Day three, and she does not know where she is

An 84-year-old admitted with a hip fracture, now post-operative day 2, was 'sharp as a tack' on admission. This morning she thinks it is 1974.

84-year-old womanOrthogeriatric ward, bed 7Fictitious educational patient

Hip fracture, hemiarthroplasty 2 days agoHypertensionMild hearing lossLives alone, independent

Day 3 · 08:15

The morning handover

The night nurse reports she was awake most of the night, pulled at her cannula, and accused the staff of stealing her handbag. She is quiet now and 'a bit vacant'. Her daughter says she was completely herself on admission.

Vitals

HR92BP146/84RR18SpO293%T37.6

What is the diagnosis, and what is the first thing to establish?

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