| Course | NUR-3480 Nursing Care of Clients with Acute and Chronic Conditions |
|---|---|
| Module | Module 4 |
| Paper type | Nursing paper: delirium in hospitalized older adults |
| Length | About 1,021 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | B.S.N., Accelerated Second Degree |
| Updated | October 2026 |
Free sample paper for NUR 3480 Module 4
Picking at the Blanket: Detecting and Preventing Delirium in an Older Woman on a Trenton Medical Unit
Student Name
B.S.N., Accelerated Second Degree, Thomas Edison State University
NUR-3480: Nursing Care of Clients with Acute and Chronic Conditions
Mentor Name
Month Day, Year
Picking at the Blanket: Detecting and Preventing Delirium in an Older Woman on a Trenton Medical Unit
The Patient
This case is invented, including the Trenton unit. Mrs. Abate, 82, lives with her son and his family and came in dehydrated with a bladder infection. On admission she was alert, chatted with staff in English and Amharic and knew where she was. She wears glasses and a hearing aid, both of which stayed on her nightstand at home. On her second evening, the student found her quiet, picking at her blanket and unable to follow a conversation. Her son said she was not herself. The night before, she had slept little because of vital sign checks and a noisy roommate.
Detecting Delirium
Inouye et al. (1990) developed and validated the Confusion Assessment Method to help clinicians without psychiatric training identify delirium. The method asks about four features: whether the change came on suddenly and fluctuates, whether the person struggles to pay attention, whether their thinking is disorganized and whether their level of alertness has changed. Delirium is present when the first two features are present along with either the third or the fourth. In validation, the method was highly sensitive and specific compared with psychiatric diagnosis.
The student and her nurse assessed Mrs. Abate. Her change was acute, by her son's account, and fluctuating. Asked to say the days of the week in reverse, she lost her place, a sign of inattention. Her speech wandered between topics. Her level of consciousness was lethargic. The Confusion Assessment Method was positive for delirium, of the quieter, hypoactive type that is often missed.
Understanding Delirium
Marcantonio (2017) reviewed delirium in hospitalized older adults. Delirium is common, is often unrecognized, especially in its hypoactive form, and is associated with longer stays, functional decline, institutionalization and death. It usually results from an interaction between a vulnerable patient, such as one with dementia, sensory impairment or frailty, and precipitating factors, such as infection, dehydration, medications, sleep loss and immobility. Management focuses on finding and treating causes and on nonpharmacologic measures; the evidence does not show that antipsychotics prevent delirium or make it shorter, so they are kept for agitation that endangers safety.
Preventing Delirium
Inouye et al. (1999) put the HELP program to the test among older patients on a general medicine service. The program went after six risk factors (cognitive impairment, lost sleep, immobility, poor vision, poor hearing and dehydration), with protocols such as orientation and activities, a nonpharmacologic sleep protocol, early mobilization, glasses and magnifiers, hearing aids and amplifiers and fluids. Delirium developed in fewer patients in the intervention group than in matched controls, and total days of delirium were fewer. Once delirium had developed, the intervention did not reduce its severity or recurrence, which shows why prevention matters most.
| Source | Key point | Nursing action |
|---|---|---|
| Inouye et al. (1990) | Four-feature method detects delirium | Assess every shift; report positive results |
| Marcantonio (2017) | Search for causes; avoid antipsychotics for prevention | Review medicines, hydration, infection, sleep |
| Inouye et al. (1999) | Multicomponent prevention reduced delirium | Glasses, hearing aid, sleep, mobility, fluids, orientation |
Searching for Causes
The student reported the positive assessment to the nurse, who notified the provider. Together they reviewed possible causes: the infection was being treated but she was still dehydrated, with low urine output; she had received a sedating antihistamine the night before to help her sleep; her glasses and hearing aid were missing; and she had barely slept. The provider stopped the antihistamine and increased her fluids.
Nursing Diagnoses
The student identified acute confusion related to infection, dehydration, medication and sleep loss; risk for falls; and disturbed sensory perception related to missing glasses and hearing aid.
The Prevention Plan
Following the HELP protocols, the student asked Mrs. Abate's son to bring her glasses and hearing aid that evening. Staff reoriented her with a clock, a calendar and her son's photographs, and an interpreter line was used for important conversations in Amharic. Vital signs were clustered to allow sleep from midnight to five, her roommate was moved and she was offered warm milk and quiet music at bedtime. She was helped to walk to the bathroom and sat up for meals. Fluids were offered every hour while awake.
Medications to Avoid
The student and pharmacist reviewed Mrs. Abate's medications for drugs that raise delirium risk in older adults, such as sedating antihistamines, benzodiazepines and some bladder medicines. The diphenhydramine given for sleep was stopped, and a note was added to her record so that it would not be given again. Her pain was treated with scheduled acetaminophen, since untreated pain can itself contribute to delirium. The student learned that the safest sleep aid for an older inpatient is often a quiet room, a warm drink and fewer interruptions.
