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Specifically designed and developed
to help improve awareness and
recognition of delirium in older
hospitalised persons

Learn About Delirium

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This website will help you to understand delirium and delirium superimposed on dementia. It will provide you with fundamental information to build on your current knowledge and encourage you to continue to construct your knowledge and clinical experiences related to delirium.

The site aims to facilitate independent learning and extend on existing knowledge. You can navigate through the information in a way that suits your individual learning preference. Vignettes are provided to represent life-like scenarios to further enhance learning.

Transcript - Hypoactive delirium

Setting:

[In patient's room] Patient is lying in hospital bed and is asleep. Relative is sitting on chair next to her.

[Nurse enters room]

Nurse:

(In a cheerful voice)

Hello Mrs Jones, how are you today? I'm Julie; I'm your nurse. Mrs Jones, are you all right?

Daughter:

(To nurse)

She's been sleeping a lot since her operation, she doesn't normally sleep this much.

Nurse:

(Looking at daughter)

Does she know you are here?

Daughter:

(Worried)

On and off, we had a sensible conversation this morning but now I can't understand her.

Nurse:

(Questioning)

Was she like this before she came into hospital?

Daughter:

No, not really. Her memory is great, she never forgets birthdays and she plays cards and bingo.

Mr Jones:

(To daughter)

Hello Sue, I didn't know you were here.

Daughter:

Sue's at home, it's me, Megan.

[Mrs Jones moaning]

Daughter:

How are you feeling? Is your hip all right? Does it hurt?

Mr Jones:

Can you make me a cup of tea?

Daughter:

Of course

(To nurse)

Oh, she's not normally like this.

(To Mrs Jones)

Mum, do you know where you are? Do you remember? You're in [Interrupted by Mrs Jones]

Mr Jones:

Susan, hairdresser.

Mum it's me, it's Megan. Sue's at home, you're in hospital and you had an operation.

Mr Jones:

I have to go to the hairdresser to get a cup of tea.

Daughter:

Mum.

Nurse:

Mrs Jones I'm Julie, I'm your nurse. Mrs Jones, can you open your eyes for me?

[Mrs Jones slowly opens her eyes]

That's great Mrs Jones. Can you tell me where you are?

Mr Jones:

Oh, hello dear. Who are you? Have you been to the shop yet?

Nurse:

I'm Julie; I'm your nurse. Mrs Jones I just wanted to ask you a few questions. Could you tell me the days of the week?

Mr Jones:

Monday, Mon (hesitates), Saturday, Seven, Eight.

Nurse:

That's great Mrs Jones. Could you tell me today's date?

Mr Jones:

What?

Nurse:

What's the date today?

Mr Jones:

I don't know.

Nurse:

Mrs Jones could you tell me where you are?

Mr Jones:

Monday.

Nurse:

That's great Mrs Jones, it's actually Thursday today. Mrs Jones I'm going to take your blood pressure, is that all right?

[Mrs Jones nods]

Daughter:

(To nurse)

She's not normally like this. She's so sleepy and confused; I'm a bit worried.

Nurse:

I understand your concern; there could be a number of possible reasons why she is confused. Often pain medication can make older people a little bit more sleepy a bit more confused, and she's had quite a lot of these. There could be other possible causes, and we'll look into these as well.

Daughter:

Do you have any idea what's wrong with her?

INTERLUDE

Daughter:

And what's that?

Nurse:

It's a fluctuating condition and it occurs over a very short period of time. It's often seen in older people when they've been unwell, when they've had a major operation or they're a little frail. Your mum seems to fit the picture given it's happened over a short period of time and her condition changes a lot throughout the day. We'll look into it and see if there are any other possible causes as well. It's usually only short term; I'll find the doctor now and get him to do a thorough assessment.

Daughter:

Thanks.

Transcript - Hyperactive delirium

Setting:

[In patient's room] Mrs Howard is lying in bed, nurse 1 walks in to take patient's blood pressure.

Nurse 1:

Good morning.

Mrs Howard:

Oh get away from me, get away.

Nurse 1:

Mrs Howard do you know that you've been sick? You're in hospital. I'm your nurse and my name is Julie.

Mrs Howard:

(Agitated)

Where's my handbag?

Nurse 1:

Did you bring your handbag into hospital with you?

Mrs Howard:

My handbag!

Nurse 1:

How about I have a look.

