A nurse is collecting data from a client who has anorexia nervosa. Which of the following findings should the nurse identify as an expected outcome of treatment?

Delirium is an acute, fluctuating disturbance in attention and cognition commonly triggered by infection, hypotension, hypoxia, or systemic inflammation. In this case, the client has sepsis likely from a surgical site infection, evidenced by fever, hypotension, elevated WBC count, and wound drainage. Neurologic changes such as fluctuating orientation and perceptual disturbances are key indicators of delirium and require immediate identification to prevent injury and worsening clinical decline.

Rationale for correct choices:

• Change in orientation: An acute change in orientation, such as confusion about time, place, or situation, is one of the earliest and most reliable indicators of delirium. The client initially was oriented but later becomes disoriented to time (“It’s 1975”) and only partially oriented to person and place. This fluctuating cognitive status reflects acute brain dysfunction rather than a chronic condition like dementia. Such changes are often caused by systemic infection, hypoperfusion, or metabolic disturbances and require urgent intervention.

• Hallucinations: Hallucinations, such as the client reporting spiders crawling on the bed, are a hallmark of severe delirium. These false sensory perceptions occur due to acute brain dysfunction affecting perception and reality testing. In this case, the visual and tactile hallucinations indicate worsening neurocognitive impairment likely driven by sepsis and hypotension. Hallucinations significantly increase risk for agitation, unsafe behaviors, and self-harm, requiring immediate safety interventions and medical evaluation.

Rationale for incorrect choices:

• Illusions: Illusions are misinterpretations of real external stimuli rather than perceiving something that is not present. While delirious clients can experience illusions, the scenario specifically describes hallucinations (seeing and feeling spiders with no external stimulus). Therefore, illusions do not best fit the described symptoms. The client’s presentation reflects more severe perceptual disturbance consistent with hallucinations rather than simple misinterpretation.

• Past medical history: Although the client has significant past medical conditions such as Parkinson’s disease and heart failure, these do not directly indicate the development of delirium. Past medical history may increase vulnerability but is not a clinical sign of acute cognitive change. Delirium is diagnosed based on current acute changes in mental status, not historical health information.

Delirium is an acute, fluctuating disturbance in attention, cognition, and consciousness that develops over a short period of time. It is commonly triggered by an underlying medical condition, medication effect, or metabolic imbalance. Older adults and hospitalized clients are especially vulnerable. Identifying and treating the underlying cause is essential for reversing symptoms and preventing complications such as injury or prolonged cognitive impairment.

Rationale:
A. Amyloid plaque is associated with chronic neurodegenerative processes such as Alzheimer’s disease, which leads to gradual cognitive decline rather than the acute, fluctuating changes seen in delirium. While dementia increases vulnerability to delirium, amyloid plaques themselves are not an acute precipitating risk factor.

B. Urinary tract infection is a correct risk factor because infections are one of the most common reversible causes of delirium, especially in older adults. Infections such as Urinary tract infection can trigger systemic inflammation and metabolic changes that affect brain function, leading to acute confusion, restlessness, and disorientation.

C. High cholesterol is a long-term cardiovascular risk factor but is not directly associated with the acute onset of delirium. It contributes to chronic vascular disease over time rather than causing sudden cognitive changes. Therefore, it is not considered an immediate precipitating factor.

D. Hypersomnia refers to excessive sleepiness and is more commonly associated with sleep disorders, depression, or medication effects. It is not a known direct risk factor for delirium, which is characterized by acute confusion and fluctuating levels of consciousness rather than increased sleep duration.