A 68-year-old client who is hospitalized with pneumonia is disoriented and confused 3 days after admission. Which information indicates that the client is experiencing delirium rather than dementia?

Choice A reason: Redirecting to an activity uses distraction to reduce agitation in Alzheimer’s, where hippocampal and cortical degeneration causes disorientation and memory loss. Engaging in familiar activities leverages preserved procedural memory, calming the client without confronting their delusion, which aligns with neurobiological strategies to manage confusion and distress.

Choice B reason: Stating the mother died confronts the client’s delusion, likely increasing agitation due to impaired reality testing from Alzheimer’s-related cortical damage. This approach disregards the client’s cognitive limitations, as memory deficits prevent processing such corrections, potentially worsening emotional distress and behavioral symptoms.

Choice C reason: Asking why the client seeks her mother probes a delusion rooted in Alzheimer’s-related memory loss and hippocampal dysfunction. This may confuse or frustrate the client, as they cannot articulate reasons due to cognitive impairment. Redirection is more effective than exploring motives in advanced dementia.

Choice D reason: Assuming upset and addressing emotional distress may escalate agitation, as Alzheimer’s impairs emotional regulation due to amygdala and prefrontal cortex damage. While empathetic, this response risks focusing on the delusion, which the client cannot process, making redirection to an activity a more effective, neurobiologically informed approach.

Choice A reason: Mild delirium involves acute confusion and impaired judgment due to cerebral dysfunction, often from metabolic or infectious causes. Accompanying the client ensures safety, as disorientation increases wandering or injury risk. Supervision mitigates risks from altered cognition while allowing mobility, supporting cerebral recovery without exacerbating confusion.

Choice B reason: Restricting the client to the unit may increase agitation, as delirium’s neurochemical imbalances, like acetylcholine deficiency, heighten restlessness. While safety is critical, blanket restriction ignores the potential benefits of supervised movement, which can reduce stress and improve cerebral perfusion, making this less appropriate than supervised accompaniment.

Choice C reason: Assessing motives may clarify intent but delays addressing immediate safety in delirium, where confusion stems from cerebral dysfunction, such as hypoxia or electrolyte imbalance. The client’s impaired judgment requires supervision over exploration of motives, as disorientation increases risk of harm, making this a secondary action.

Choice D reason: Allowing an unsupervised walk is unsafe in delirium, as acute cognitive impairment from neurotransmitter imbalances or metabolic disturbances increases wandering or injury risk. Without supervision, the client may become disoriented or lost, exacerbating cerebral stress. Accompanied walks better balance safety and mobility in this condition.