| Course | NURS 6912 Symptom Management for the Hospice and Palliative Care Clinician |
|---|---|
| Week | Week 6 |
| Paper type | Delirium case analysis |
| Length | About 1,020 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6912 Week 6
Tired, Then Dying, Then Delirious: A Case Analysis of Delirium at Home in a 74-Year-Old With Multiple Myeloma, With the Workup Set by Her Goals
Student Name
College of Nursing, Walden University
NURS 6912: Symptom Management for the Hospice and Palliative Care Clinician
Instructor Name
Month Day, Year
Tired, Then Dying, Then Delirious: A Case Analysis of Delirium at Home in a 74-Year-Old With Multiple Myeloma, With the Workup Set by Her Goals
Case Presentation
Diagnosed with multiple myeloma three years ago, a 74-year-old former postal clerk has lived at home with her husband since stopping treatment four months ago. She receives home palliative care visits and takes a long-acting opioid for bone pain. Her husband and daughter describe the change in her over ten days. At first she slept more and spoke less, and they thought she was tired. After a week she stopped following conversations and sometimes did not answer when spoken to, and they wondered whether she was dying. Then, over the past three nights, she has become agitated after dark, picking at her bedclothes, trying to climb out of bed and saying there are people in the shadows. By day she is drowsy again and does not remember the night.
Two months ago, at the family meeting, she stated her goals: to stay at home, to avoid another hospital admission and to be comfortable. She said she would accept simple tests at home but not a trip to the emergency department.
Is This Delirium?
Inouye et al. (1990) built the Confusion Assessment Method around four features: a sudden start with a waxing and waning course and poor attention must both be present, joined by muddled thinking, a changed state of alertness or both. Applied to her case:
Acute onset and fluctuation. Present. The change developed over days, and her state swings between drowsiness by day and agitation at night.
Inattention. Present. At the nurse's visit she could not name the days of the week backward and lost track of the conversation midway through.
Disorganized thinking. Present. She talked about needing to sort the mail at work and did not follow her daughter's questions.
Altered level of consciousness. Present. She is drowsy by day and hyperalert and frightened at night.
She meets the criteria for delirium. The first week, when she was quiet and sleepy, was probably the hypoactive form, which is easily mistaken for tiredness, depression or approaching death. The agitated nights are the hyperactive phase, making this a mixed presentation.
Reversible Contributors, Ranked for Her
Delirium in advanced cancer is common and often has more than one cause, and in a prospective study about half of episodes reversed, more often when opioids, other psychoactive drugs or dehydration were involved (Lawlor et al., 2000). Guidance recommends looking for reversible causes in proportion to the patient's goals and prognosis (Bush et al., 2018). The contributors are ranked by likelihood in her case, with what could be done at home.
Table 1
Possible Contributors and Home-Based Assessment
| Contributor | Why likely for her | Assessment at home | If found |
|---|---|---|---|
| Hypercalcemia | Common in myeloma; causes drowsiness, confusion, constipation | Blood draw by the home nurse | Discuss treatment options that fit her goals |
| Opioid accumulation | Myeloma can impair kidney function, and less fluid intake reduces clearance | Same blood draw for kidney function; medication review | Prescriber may reduce or change the opioid |
| Infection | Myeloma weakens immunity | Temperature; urine sample; chest and skin check | Oral treatment at home if appropriate |
| Urinary retention | Can cause agitation in older adults | Bladder scan by the nurse | Catheter if retained |
| Constipation | Opioid use, low intake | Bowel history; abdominal and rectal check | Bowel regimen |
| Dehydration | Drinking little for a week | Intake history, mouth and skin | Oral fluids; discuss further options |
The blood draw can test calcium and kidney function together, and the bladder scan, urine sample and bowel check are simple and done at home, so the most likely contributors can be examined without leaving the house.
Letting Her Goals Set the Limits
Her stated goals determine how far the search goes. Every test in Table 1 can be done in her bedroom, and each could lead to a treatment she might accept at home. Imaging of the brain, admission for intravenous treatment or an emergency visit would be inconsistent with what she asked for, and the team will not propose them unless her family, as her surrogates, reports that her wishes were different. If hypercalcemia is found, the team will discuss with her husband and daughter what treatment options fit her goals, including whether any can be given at home, and what not treating would mean.
Is This Terminal Delirium?
The family's second reading, that she was dying, may yet prove correct. Delirium in the last days of life is often irreversible. But that judgment should follow, not precede, a look for reversible causes, because the most common ones here are treatable at home and a reversed delirium could give her more good days. If the workup finds nothing reversible, or if she declines further, the team will reframe the goal as comfort and calm, and the family will be prepared for that change.
Nondrug Management and Family Support
Whatever the cause, the plan includes measures that reduce distress: a night light and familiar objects, one family member speaking calmly at the bedside, glasses and hearing aids in place, a regular day and night pattern and removal of unnecessary medicines. Guidance recommends these nondrug measures as the foundation of management (Bush et al., 2018). If agitation places her at risk or causes severe distress despite them, the prescriber will consider medication for symptom relief.
The family needs explanation as much as she does. The nurse will explain that delirium is a medical condition, that her words at night are not her true feelings and that the quiet week was part of the same problem. Her husband has not slept for three nights; the team will arrange a night sitter for two nights so he can rest.