Teaching Staff
On her final day, the student shared Mrs. Abate's story at the unit huddle, with permission from her instructor, to remind staff that quiet confusion can be delirium and that glasses and hearing aids are part of the care plan. The charge nurse added a prompt to the admission checklist asking families to bring sensory aids.
Family
Her son and granddaughter took turns staying with her in the evenings, talking to her about family and helping her eat. The student explained what delirium is, that it usually improves when its causes are treated and how they could help.
Evaluation
Over three days, Mrs. Abate's assessments became negative, she slept through the night and she was walking with assistance. Her urine output improved with fluids. She went home with her son on day five, with teaching about watching for confusion at home.
Limits
The HELP trial was not randomized, though it used matching. Hypoactive delirium can be missed even with screening. A single patient's improvement reflects treatment of the infection as well as nursing measures.
Conclusion
Mrs. Abate's quiet confusion was hypoactive delirium. The Confusion Assessment Method detected it, Marcantonio's review guided the search for causes and the HELP trial showed which nursing measures prevent and limit it. Restoring her glasses and hearing aid, protecting sleep, moving her, hydrating her and involving her family helped her recover.
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. 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. New England Journal of Medicine, 377(15), 1456-1466. https://doi.org/10.1056/NEJMcp1605501
Reading the NUR 3480 Module 4 assignment instructions
TESU's catalog description of NUR-3480 includes care across acute and chronic conditions, and with no public syllabus, module four is planned as a delirium paper about an older adult. Plan a paper that assesses with a validated tool, explains delirium's causes and risks, searches for precipitating factors, applies evidence-based prevention and nonpharmacologic management, writes nursing diagnoses and evaluates over several days, including the family's role. Some sections ask for a paper on dementia-related behaviors instead, which requires distinguishing delirium from dementia. Check which delirium tool your clinical site uses and whether the brief expects the four features explained one by one. Review the patient's medications for drugs that raise delirium risk, and describe how you will share the lessons with staff. Involve the family from the start.
How the NUR 3480 Module 4 example is put together
An invented 82-year-old woman with a urinary infection on a Trenton medical unit, picking at her blanket on her second evening, opens the paper. The Confusion Assessment Method detects hypoactive delirium, Marcantonio's review guides the search for causes and the HELP trial shapes prevention, each tied to nursing actions in a table. A sedating antihistamine is stopped and fluids increased. Glasses and hearing aid, clustered vital signs, mobility, fluids and family presence follow. Over three days she recovers, going home on day five, before the paper notes its limits. Sections on medications to avoid and on teaching staff at the huddle complete the plan.
NUR 3480 Module 4 rubric: what earns full marks
Delirium papers earn credit for correct use of a validated tool, accurate explanation of causes and risk factors, a search for precipitating factors, evidence-based prevention and nonpharmacologic care, attention to family and evaluation over time. Mentors notice when a student recognizes the hypoactive form. Identifying a sedating medicine as a cause shows medication awareness. Using an interpreter for a patient's own language shows careful communication. Cite both Inouye papers in full, keeping the Jr. suffixes the authors use. Identifying and stopping a high-risk sleep medicine shows medication safety in older adults. Sharing the lesson with staff shows leadership from a student. Changing the admission checklist shows a lasting fix.
NUR 3480 Module 4 help from the desk
Delirium papers often describe agitation and forget the quiet form; assess every shift with a tool. Another frequent gap is reaching for medication before searching for causes. Bring glasses and hearing aids. Protect sleep by clustering care. Get patients moving and drinking. Involve the family. A first draft about your own older patient is free with your brief. Look for high-risk medicines such as sedating antihistamines. Treat pain, since it can drive delirium. Share what you learn with the team. Assess every shift with a validated tool, and remember the hypoactive form. Ask families to bring sensory aids on admission.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 3480 Module 4 questions, answered
Where can I find a free NUR 3480 Module 4 sample paper?
The delirium paper about an invented older woman on a Trenton medical unit, from the first assessment to recovery, is printed here in full.
What are the four features of the Confusion Assessment Method?
Four: a fast, fluctuating change in mental state; poor attention; jumbled thinking; and a shift in alertness.
How is delirium diagnosed with the CAM?
Both the first two features are required, together with one of the last two.
Can delirium be prevented?
The Hospital Elder Life Program reduced delirium by targeting six risk factors, including sleep, mobility, vision, hearing and hydration.
Should antipsychotics be used to prevent delirium?
No. Marcantonio's review found no proof that they prevent it or shorten it, so they are kept for dangerous agitation.