[Nurse checks drawers]

Mrs Howard do you remember bringing your handbag into hospital? It's not in the cupboard.

Mrs Howard:

(Confused)

What?

Nurse 1:

Do you know where you are?

[Mrs Howard is inattentive]

Mrs Howard:

What are those things on the wall?

Nurse 1:

Those things on the wall?

Mrs Howard:

(Getting agitated)

Yes, what are those? [Moans]

Nurse 1:

Mrs Howard it's all right, that's some paint it's peeling off the wall. You're in hospital; you're nice and safe.

[Mrs Howard calms down]

Mrs Howard:

Oh.

Nurse 1:

Do you remember what the date is today?

Mrs Howard:

31st of February 1939.

Nurse 1:

Thankyou, that's your birth date though.

Mrs Howard:

Oh.

Nurse 1:

Do you know what the day is?

Mrs Howard:

No.

[Mrs Howard gets agitated]

Get away from me!

Nurse 1:

How about I take your blood pressure now.

Mrs Howard:

Get away from me! Get away.

[Nurse 2 walks in]

Nurse 2:

(To nurse 1)

What's all this noise?

Nurse 1:

(To nurse 2)

I came in to take Mrs Howard's blood pressure and she started lashing out at me. She's very confused and agitated. She wasn't like this yesterday.

Nurse 2:

Yeah, the night staff did say she was a bit confused. She hasn't slept very well.

Nurse 1:

When she was admitted to the hospital through the emergency department, she was admitted with a kidney infection. When Mrs Howard presented to the emergency department she was complaining of some lower back discomfort and also she had a high temperature.

Nurse 2:

She's on quite a few medications but I can't see anything abnormal here although her temperature is still quite high. Maybe the antibiotics aren't working yet.

Nurse 1:

This is very strange for her, this is just not normal. She wasn't like this yesterday.

Nurse 2:

Some older people do get confused when they get sick, maybe you could stay with her while I organise a nurse special. I'll have a talk to the hospital co-ordinator. Maybe you could show her the family photos, that might settle her.

Nurse 1:

Sure

Nurse 2:

She seems settled now but I'll come back later and do her blood pressure. I'll go and talk to the doctor now because we should get this sorted otherwise it can be really dangerous.

Nurse 1:

Sure, thanks.

Transcript - Hypoactive Delirium superimposed on dementia

Setting:

[In patient's room] Mrs Hall is lying in bed asleep with drip attached, breathing heavily. Her husband, Collin, is sitting on a chair next to her. Nurse enters the room.

Nurse:

(To Collin)

Good afternoon Collin, how is she today?

Collin:

(To nurse)

She's so drowsy; I don't think she knows who I am. She gets better for a while but then she starts mumbling again. She doesn't normally sleep this much. She paces up and down the corridor all day.

[Patient coughing]

Nurse:

Yes it is a concern that this is not her normal behaviour but it could be associated with her pneumonia.

Collin:

You could be right. She's so different. Her memory is bad but she always knows who I am, even in the nursing home.

Nurse:

(To Mrs Hall)

Mrs Hall? Do you know where you are Mrs Hall?

[Mrs Hall begins to wake]

Mrs Hall, can you open your eyes?

[Mrs Hall opens her eyes]

Oh hello Mrs Hall. You've been very sleepy. Collin is here.

(To Collin)

How long has she been in a nursing home?

Collin:

About 18 months, I'm too old to look after her. She wandered outside the house and couldn't find her way back; I was so worried I wouldn't find her.

Nurse:

Yes, I can see that it hasn't been easy for you.

Collin:

It's been tough, we talked to the doctor and decided that the best place was a nursing home.

Mrs Hall:

Collin? Collin? Where are you?

Collin:

(To Mrs Hall)

I'm here love.

Mrs Hall:

Collin, can you hear me?

Collin:

I'm here love.

(To nurse)

I've been trying to talk to her, but she won't listen to me. She thinks we're at home with the kids.

[Mrs Jones coughing]

Nurse:

(To Collin)

Is this her behaviour in the nursing home?

Collin:

No, she's not normally like this.

Nurse:

I understand your concern Collin, but we are looking after her. The aged care team saw her yesterday and they'll be coming back again tomorrow.

Transcript - Hyperactive delirium superimposed on dementia

Setting:

[In patient's room] Mrs Hartley has pulled over drip stand and is wandering around room interfering with co patient. Patient sharing the room with Mrs Hartley calls for nurse. Nurse 1 enters the room.

