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Here is a quick mnemonic “PHYSICIANS AND NURSES to remember about Approach To A Patient With Delirium

This can be valuable for patients as well as medical doctors, nurses & students doing their clinical rounds. You can also find it very useful for med exams like USMLE, MBBS, NEET PG, FMGE, NExT, MCAT & NCLEX exams

Approach To A Patient With Delirium : How To Remember Easily ?

  • P – Patients with possible confusional states should undergo a careful history and physical examination for the diagnosis of delirium.
  • H – History from a collateral source is invaluable in eliciting an accurate history in delirious patients with altered levels of consciousness.
  • Y – Younger delirious patients should be screened for illicit drug use, alcoholism, or toxin exposure.
  • S – Screening tools such as the Confusion Assessment Method (CAM) and the Delirium Rating Scale can aid physicians and nurses in identifying patients with delirium.
  • I – Inattention accompanied by either disorganized thinking or an altered level of consciousness is a key criterion for diagnosing delirium using the CAM.
  • C – Cognitive function assessment, including baseline cognitive function and time course of the present illness, is important in evaluating patients with delirium.
  • I – Impairment in attention can be assessed through a simple bedside test of digit span forward.
  • A – Acute onset and fluctuating course of delirium should be considered in patients with an altered level of consciousness or deficit of attention.
  • N – Neurologic examination should focus on mental status, level of consciousness, and signs of focal neurologic deficits.
  • S – Systemic infections, medications, metabolic abnormalities, and cerebrovascular etiologies should be considered in the evaluation of delirium.
  • A – Attentional deficit is a hallmark of delirium and can be assessed through a screen for an attentional deficit.
  • N – Neuropsychological testing, such as the Mini-Mental State Examination (MMSE), can provide information regarding orientation, language, and visuospatial skills.
  • D – Delirium can be caused by a large group of insults, and the cause in many patients is multifactorial.
  • N – Neuropsychological testing is often cumbersome and time-consuming in the inpatient setting.
  • U – Unfamiliar environment in a hospital can contribute to delirium, especially in susceptible individuals.
  • R – Relevant laboratory studies, imaging, and other ancillary tests may be required to confirm the etiology of delirium.
  • S – Signs of infection, such as fever and pulmonary consolidation, should be screened during the physical examination.
  • E – Etiologies of delirium can include medications, illicit drugs, toxins, systemic infections, and metabolic abnormalities.
  • S – Seizure activity, both nonconvulsive status epilepticus and recurrent seizures, can cause delirium.


Dr. Arin Nandi

Passionate About Medical Science & Helping Future Doctors Achieve Top Ranks In Medical Exams. He is professionally a dentist as well as a public health expert from JIPMER (1), (2)working in health department