NRNP 6566 Week 9 Delirium Workup Example

Course	NRNP 6566 Advanced Care of Adults in Acute Settings I
Week	Week 9
Paper type	Inpatient delirium workup
Length	About 850 words, 6 pages
Format	APA 7 student paper
School	Walden University
Program	MSN Adult-Gerontology Acute Care Nurse Practitioner (AGACNP)
Updated	October 2026

Free sample paper for NRNP 6566 Week 9

Inpatient Delirium Workup: A Quiet 84-Year-Old on Hospital Day 3 After Rib Fractures, and Six Causes Found in One Grid

Student Name

College of Nursing, Walden University

NRNP 6566: Advanced Care of Adults in Acute Settings I

Instructor Name

Month Day, Year

What this page is doingThe title calls the patient quiet on purpose. Hypoactive delirium is the form most often missed, and naming it in the title tells the reader this workup was built around a drowsy patient rather than an agitated one.

Inpatient Delirium Workup: A Quiet 84-Year-Old on Hospital Day 3 After Rib Fractures, and Six Causes Found in One Grid

Baseline From a Collateral Source

Composite case. An 84-year-old retired barber, admitted 3 days ago after a fall at home with three right rib fractures. His daughter, who visits him daily and lives 10 minutes away, gave this baseline on day 3, dated to the week before admission: independent in bathing, dressing, and walking with a cane; manages his own bills and medications; reads the newspaper every morning and does the crossword; a cognitive screen at his clinic last year scored 27 of 30. She says: "He's not himself. Yesterday he slept all afternoon and didn't know I'd been there in the morning. He never naps."

Screening Features, One by One

The Confusion Assessment Method was applied, with each feature documented (Inouye et al., 1990):

Feature 1, acute onset and fluctuating course: present. He has moved away from the baseline above within 36 hours; nursing notes describe him as "alert and chatty" at 06:00 and "hard to rouse" at 14:00.

Feature 2, inattention: present. Reciting the months in reverse, he stalled at October; lost track during a question and looked away.

Feature 3, disorganized thinking: present. Asked where he was, answered, "At the shop, the chair needs oiling," and drifted to another subject.

Feature 4, altered level of consciousness: present. Drowsy, eyes closing mid-sentence, rousable to voice.

Result: positive, with features 1 and 2 plus both 3 and 4. This is hypoactive delirium: he is quiet, not agitated, and he would not have been flagged by a unit that watches only for pulled lines and shouting.

What this page is doingEach feature of the screen is documented separately with the observation behind it, so the route to a positive result is visible. A result reported only as positive would give the grader nothing to check.

Delirium, Dementia, or Depression

Dementia: argued against by an independent baseline with a normal screen last year and by an onset measured in hours, not months; dementia does not fluctuate this way over a single day. Depression: argued against by the fluctuating level of consciousness and inattention; depression slows a person but does not make him lose track in the middle of a sentence. Delirium can coexist with either, but on this evidence it stands alone.

The Cause Grid

Delirium in hospitalized older adults is usually multifactorial, and the search should be structured rather than stopped at the first cause found (Marcantonio, 2017).

Medications with sedative or anticholinergic effect: present. Oxycodone 5 mg every 4 hours, scheduled rather than as needed, since admission; promethazine 25 mg given twice last night for nausea, an anticholinergic antihistamine.

Infection: not found. Afebrile; urinalysis negative; chest radiograph shows right basal atelectasis, no consolidation.

Oxygenation and carbon dioxide retention: present. Saturation 92% on 2 liters; venous blood gas carbon dioxide 58 mm Hg; breathing shallow because of rib pain, and sedated by opioids.

Metabolic: not found. Sodium 136 mmol/L, glucose 118 mg/dL, calcium normal, creatinine at baseline.

Urinary retention: present. Bladder scan 650 mL; he had not voided in 9 hours.

Constipation: present. No bowel movement for 4 days, on scheduled opioids.

Pain: present. Winces and splints when moved, though he denies pain when asked directly.

Withdrawal: unlikely. Two beers a night by his daughter's account; no tremor, sweating, or tachycardia on day 3.

Sleep and sensory: present. Woken for vital signs every 4 hours; his hearing aids are in a bag at home.

Six contributors found, none of them alone sufficient, which is the usual pattern.

Plan Ordered by Cause

1. Urinary retention: straight catheterization now, then bladder scans every 6 hours, with a second catheterization if the volume exceeds 400 mL.

2. Carbon dioxide retention and oxygenation: reduce the opioid, as below; incentive spirometry every hour while awake, with the nurse coaching; head of bed up; repeat blood gas in 6 hours.

3. Medications: stop promethazine and use ondansetron if nausea recurs; change oxycodone from scheduled to as needed at 2.5 mg, with scheduled acetaminophen 1 g every 8 hours and a lidocaine patch over the fractures; ask anesthesia whether a regional block for the rib fractures is appropriate, since pain relief without systemic opioid would address two causes at once.

4. Constipation: senna and polyethylene glycol today, suppository if no result by tomorrow.

5. Pain: assessed by observed behavior as well as by asking, since he minimizes it.

6. Sleep and sensory: cluster night-time vital signs to allow a 6-hour sleep window; daughter to bring his hearing aids and glasses today; lights on and blinds open by day; walking with physical therapy once his pain allows. A multicomponent program aimed at sleep, vision, hearing, mobility, hydration, and orientation lowered the rate of new delirium among older medical inpatients from 15.0% to 9.9% in a controlled trial, although it did not reduce the severity of episodes that did occur (Inouye et al., 1999). For a patient already delirious, the same measures are applied to remove contributors and to prevent a second episode, with the expectation set honestly with his daughter that recovery may take days.

