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Postoperative delirium after hip fracture — SCE Geriatric Medicine MCQ

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ModerateDeliriumPostoperative delirium after hip fractureSCE Geriatric Medicine

An 84-year-old woman develops agitation on the second night after hip fracture surgery. She is pulling at her cannula, has pain on movement, has not opened her bowels for four days and has urinary retention of 850 mL on bladder scan. Temperature is 37.5°C, oxygen saturation is 95% on air and sodium is 136 mmol/L. What is the most appropriate management?

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Correct answer: E — Treat pain, constipation and urinary retention with delirium prevention measures

This is postoperative delirium with multiple modifiable precipitants: pain, constipation, urinary retention, sleep disruption and unfamiliar environment. NICE CG103 emphasises identifying and treating underlying causes and using non-pharmacological measures first. Haloperidol may be needed briefly for severe risk after de-escalation, but it is not definitive treatment. Orthogeriatric delirium management depends on actively seeking reversible drivers.

Reference: NICE CG103; BOA/BGS Blue Book