| Course | PA 505 Behavioral Medicine I |
|---|---|
| Week | 5 |
| Paper type | Delirium versus depression comparison |
| Length | About 1,120 words, 6 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 505 Week 5
Delirium Versus Depression, Feature by Feature: A Quiet Second Hospital Day With Pneumonia in a 68-Year-Old Whose Chart Already Says Depressed
Student Name
Chamberlain University
PA 505: Behavioral Medicine I
Instructor Name
Month Day, Year
Delirium Versus Depression, Feature by Feature: A Quiet Second Hospital Day With Pneumonia in a 68-Year-Old Whose Chart Already Says Depressed
The Question on Day Two
W.T., the widowed road worker followed in this course, was admitted to the county hospital on a Sunday with a right lower lobe pneumonia, a temperature of 38.9 degrees Celsius and an oxygen saturation of 89% on room air. On Tuesday morning the day nurse wrote that W.T. was "withdrawn, not eating, staring, likely the depression noted in the chart," and asked whether the clinic's mental health follow-up should be moved up. The chart did carry a positive depression screen from four weeks earlier. The question this comparison answers is whether the quiet patient on day two is showing the depression already recorded, a delirium that is new, or both.
The comparison is written feature by feature rather than condition by condition, because two accurate descriptions in sequence would not help anyone decide which one is in the bed. Hypoactive delirium, the quiet form, is the one most easily mistaken for depression and the one most often missed (Marcantonio, 2017).
Onset: Over Hours or Over Weeks
Depression in this patient has a dated start, the end of May, and built over weeks. The change the nurse described has a different shape. At admission on Sunday evening W.T. gave a clear history to the emergency physician, named all three medications and asked about the cattle. By Monday night the night nurse charted that W.T. had tried to get out of bed "to check the gate." An acute change from the patient's own baseline, over a day, is the first feature of delirium in the Confusion Assessment Method (Inouye et al., 1990), and it is the feature depression does not produce.
Level of Alertness
At the clinic, W.T. was slow but awake throughout; answers came late but they came. On Tuesday W.T. drifted off twice in the middle of my questions and had to be roused by name, then answered the next question as if the previous one had not been asked. Slowness inside a conversation and absence from it are different findings, and on Tuesday the finding was absence.
The Course of a Day
The nursing notes show a pattern. At nine in the morning W.T. was eating some breakfast and answered questions. By four in the afternoon W.T. was hard to rouse, and by evening was pulling at the oxygen tubing. Depression in clinic had looked the same at every visit, morning and afternoon alike. Fluctuation across a day is part of the first CAM feature, and it is the observation depression does not survive.
Attention
At the clinic four weeks earlier, W.T. named the months backward from December without a mistake. On Tuesday, W.T. began, "December, November," then said "September, October," and stopped. Inattention is the core feature of delirium, required in the CAM algorithm, while depression slows attention without usually breaking it on a simple task like this one (Inouye et al., 1990).
Thinking and Orientation
W.T. told me the room was "the co-op office" and asked whether the feed had come. The thought jumped from the feed to a grandchild's ball game without a link. Disorganized thinking is one of the two CAM features of which at least one must be present alongside the first two, and altered alertness is the other; W.T. showed both.
What Somebody Outside the Room Reports
The neighbor whose cattle W.T. feeds visited on Monday afternoon and told the nurse that on Saturday W.T. had been "sharp as a tack, arguing about hay prices." That account is the neighbor's, recorded as such, not something W.T. said. It matters because it fixes a baseline from outside the hospital: the person seen on Saturday had depression but was clear, and the person in the bed on Tuesday is not.
Sleep and the Night
The night notes add a feature the clinic could never see. In clinic, W.T. described waking at three thirty and lying awake, alert, thinking about the spouse; the early waking of depression is a long, clear stretch of wakefulness. On the ward, Monday night was different: W.T. slept in short bursts through the day, was awake and calling out between midnight and two, and at one point did not recognize the night nurse who had been in the room an hour earlier. A reversed sleep and waking pattern, with confusion at night, belongs to the delirium picture rather than to the depression already known, and it is one more reason the nurse's morning impression of a quiet, staring patient told only half the story.
What the Medications Add
The medication record matters to the comparison because some causes of delirium are given in hospital. W.T. received one dose of an antihistamine for itching on Sunday night and a sleeping tablet on Monday at ten. Both can cloud attention in an older adult, and both were given in the hours before the worst of the confusion. The comparison does not decide whether the drugs, the infection or alcohol is the main cause; it records that a medication timeline exists and that depression has no such timeline.
What They Share
Both conditions here produce poor intake, little speech, slowed movement and a flat face. Those features cannot separate them, and the nurse's note was built entirely from them. Both can also be present at once: an older adult with depression is at higher risk of delirium, and a delirium does not erase a depression that was already there. The comparison does not conclude that W.T. is not depressed. It concludes that the change since Sunday is not the depression.
The Result
Acute onset with fluctuation, inattention on a simple task, disorganized thinking and reduced alertness together meet the CAM algorithm for delirium. The pneumonia, low oxygen and fever are obvious candidate causes, and W.T.'s nightly whiskey makes the timing of the last drink, Saturday evening, relevant as well. The depression recorded in the chart is still present and is not the explanation for Tuesday. The clinic follow-up does not need to move; the ward team needs to know that the patient has a delirium.
Where the Writing Stops
This comparison does not set out how the delirium should be managed or what should be changed in the antibiotic or oxygen plan. Its job is to name what is in the bed so that the people managing it are working on the right problem.
