A nurse is planning care for an older adult client who is at risk for developing delirium due to a urinary tract infection.

Which of the following interventions should the nurse include in the plan?

(Select all that apply.).

The correct answer is C.

“I remember that you are my nurse and your name is Lisa.” This statement indicates an improvement in the condition of delirium, which is a temporary mental state characterized by confusion, anxiety, incoherent speech, and hallucinations.

Delirium can be caused by various factors, such as fever, infection, medication, surgery, or alcohol or drug use or withdrawal.

Delirium can have different types: hyperactive, hypoactive, or mixed.

Delirium can be distinguished from dementia by its acute and fluctuating onset, reduced awareness of surroundings, and poor thinking skills.

Choice A is wrong because “I don’t know where I am or what day it is.” indicates a lack of orientation to time and place, which is a sign of delirium.

Choice B is wrong because “I feel so sleepy all the time.

I just want to rest.” indicates a hypoactive type of delirium, which is characterized by reduced activity, sluggishness, and drowsiness.

Choice D is wrong because “I still hear voices sometimes, but they are not as loud.” indicates a presence of hallucinations, which is a symptom of delirium.

Normal ranges for cognitive function in older adults depend on various factors, such as age, education, culture, and health status.

However, some general indicators of normal cognition include being able to recall recent events, recognize familiar people and places, communicate clearly and coherently, and perform daily activities independently.

References:.

• Delirium - Symptoms and causes - Mayo Clinic.

• Delirium in elderly adults: diagnosis, prevention and treatment.

The correct answer is B.

Delirium is a reversible condition that can be cured with proper treatment.

Delirium is a serious change in mental abilities that results in confused thinking and a lack of awareness of one’s surroundings.It usually comes on fast and can be caused by various factors, such as infection, medication, surgery, or alcohol or drug use or withdrawal.Delirium can often be prevented and treated by addressing the underlying causes and providing supportive care.

Choice A is wrong because delirium is not a chronic condition that causes progressive cognitive decline.

That description fits dementia, which is different from delirium.Dementia is a gradual loss of memory and other thinking skills due to damage or loss of brain cells.

Choice C is wrong because delirium is not a normal part of aging that does not require any intervention.

Delirium is a medical emergency that needs prompt attention and treatment.Delirium can have serious consequences, such as functional decline, institutionalization, and death.

Choice D is wrong because delirium is not a genetic condition that runs in families.Delirium is not inherited, but rather triggered by environmental factors or medical conditions that affect the brain.

Normal ranges for mental status assessment in older adults are based on standardized tools, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA).

These tools measure various aspects of cognition, such as orientation, memory, attention, language, and executive function.

The MMSE has a maximum score of 30, and the MoCA has a maximum score of 26.

A score below 24 on the MMSE or below 18 on the MoCA may indicate cognitive impairment.

However, these tools are not diagnostic of delirium or dementia, and should be interpreted in the context of the patient’s history and clinical presentation.