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)


  • vital signs
  • mental state examination
  • neurological examination
  • chest, abdomen and skin: inspection, palpation & auscultation


  • 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