The nurse has been teaching the caregiver about Aricept. The nurse knows teaching has been effective by which of the following statements?

Choice A reason: Monitoring vital signs is critical in withdrawal delirium, as it is a medical emergency involving autonomic hyperactivity from alcohol or drug cessation. Dehydration and electrolyte imbalances elevate heart rate and blood pressure, risking seizures or cardiovascular collapse. Regular monitoring detects instability early, guiding fluid replacement and medication to stabilize cerebral and systemic function.

Choice B reason: Keeping the room dark may reduce sensory overload in withdrawal delirium, but it does not address physiologic instability like dehydration or autonomic hyperactivity. Darkness may calm agitation but risks disorientation in a confused patient, as visual cues aid reality testing. This choice is less critical than monitoring vital signs for ensuring systemic stability.

Choice C reason: Withholding oral fluids is contraindicated in withdrawal delirium, as dehydration exacerbates symptoms like confusion and autonomic instability. Fluid loss from sweating or vomiting, common in withdrawal, disrupts electrolyte balance and cerebral perfusion. Providing fluids corrects hypovolemia, making this choice scientifically inappropriate for maintaining physiologic stability in this critical condition.

Choice D reason: Applying ice to the tongue may reduce swelling from trauma, but it does not address the systemic instability of withdrawal delirium, such as dehydration or autonomic hyperactivity. Tongue swelling is a secondary issue compared to life-threatening risks like seizures or arrhythmias, which require monitoring vital signs and fluid management for stabilization.

Choice A reason: Orientation to person but disorientation to place and time occurs in both delirium and dementia. In delirium, acute cerebral dysfunction from causes like infection disrupts attention, while dementia’s gradual hippocampal loss affects memory. This symptom is non-specific, as it does not distinguish the acute onset critical to delirium diagnosis.

Choice B reason: Fragmented, incoherent speech can occur in delirium due to acute brain dysfunction or in advanced dementia from cortical degeneration. It reflects disrupted neural communication but is not specific to delirium’s rapid onset. This symptom alone does not differentiate the conditions, as both involve cognitive processing deficits.

Choice C reason: A history of increasing confusion over years indicates dementia, characterized by progressive neuronal loss, particularly in Alzheimer’s or vascular dementia. Delirium, conversely, has an acute onset due to reversible causes like infection. This chronic history rules out delirium, making this choice incorrect for identifying delirium.

Choice D reason: Being oriented and alert on admission, then developing confusion, indicates delirium’s acute onset, typically from pneumonia-related hypoxia or sepsis disrupting cerebral metabolism. Unlike dementia’s gradual progression, delirium’s rapid cognitive decline, often within days, reflects reversible brain dysfunction, making this the key differentiator in diagnosis.