مريضة عمرها ٧٩ سنة في اليوم الثاني بعد تثبيت كسر الورك، صارت مشوشة فجأة، تسحب القسطرة، ولا تركز، ووعيها يتقلب. الحرارة ٣٧٫٦، والتشبع ٩٥٪. تأخذ مورفين ولم تتبرز من ٣ أيام. ما التصرف الأنسب؟

A 79-year-old woman on day 2 after hip fracture fixation becomes suddenly confused, pulls at her catheter, is inattentive and has fluctuating awareness. T 37.6 °C, SpO2 95%. She takes morphine and has not opened her bowels for 3 days. What is the best action?

1. Increase morphine because she is in pain
2. Assess for delirium causes and notify
3. Treat it as new dementia needing no assessment
4. Restrain her and give a strong sleeping tablet

Answer: B) Assess for delirium causes and notify. Delirium is common after hip fracture in older adults. Causes are sought (drugs, constipation, retention, infection, hypoxia, pain) and restraints and sedatives avoided where possible.