What action should be taken if delirium persists despite nonpharmacologic measures?

• A. Increase restraints
• B. Initiate restraints
• C. Escalate for underlying causes
• D. Reduce staff involvement

Answer: (C)

When delirium persists despite nonpharmacologic strategies, the focus shifts to identifying and correcting underlying medical causes rather than continuing environmental measures alone. This means rapidly evaluating for factors such as infection, dehydration or electrolyte disturbances, hypoxia, metabolic derangements, pain, urinary retention, constipation, and adverse drug effects or interactions. Based on the assessment, initiate targeted treatments: replete fluids and correct electrolytes, treat infections, optimize oxygenation, adjust or discontinue offending medications, manage pain, and address any metabolic issues. Keep safety and calming support ongoing, but avoid using restraints as the primary approach since they don’t treat the cause and can worsen delirium. If agitation or risk remains, use de-escalation techniques and the least restrictive measures possible while the underlying causes are addressed.