Delirium
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Table 5. CAM
To diagnose delirium by CAM, 1 and 2 are needed and either 3 or 4.
1. Is there evidence of an acute change in mental status and a fluctuating course
and
2. Inattention (can test with months of year backwards, days backwards, digit spans)
• easily distractible
• having difficulty keeping track of conversation
and either
3. Disorganized thinking
• rambling or irrelevant conversation
• unclear or illogical flow of ideas
• unpredictable switching from subject to subject
or
4. Altered level of consciousness
• vigilant - startled easily to any sound or touch
• lethargic - repeatedly dozed off when being asked questions, but responded to voice
or touch.
STEP 5: Identify the potential causes of delirium
➤ Delirium could be a medical emergency; myocardial infarction or
stroke in older adults can present as delirium.
➤ Obtain vital signs for hypoxemia, fever, low or high blood pressure.
➤ Check blood glucose.
➤ Assess for pain and discomfort.
➤ Perform complete physical exam to look for acute abdomen, deep
vein thrombosis, other acute illness, focal neurologic findings, urinary
retention, fecal impaction, infection.
STEP 6: Determine the urgency of the situation – can the
patient be evaluated and treated in the facility
or does the patient need to be transferred to the
emergency department?
Table 6. Diagnostic Test Options to Help Assess the Causes of
Delirium
Targeted laboratory
evaluation
• Complete blood count (CBC) with differential, electrolytes,
glucose, renal function, liver function, thyroid function,
urinalysis, blood and urine cultures, drug levels, cortisol level
Targeted imaging • Chest x-ray, Brain computed tomography (CT) or magnetic
resonance imaging (MRI)
Other tests • Electrocardiography (EKG)
