A nurse is performing an admission assessment on an older patient who presented with a high fever and cough, reduced oral intake for 3 days, and lower extremity weakness. The patient has sunken eyes, and the patient’s skin turgor over the sternum is poor. The nurse suspects that the patient is dehydrated. Which of the following are indicators of dehydration in this patient? (Select all that apply.)

Choice A reason: Functional incontinence refers to a situation in which the lower urinary tract is intact, but the individual is unable to reach the toilet because of environmental barriers, physical limitations, or severe cognitive impairment. This is the most likely type of incontinence for an older female adult with severe cognitive impairments, as she may not be aware of her bladder sensations, forget where the bathroom is, or have difficulty communicating her needs.

Choice B reason: Stress incontinence is when urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. This is not the most likely type of incontinence for an older female adult with severe cognitive impairments, as it is not related to her cognitive status, but rather to the weakening of the pelvic floor muscles and the urethral sphincter.

Choice C reason: Postvoid residual is when the bladder does not empty completely after urination, causing frequent or constant dribbling of urine. This is not the most likely type of incontinence for an older female adult with severe cognitive impairments, as it is not related to her cognitive status, but rather to the obstruction of the bladder outlet, the underactivity of the bladder muscle, or the dysfunction of the bladder nerves.

Choice D reason: Urge incontinence is when you have a sudden, intense urge to urinate followed by an involuntary loss of urine. This is not the most likely type of incontinence for an older female adult with severe cognitive impairments, as it is not related to her cognitive status, but rather to the overactivity of the bladder muscle, the irritation of the bladder lining, or the infection of the urinary tract.

Choice E reason: None of the above is not the correct answer, as there is one choice that is the most likely type of incontinence for an older female adult with severe cognitive impairments.

Choice A reason: Sudden onset of symptoms is a sign of hyperthyroidism, as it indicates a rapid increase in thyroid hormone levels that can cause a thyroid storm, a life-threatening condition that requires immediate medical attention. Symptoms of a thyroid storm may include fever, agitation, confusion, sweating, nausea, vomiting, diarrhea, and chest pain.

Choice B reason: Atrial fibrillation is a sign of hyperthyroidism, as it indicates an irregular and fast heartbeat that can result from the excess stimulation of the heart by thyroid hormones. Atrial fibrillation can increase the risk of blood clots, stroke, and heart failure.

Choice C reason: Cold intolerance is not a sign of hyperthyroidism, but rather a sign of hypothyroidism, a condition where the thyroid gland produces too little thyroid hormone. Cold intolerance means feeling cold even in warm environments, due to the reduced metabolic rate and heat production.

Choice D reason: Constipation is not a sign of hyperthyroidism, but rather a sign of hypothyroidism, a condition where the thyroid gland produces too little thyroid hormone. Constipation means having difficulty passing stools, due to the slowed intestinal motility and digestion.

Choice E reason: Heart failure is not a sign of hyperthyroidism, but rather a complication of hyperthyroidism, a condition where the thyroid gland produces too much thyroid hormone. Heart failure means the inability of the heart to pump enough blood to meet the body's needs, due to the increased workload and damage to the heart muscle.