Patient 1:

Nurse! Nurse! I think you better come to Mrs Hartley.

Nurse 1:

What's wrong?

Patient 1:

She's acting really strangely.

Mrs Hartley:

Megan? Megan?

Nurse 1:

Mrs Hartley? Mrs Hartley, are you okay?

Mrs Hartley:

(To nurse)

Megan?

Nurse 1:

Mrs Hartley, your daughter's at home. Let me help you back to bed.

Mrs Hartley:

(Confused)

What's happening?

Nurse 1:

I'll call Megan at home. Let me help you back into bed.

Mrs Hartley:

My husband. You know, it must be time to feed the kids and the animals.

Patient 1:

She wasn't this bad this morning. She has trouble with her memory you know. She's got dementia.

Mrs Hartley:

Where's my dinner? I haven't had breakfast yet.

Nurse 1:

Let me help you back into bed, everything's fine Mrs Hartley. You're in hospital.

Mrs Hartley:

Oh I'm bleeding here.

Nurse 1:

I'm Julie; I'm your nurse.

Mrs Hartley:

Where's my dinner?

[Nurse two enters the room]

Nurse 2:

Oh hi Julie, what's up? Looks like she pulled her IV out.

Nurse 1:

She's really, really agitated and she's not listening to a word I'm saying.

Nurse 2:

Well she was fine this morning, happily talking to her family at lunch. She could have delirium; people with dementia often get delirium. She has all the symptoms.

Nurse 1:

Yeah, she wasn't this confused before her operation, this is new. I spoke to her yesterday and she was a little bit disorientated and her memory's not the best but this is definitely new.

Nurse 2:

I'll call the doctor. Maybe stay with her and turn down the lights. Distracting her might help.

Transcript - Dementia

Setting:

[In patient's room] Mrs Ford is lying in her bed. Her husband, John, is sitting in the chair next to her. Nurse enters room.

Nurse:

(To Mrs Ford)

Good afternoon Mrs Ford, I've brought your pills.

Mrs Ford:

When's lunch? I'm really hungry.

Nurse:

Well we've actually had lunch, and dinner as well. It's almost 7 o'clock in the evening.

Mrs Ford:

(Confused)

Oh, well I thought it was time.

[Mrs Ford fiddling with physiotherapy equipment]

(To nurse)

Is this yours?

Nurse:

No, it's yours. The physio has brought it down for you to practice before your surgery.

John:

(To nurse)

Her memory's not so great; it's gotten worse in the past couple of years.

Mrs Ford:

(To nurse)

John says my memory is bad; you should see his.

Is this yours? [Referring to physiotherapy equipment in hand]

Nurse:

No, it's yours.

John:

(To Mrs Ford)

I'll help you practice with it soon love.

(To nurse)

She can't always dress herself properly. I always set out her clothes in the morning and help her put them on. If I let her do it she gets her shirt on in-side-out.

(To Mrs Ford)

Isn't that right love?

[Mrs Ford inattentive]

(To nurse)

The doctors say she's got dementia. I need you to know that she gets aggressive sometimes, she tells me off about things. She's been taking something for it.

Nurse:

Don't worry too much. It'll all be documented in her care plan and we'll take good care of her.

John:

Thankyou.

Nurse:

(To Mrs Ford)

Mrs Ford, your surgery is booked for 8 o'clock in the morning. The orderly will come and collect you and you won't be able to eat or drink after 12 midnight tonight. ,/

Mrs Ford:

Thankyou nurse, okay, all right.

[Attention on physiotherapy equipment]

(To nurse)

Is this yours?

John:

(To Mrs Ford)

No, it's your love I'll help you with it soon.

(To nurse)

You'll need to take the water away; she won't remember what you've told her. What time will she be back?

Nurse:

(To John)

Well a hernia is relatively short so I'd say around 10 o'clock in the morning. I'll let the night staff know and they'll make sure she doesn't have anything to eat or drink.

Mrs Ford:

(To nurse)

I'm having that lump fixed.

John:

(To nurse)

I'll stay with her tomorrow and make sure she is comfortable. She gets a bit upset if she has to go to other places. Could you show her the photos of her grandkids if I'm not here? She loves looking at them.

(To Mrs Ford)

Don't you love?

Mrs Ford:

[Holding picture frame]

They're so so beaut.. They're so pretty.