A nurse is reviewing assessment data collected from a post-operative patient. What assessment findings would serve as cues that the client may be experiencing hypoactive delirium? Select all that apply.

Choice A Reason: Assess regularly for self-harm during treatment

Regular assessment for self-harm is crucial in any psychiatric care plan, especially for clients with conversion disorder who may experience significant distress. However, this action alone does not address the underlying issues or provide the client with tools to manage their symptoms. Continuous monitoring is important, but it should be part of a broader, more comprehensive care plan.

Choice B Reason: Allow for unlimited discussion on physical symptoms

While it is important to validate the client’s experiences and provide a space for them to discuss their symptoms, allowing unlimited discussion can sometimes reinforce the symptoms and lead to increased focus on physical complaints. This approach may not be beneficial in the long term and can detract from addressing the psychological aspects of the disorder.

Choice C Reason: Discuss alternative coping strategies with the client

This is the correct answer. Discussing alternative coping strategies helps the client develop skills to manage their symptoms more effectively. Techniques such as cognitive-behavioral therapy (CBT), relaxation exercises, and stress management can be very beneficial. These strategies empower the client to handle stress and reduce the impact of their symptoms. Providing education on coping mechanisms is a proactive approach that can lead to better outcomes.

Choice D Reason: Encourage alone time for the client in seclusion

Encouraging alone time in seclusion is generally not recommended for clients with conversion disorder. Seclusion can increase feelings of isolation and distress, potentially exacerbating symptoms. Instead, supportive and interactive interventions are preferred to help the client feel connected and understood.

Choice A Reason:

Obtunded describes a state where the patient has a decreased level of consciousness and is difficult to arouse. They may respond slowly and be somewhat confused. This level of consciousness is more severe than lethargy and typically requires more vigorous stimulation to elicit a response. The client’s ability to answer questions appropriately before falling back to sleep suggests a less severe impairment than obtundation.

Choice B Reason:

Stuporous refers to a condition where the patient is almost entirely unresponsive and can only be aroused by vigorous and repeated stimuli. This state is more severe than lethargy and obtundation. The client’s ability to respond appropriately to questions indicates a higher level of consciousness than stupor. Therefore, stuporous is not the correct description of the client’s condition.

Choice C Reason:

Lethargic describes a state where the patient is very drowsy but can be aroused to respond to questions and then falls back to sleep. This matches the client’s presentation as they are able to answer questions appropriately but fall asleep immediately afterward. Lethargy is a common level of altered consciousness in various medical conditions and is less severe than obtundation or stupor.

Choice D Reason:

Alert describes a state where the patient is fully awake, aware, and responsive to stimuli. The client’s tendency to fall back to sleep immediately after responding to questions indicates that they are not fully alert. Therefore, this term does not accurately describe the client’s level of consciousness.