References
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P., & Horwitz, R. I. (1990). Clarifying confusion: The confusion assessment method. A new method for detection of delirium. Annals of Internal Medicine, 113(12), 941-948. https://doi.org/10.7326/0003-4819-113-12-941
Marcantonio, E. R. (2017). Delirium in hospitalized older adults. New England Journal of Medicine, 377(15), 1456-1466. https://doi.org/10.1056/NEJMcp1605501
PA 505 Week 5 instructions, in plain terms
The fifth week asks you to compare delirium and depression in a case where both are plausible. Organize the comparison by feature, not by condition, so each passage helps decide which condition is present. Cover onset and whether it can be dated, level of alertness, how the picture changes across a day, attention on a simple task, orientation and the organization of thinking, and what someone who knew the patient before reports. Use a recognized method, such as the Confusion Assessment Method, where it fits, with a source. Name the features the two conditions share and say why they cannot separate them. Allow for both conditions being present at once. State your conclusion clearly, and do not go on to set out treatment, which belongs to another assignment.
How the PA 505 Week 5 example is put together
The comparison opens on day two of W.T.'s admission for right lower lobe pneumonia, when the nurse wrote that the patient was withdrawn and staring and likely showing the depression in the chart. It explains why two side-by-side descriptions would not help and notes that the quiet form of delirium is the one most often missed. Passages follow by feature. Onset is dated: clear at admission on Sunday, trying to check the gate by Monday night. Alertness drifts mid-sentence on the ward, unlike the slow but present patient in clinic. Mornings are clearer than afternoons. The months-backward task, done perfectly in clinic, breaks down. Thinking jumps from cattle feed to a ball game. The night pattern and a timeline of two sedating doses are added, and the neighbor's account fixes a clear baseline on Saturday. Shared features are named, and the conclusion separates the new delirium from the depression that remains.
Reading the PA 505 Week 5 grading rubric
The comparison that loses the most is written condition by condition: two accurate summaries in sequence with nothing in either that separates them in the patient actually in the bed. Nearly as costly is separation by impression, withdrawn against vacant, which no second reader can check. Further deductions follow for a comparison with no time in it, where onset and the shape of a day are missing; for a feature claimed for one condition when both share it; for an outside account folded into the record as though the patient said it; and for a closing section that drifts into management. Strong work runs feature by feature, dates the onset, contrasts the same patient at two points, uses a recognized method with a source, names shared features and allows both conditions to coexist. A clear statement of what the comparison concludes, and what it leaves standing, earns the final points.
Common PA 505 Week 5 mistakes, and how to avoid them
Delirium and depression comparisons go wrong most often because they are written as two textbook entries. Send us the case your instructor posted and we will help you reorganize it by feature, find the observations that date the onset and show fluctuation, and map what you saw to the Confusion Assessment Method. We can also help you keep an outside informant's account labeled as theirs and write a conclusion that allows both conditions at once. Students often stop before the shared features, which is where a marker looks for judgment, and we can help you write that passage around your own case. Stopping before treatment is the other discipline this week asks for. The clinical reasoning remains yours. If your section names another tool, such as the 4AT or a nursing delirium scale, the custom sample applies that tool to your case.
Get a PA-505 Week 5 example written to your instructions
Send the case material your section issued, the assignment and the rubric, and say whether the comparison is meant to run as prose or in a fixed table, since the two spend their length differently. A custom PA-505 Week 5 comparison is written to that material and returned inside 24-48h, the first one free.
More PA 505 papers and MPAS samples
- PA 505 Week 1: Where Depression Is First Met
- PA 505 Week 2: MSE Narrative
- PA 505 Week 3: PHQ-9 Score Interpretation
- PA 505 Week 4: Criteria Application Exercise
- PA 505 Week 6: Substance Use History Brief
- PA 505 Week 7: Risk Formulation Note
- PA 505 Week 8: Capacity Determination Note
- PA 504 Week 5: Interpreted Encounter Analysis
- PA 503 Week 5: Test Characteristics Problem Set
- PA 502 Week 5: Applicability Write-Up
- PA 501 Week 5: Supervision Model Comparison
PA 505 Week 5 questions, answered
Our case gives one moment only. Can the comparison still be written?
Yes, and the honest version says what a single moment cannot settle. Write the features the material does supply, then name what would have to be observed at another hour or asked of somebody who knows the person, and say which way each result would push. A comparison identifying its own missing evidence reads as competent rather than as thin.
Should other conditions appear in the comparison?
Keep to the pair unless your assignment widens it. A document reaching for every condition that can look psychiatric turns into a catalog, and the catalog belongs to other courses in the program. One sentence acknowledging that the pair sits inside a larger set is enough, and it protects the comparison from reading as though the writer had never heard of anything else.
Does the comparison have to decide which one it is?
Only where the assignment says so. Many versions want the features laid out and the decision left open, and a document forcing a conclusion the material does not support loses more than one leaving it unresolved. Where a decision is required, name the feature that carried it in the same sentence, so the reasoning is visible rather than implied.
Where can I find a free PA 505 Week 5 sample paper?
This page has a full PA 505 Week 5 comparison of delirium and depression for a patient with pneumonia, written feature by feature.
What decides the comparison in the PA 505 Week 5 sample?
An acute dated change with fluctuation, failure on a simple attention task, disorganized thinking and reduced alertness, which together meet the Confusion Assessment Method for delirium.