An 88-year-old man is admitted to the ICU after a right-hip hemiarthroplasty to repair an intertrochanteric femur fracture sustained during a fall from standing. On postoperative day 1, he is confused and intermittently agitated with a disorganized thought process. His nurse completed the CAM-ICU screen and reports that the result was positive.
• While opioids may indeed contribute to delirium, inadequate pain control is also associated with delirium.
• It may be beneficial to optimize pain control with other nonopioid adjuncts such as acetaminophen, but removal of all opioids may not be practical or helpful.
• Encouraging sleep health, reorienting the patient to his surroundings, and minimizing sedatives are all important treatments for delirium.