A nurse is educating the family of a client who has Alzheimer's disease. The nurse should be sure to communicate that which of the following behavioral manifestations can occur in clients with Alzheimer’s disease? (Select All that Apply.)

A. Female sex: While gender can influence the risk of certain health conditions, such as cardiovascular diseases, there isn't a direct correlation between being female and an increased risk of delirium. Both males and females can develop delirium under certain circumstances.

B. History of drug and alcohol use: A history of drug and alcohol use increases the risk for the development of delirium. Substance abuse, including alcohol, illicit drugs, and certain prescription medications, can disrupt neurotransmitter function and lead to alterations in mental status, including delirium. Additionally, withdrawal from alcohol or drugs can precipitate delirium in susceptible individuals.

C. Lack of medical insurance: While access to healthcare and socioeconomic factors can impact overall health outcomes, there isn't a direct association between lack of medical insurance and an increased risk of delirium. Delirium is more closely linked to medical conditions, substance use, and other physiological factors.

D. History of lymphoma: While certain medical conditions, such as infections, metabolic disturbances, and neurological disorders, can increase the risk of delirium, there isn't a direct correlation between a history of lymphoma and the development of delirium. Delirium is more commonly associated with acute illness, surgery, or medication use.

A. Apply soft restraints to wrists and chest: Using restraints should only be considered as a last resort and should not be the first intervention for managing delirium. Restraints can exacerbate agitation and increase the risk of complications such as skin breakdown, musculoskeletal injury, and psychological distress. Therefore, applying restraints should not be the first action taken by the nurse.

B. Administer antipsychotic medications as prescribed: While antipsychotic medications may be used to manage symptoms of delirium in some cases, they should not be the first intervention for preventing client injury. Additionally, the use of antipsychotics in the ICU requires careful consideration due to potential adverse effects, such as sedation, hypotension, and prolongation of the QT interval. The decision to administer antipsychotic medications should be based on a comprehensive assessment and in consultation with the healthcare team.

C. Administer sedative medications as prescribed: Administering sedative medications may help calm an agitated client with delirium, but it should not be the first intervention for preventing client injury. Sedatives can further impair cognition and increase the risk of falls or other complications. Like antipsychotic medications, the use of sedatives should be based on a thorough assessment and in collaboration with the healthcare team, rather than being the initial action taken by the nurse.

D. Arrange for one-on-one observation for the client: Delirium in the intensive care unit (ICU) is a serious condition that can lead to confusion, disorientation, and an increased risk of injury to the client. The priority intervention for preventing client injury in this situation is to ensure constant monitoring and supervision. By arranging for one-on-one observation, the nurse can provide continuous monitoring of the client's behavior, assess for changes or signs of agitation, and intervene promptly to prevent falls or other injuries.