New confusion in an older client with a worried daughter
IENCAP OSCE practice station
Risk assessment · 2 min to read · 13 min to perform
Assess Mr Gagnon for a change in his thinking and alertness and look for possible causes.
Arthur GagnonIs the shift over? I have to lock up the shop.
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Open the full station (charts, voice, result letter) →The task
You are the nurse on a medical unit in Ontario. Arthur Gagnon, aged 79, was admitted two days ago with pneumonia. His daughter Sophie has come to visit and says her father is not himself. Introduce yourself to both. Assess Mr Gagnon for a change in his thinking and alertness and look for possible causes. Decide what to do and who to tell. Explain your plan and your concern to Sophie. Record your assessment and plan in the note provided.
What this station tests
- Delirium is acute, fluctuating and shows inattention. Ask the family what is different from his usual self.
- Look for treatable causes: infection, retention, constipation, medicines, pain, dehydration, sensory aids.
- Treat delirium as a medical emergency and escalate promptly.
- Use non-drug measures early and involve the family.
- Explain honestly to family that it is not the same as dementia.
Sources for the clinical content
- Canadian Coalition for Seniors' Mental Health: Delirium
- RNAO Best Practice Guideline: Delirium, Dementia, and Depression in Older Adults
An original practice scenario with invented patients. Not an exam question.