A nurse is providing teaching to a client who is to start taking valproic acid. Which of the following instructions should the nurse include?

Choice A reason: Reminding a dementia patient of forgotten information supports memory function and reduces frustration. Dementia involves progressive neuronal loss, impairing short-term memory due to hippocampal and cortical damage. Gentle reminders align with cognitive support strategies, maintaining patient comfort without overwhelming their limited cognitive capacity, making this approach appropriate.

Choice B reason: Engaging in favorite activities leverages preserved long-term memory in dementia, as the disease primarily affects short-term memory and executive function due to amyloid plaques and tau tangles. Familiar tasks reduce agitation and promote well-being, as they align with the patient’s cognitive abilities, making this a scientifically sound caregiving strategy.

Choice C reason: Introducing new and different activities daily is inappropriate, as dementia patients struggle with learning and adapting due to impaired neuroplasticity and hippocampal dysfunction. Novel tasks can cause confusion and agitation, as they overwhelm cognitive reserves. Familiar routines are more effective, requiring intervention to educate the caregiver on maintaining consistency.

Choice D reason: Encouraging discussion about friends and family taps into preserved long-term memory in early dementia, as the disease initially spares autobiographical memory. Social engagement supports emotional well-being and cognitive stimulation, reducing isolation. This approach is scientifically appropriate, as it aligns with the patient’s cognitive strengths and promotes quality of life.

Choice A reason: Aphasia, a language impairment, is not a hallmark of delirium but is associated with neurological conditions like stroke affecting Broca’s or Wernicke’s areas. Delirium involves acute cognitive dysfunction due to underlying causes like infection or hypoxia, primarily affecting attention and awareness, not specific language processing, making this choice scientifically inaccurate for delirium.

Choice B reason: Confusion is a core feature of delirium, characterized by disorientation and impaired attention due to acute brain dysfunction. It results from disruptions in cerebral metabolism, often triggered by systemic issues like electrolyte imbalances or sepsis. This symptom distinguishes delirium from dementia, as it reflects rapid, reversible cognitive changes, requiring immediate assessment.

Choice C reason: Impaired level of consciousness, such as fluctuating alertness or stupor, is a defining feature of delirium. It stems from diffuse brain dysfunction, often due to toxic, metabolic, or infectious causes affecting neurotransmitter balance or cerebral perfusion. This distinguishes delirium from dementia, which typically preserves consciousness, making this a critical diagnostic criterion.

Choice D reason: Long-term memory impairment is characteristic of dementia, not delirium. Delirium involves acute, reversible cognitive deficits, primarily affecting attention and short-term memory due to transient brain dysfunction. Long-term memory remains relatively intact in delirium, as the underlying pathology does not typically involve chronic neuronal loss, unlike Alzheimer’s or other dementias.

Choice E reason: Mood fluctuations occur in delirium due to acute brain dysfunction affecting emotional regulation, often linked to neurotransmitter imbalances or systemic stressors like infection. However, they are not a primary diagnostic criterion compared to confusion, impaired consciousness, and rapid onset, as they may also occur in other psychiatric conditions, reducing specificity.

Choice F reason: Rapid onset of symptoms is a hallmark of delirium, distinguishing it from dementia’s gradual progression. Symptoms develop over hours to days due to acute insults like hypoxia, infection, or medication toxicity, disrupting cerebral function. This rapid timeline is critical for diagnosis, as it indicates a reversible condition requiring urgent intervention.