are possibilities that in the pursuit of agitation Mrs. Fisher might hurt herself; hence, this raises safety concern for her. Moreover, enviromental-related factors such as-noisy or unfamiliar environment creates persisting issues in gaining patient trust and further impacts her health outcomes in negative manner.
It is important to address all of these needs and prior focus requires to be integrated on providing holistic support to patient (Méndez-Martínez et al, 2021). The underlying cause of delirium in patient requires to be identify as in past there is no episode of delirium has been experienced. Integration of person-centred approach is essential for complying with Mrs. Fisher needs and accordingly, her preferences related to physical, social, emotional, safety and environmental aspects must be managed. Furthermore, nurses are accountable for fostering Mrs. Fisher engagement in care procedure and in this manner person-centred care approach can be incorporated,
Best assessment tool
In current case context, “The Confusion Assessment Tool [CAM]” proves to be best assessment tool; it is delineated as a standardised evidence-based tool comprises with nine delirium features. This facilitates detailed psychosocial assessment and subsequently, analyse the fluctuation and presence of nine delirium domains “inattention, acute onset, disorganized thinking, altered level of consciousness, disorientation, memory impairment, perceptual disturbances, psychomotor agitation or retardation, and altered sleep-wake cycle” (Méndez-Martínez et al, 2021). Thus, these symptoms are identified in Mrs. Fisher case and thereby, CAM is appropriate for conducting clinical assessment and integrating person-centred and recovery-oriented approach. These frameworks supports in considering patient autonomy and accordingly, Mrs. Fisher would be empowered and an effective therapeutic alliance could be developed. On the other hand, criticism of CAM depicts that this tool does not provide relevant results, particularly when patient suffers from severe cognitive impairment (Zhou et al, 2024). In this condition this tool does not provide effective results; however, from severe cognitive impairment. In this condition this tool does not provide effective results; however, from medical history of Mrs. Fisher no such situation were evident and therefore, CAM can be used for undertaking assessment and consequently, her needs could be addressed.
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Conclusion
Conclusively; this can be depicted that Mrs. Fisher symptoms aligns with hyperactive delirium and it is important to assure holistic support to her. Furthermore, CAM found to be most effective assessment method in current case context; it supports in considering nine delirium features and subsequently, appropriate action can be taken.
References
Books and Journals
- Bellelli, G., Brathwaite, J. S., & Mazzola, P. (2021). Delirium: a marker of vulnerability in older people. Frontiers in aging neuroscience, 13, 626127.
- Garcez, F. B., Avelino-Silva, T. J., de Castro, R. E. V., & Inouye, S. K. (2021). Delirium in older adults. Geriatrics, Gerontology and Aging, 15(1), 1-12.
- Igwe, E. O., Nealon, J., O'Shaughnessy, P., Bowden, A., Chang, H. C., Ho, M. H., ... & Smerdely, P. (2023). Incidence of postoperative delirium in older adults undergoing surgical procedures: a systematic literature review and meta‐analysis. Worldviews on Evidence‐Based Nursing, 20(3), 220-237.
- Kaewpongsa, P., Jayanama, K., & Ruangritchankul, S. (2025). Risk factors and outcomes of hyperactive delirium in older medical inpatients admitted to non-intensive care unit: a prospective cohort study. BMC psychiatry, 25(1), 330.
- Kwak, M. J. (2021). Delirium in frail older adults. Annals of geriatric medicine and research, 25(3), 150.
- Lin, C. J., Fick, D. M., Traynor, V., Chen, Y. C., Hsiang, H. F., & Chiu, H. Y. (2025). Comparative Diagnostic Accuracy of Nursing Delirium Screening Scale Versus Confusion Assessment Method for Postoperative Delirium: A Systematic Review and Meta‐Analysis. Journal of Clinical Nursing, 34(1), 287-298.
- Méndez-Martínez, C., Fernández-Martínez, M. N., Garcia-Suarez, M., Martínez-Isasi, S., Fernández-Fernández, J. A., & Fernandez-Garcia, D. (2021, August). Related factors and treatment of postoperative delirium in old adult patients: an integrative review. In Healthcare (Vol. 9, No. 9, p. 1103). MDPI.
- Nussbaum, A. M. (2022). The pocket guide to the DSM-5-TR™ diagnostic exam. American Psychiatric Pub.
- Simó, F. Z. (2022). Diagnostic and Statistical Manual of Mental Disorders (Dsm): To Be Or Not To Be.
- Zhou, C., Wang, H., Wang, L., Zhou, Y., & Wu, Q. (2024). Diagnostic accuracy of the Family Confusion Assessment Method for delirium detection: A systematic review and meta‐analysis. Journal of the American Geriatrics Society, 72(3), 892-902.
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