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Delirium and asymptomatic bacteriuria — DGM MCQ

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HardDeliriumDelirium and asymptomatic bacteriuriaDGM

An 87-year-old woman is brought from a care home with new confusion. Temperature is 37.1°C, pulse 92/min, oxygen saturation 95% and she denies urinary symptoms. Urine dipstick is positive for nitrites and leucocytes; she is constipated, dehydrated and taking tramadol. What is the most appropriate assessment?

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Correct answer: E — Assess for delirium and search for multiple triggers rather than treat dipstick alone

A positive dipstick is common in older care-home residents and should not be the sole explanation for delirium without compatible symptoms. Constipation, dehydration and opioids are plausible triggers requiring review. Delirium assessment should resist diagnostic anchoring on urine results.

Reference: NICE CG103; NICE NG109