Summary
This woman has mixed delirium with a hypoactive onset that was missed. Several reversible contributors are likely, and the most probable, hypercalcemia and opioid accumulation, can be tested with one blood draw at home. Her goals keep the workup in her bedroom and rule out hospital-based tests. The team will act on what the home workup finds, support her family and revisit whether this has become terminal delirium if no reversible cause emerges.
References
Bush, S. H., Lawlor, P. G., Ryan, K., Centeno, C., Lucchesi, M., Kanji, S., Siddiqi, N., Morandi, A., Davis, D. H. J., Laurent, M., Schofield, N., Barallat, E., & Ripamonti, C. I. (2018). Delirium in adult cancer patients: ESMO clinical practice guidelines. Annals of Oncology, 29(Suppl. 4), iv143-iv165. https://doi.org/10.1093/annonc/mdy147
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
Lawlor, P. G., Gagnon, B., Mancini, I. L., Pereira, J. L., Hanson, J., Suarez-Almazor, M. E., & Bruera, E. D. (2000). Occurrence, causes, and outcome of delirium in patients with advanced cancer: A prospective study. Archives of Internal Medicine, 160(6), 786-794. https://doi.org/10.1001/archinte.160.6.786
The Walden NURS 6912 Week 6 instructions
The delirium assignment at this point in the term has you analyze a case of confusion in a palliative patient: establish whether it is delirium, identify likely causes and propose management consistent with the patient's goals. Papers often run four to five pages. Present the change over time, since onset and fluctuation matter for diagnosis. Apply a validated tool feature by feature. Distinguish hypoactive, hyperactive and mixed forms. Rank reversible contributors for this patient rather than listing every cause in a textbook. Let the patient's goals decide how far the workup goes and say where it stops. Address non-drug management and the family, who often misread the early signs and are exhausted by the later ones.
Inside the NURS 6912 Week 6 example
A case presentation follows the family's account over ten days and records her goals from an earlier meeting. A diagnostic section cites Inouye and colleagues and applies the four features of the Confusion Assessment Method. Table 1 ranks six contributors with reasons and home-based assessment, citing Lawlor and colleagues on reversibility in advanced cancer and Bush and colleagues' ESMO guideline. A goals section explains which tests fit her wishes. A terminal delirium section argues that the question follows the workup. Non-drug measures and family support, including a night sitter for her husband, precede a summary that names the next steps. Every step keeps the search for causes inside the limits she set two months earlier.
Reading the NURS 6912 Week 6 rubric
Delirium analyses are generally graded on diagnostic accuracy, reasoning about causes, alignment with goals and management of distress. Diagnostic credit requires a validated tool applied to the case with each feature addressed. Reasoning is scored on whether contributors are ranked for the patient and linked to feasible assessment. Goal alignment often carries a distinct share, rewarded when the workup is explicitly limited by what the patient said she wants. Management should include non-drug measures first and family education. Recognizing hypoactive delirium is frequently a named criterion. Honest discussion of terminal delirium earns credit. APA references and concise case writing complete the rubric. A table that pairs each contributor with a home-based check makes the reasoning easy to follow.
NURS 6912 Week 6 help: mistakes that cost marks
Delirium papers lose marks when they label confusion as dementia or dying without applying a tool. Another loss is missing the hypoactive phase that preceded the agitation. Some papers list every possible cause and order tests the patient would refuse. Others jump to sedating medication without non-drug measures. Present the timeline, apply the tool feature by feature, rank contributors for this patient, keep the workup inside her goals, discuss reversibility honestly and support the family. The desk can draft an analysis for the case in your prompt. If your patient is in a hospital, adjust the workup to that setting and to what she has said.
Get a NURS 6912 Week 6 example written to your instructions
Share your Week 6 scenario, prompt and rubric, along with any goals the case records. The analysis applies a named delirium instrument, ranks reversible causes for that patient, sizes the workup to the goals and returns within 24-48 hours; your first is free. Tools such as the MDAS replace the CAM if your course uses them.
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NURS 6912 Week 6 questions, answered
What is hypoactive delirium?
A form of delirium marked by drowsiness, withdrawal and reduced activity rather than agitation. It is easily mistaken for fatigue, depression or the approach of death, so the quiet days before the agitated nights are counted in the example as part of the same episode. Recognizing it in your case analysis often earns credit, because many papers only see delirium once it becomes loud.
Why let her goals limit the workup?
Because investigation has burdens, and a test that requires a hospital stay may conflict with what she named as most important. The example proposes checks that fit her wish to remain at home, such as a blood test drawn there, and explains why others are set aside. Your rubric likely rewards this proportionality more than an exhaustive list of tests.
Is this terminal delirium?
Not by assumption. The episode is treated as potentially reversible until the proportionate checks are done, while the family hears honestly that it may not resolve. Terminal delirium is discussed as a possibility the team would recognize if causes are excluded or cannot be treated, and the plan shifts toward comfort if that happens.
Where can I find a free NURS 6912 Week 6 sample paper?
The full case analysis, the CAM applied, the ranked contributor table and the goals and family sections, are reproduced here without a paywall. An analysis of your prompt's case can be requested.
Which contributors does the NURS 6912 Week 6 analysis rank highest?
Hypercalcemia from myeloma and opioid accumulation from reduced kidney function, both of which one blood draw at home can test.