Avoid: physical restraints; routine antipsychotics, which are not indicated for a quiet, safe patient; any new sedative. Reassess the four screening features each shift, with the daughter asked each day whether he is closer to himself.

References

Inouye, S. K., Bogardus, S. T., Jr., Charpentier, P. A., Leo-Summers, L., Acampora, D., Holford, T. R., & Cooney, L. M., Jr. (1999). A multicomponent intervention to prevent delirium in hospitalized older patients. The New England Journal of Medicine, 340(9), 669-676. https://doi.org/10.1056/NEJM199903043400901

Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P., & Horwitz, R. I. (1990). Clarifying confusion: The confusion assessment method: A new method for detection of delirium. Annals of Internal Medicine, 113(12), 941-948. https://doi.org/10.7326/0003-4819-113-12-941

Marcantonio, E. R. (2017). Delirium in hospitalized older adults. The New England Journal of Medicine, 377(15), 1456-1466. https://doi.org/10.1056/NEJMcp1605501

Reading the NRNP 6566 Week 9 instructions

Week 9 of NRNP 6566 usually asks for a workup of delirium in a hospitalized older adult. You establish baseline from a collateral source, screen with a validated tool, distinguish delirium from dementia and depression, search systematically for causes, and plan treatment ordered by cause with nonpharmacological measures first. Faculty deduct for a missing baseline. Cite the CAM and delirium guidelines in APA 7. Hypoactive delirium is often missed and should be considered. Medications for agitation should be discussed only after causes are addressed. Family involvement is part of the plan. NRNP 6566 faculty want the baseline dated and attributed to its source. Each CAM feature should be shown with the evidence for it. The cause grid should list every candidate with a result. Order the plan by the causes most likely to help.

How the NRNP 6566 Week 9 example is put together

Baseline comes first: cognition, function and usual alertness before admission, taken from a collateral source and dated. The Confusion Assessment Method is then applied with each feature documented separately, acute change with fluctuation, poor attention, muddled thinking and a shifted level of alertness, so the route to the positive result is visible. The workup names the hypoactive presentation explicitly, since a quiet patient is the one most often missed. A cause search follows as a structured list: recent medications with sedative or anticholinergic effect, infection, oxygenation and carbon dioxide retention, metabolic derangement, urinary retention, constipation, pain, withdrawal and sleep disruption, each marked supported, excluded or pending. The plan explains nonpharmacologic measures, medication review, safety and monitoring by category. He is a composite, and so is the daughter who supplies his history.

Where the marks sit in the NRNP 6566 Week 9 rubric

Workups without a documented baseline lose points immediately, because the diagnosis is defined by change and nothing in the record shows what changed. Screening results reported as positive with no features documented are the next common loss. Faculty often comment when the hypoactive form goes unmentioned in a case built around a drowsy patient, since that omission is the pattern the week is designed to expose. A cause search written as a paragraph, rather than a structured list with a status for each item, hides what was never checked. Medication review is weighted heavily; overlooking a recently added sedating drug costs more than its single line suggests. Plans that open with medication for behavior, before any contributor is addressed, tend to be marked down for sequence.

NRNP 6566 Week 9 help: mistakes that cost marks

Delirium workups lose points immediately without a documented baseline, because delirium is defined by change. Get one from family and date it. Another common gap is missing hypoactive delirium, since a quiet patient draws less attention. Screen anyway. Writers also stop at the first cause, though delirium usually has several. Use a grid. Avoid starting antipsychotics before addressing pain, retention and sleep. Return hearing aids and glasses. Balance pain control and opioid side effects carefully in rib fractures. Close with daily screening and who will repeat it. Writers also forget sleep and the environment, such as night vital signs and lights. Address them. Another frequent slip is not involving the daughter in reorientation. Ask her to help. Keep the CAM result consistent with the description.

Get a NRNP 6566 Week 9 example written to your instructions

Send the Week 9 prompt with the rubric, plus any case your section distributes, and a delirium workup comes back on a composite hospitalized adult matching your case, baseline and screening documented. No fee for the first sample; turnaround is 24 to 48 hours. The daughter who supplies the baseline is as fictional as her father.

More NRNP 6566 papers and AGACNP samples

NRNP 6566 Week 9 questions, answered

Why does the workup rely on a family member for the baseline?

Because a patient with delirium cannot reliably report their own prior cognition, and the diagnosis rests on a change from that prior state. The example attributes the baseline to a named relationship and dates it, so a reader can judge its reliability. When no collateral source exists, the example says so and explains what was used instead.

Is the Confusion Assessment Method required?

Many sections name it and some leave the tool open. The example uses it because its features can be documented one by one, which makes the positive result traceable. If your prompt names another validated instrument, the sample uses that. What graders check regardless is that the features supporting the diagnosis are written down rather than summarized as confused.

Does the plan recommend medications for agitation?

No. The plan explains why removing contributors comes before managing behavior, and it records that any medication decision would rest with the treating team. Drug names and doses are absent by design. The page describes what a graded workup contains, and it offers no direction for anyone's actual care.

Where can I find a free NRNP 6566 Week 9 sample paper?

The quiet 84-year-old's delirium workup is reproduced here with the daughter's baseline, the CAM features, the three-way distinction, the cause grid and the ordered plan.

What type of delirium appears in NRNP 6566 Week 9?

Hypoactive delirium, in a man who became quiet after rib fractures, separated from dementia and depression.