Identifying the cause
Think: What could be possible reason/s and/or contributing factors to Mr. William's delirium? What useful assessment data would you collect about Mr. Williams prior to contacting the doctor.
Hint: What tests results, observations and present and past history would be helpful in identifying the possible cause?
Looking for the cause
Obtain history
A history can be obtained from a number of sources including medical records, the family or significant others, the patients General Practitioner and from other staff members. The history should include:
- past medical history and comorbidities
- medications (including over the counter medications)
- dietary and fluid intake
- bowel and bladder function
- falls
- infections
- alcohol intake
- social history
- sensory impairment (glasses, hearing aids)
Examination
- vital signs
- mental state examination
- neurological examination
- chest, abdomen and skin: inspection, palpation & auscultation
Investigations
- urinalysis (MSU if abnormal urinalysis)
- blood work including: Full blood count, urea and electrolytes, glucose, calcium, liver function tests and cardiac enzymes
- chest x-ray
- electrocardiograph
Depending on the clinical features other investigations may include:
- specific cultures (blood, sputum, wound)
- arterial blood gases
- CT brain (if history of falls, anticoagulant therapy or focal neurological signs present)
- lumbar puncture (if headaches and fever and meningism present)
- EEG
- thyroid function tests, B12 and folate