The nurse is caring for a client admitted with severe exacerbation of posttraumatic stress disorder that is experiencing flashbacks and hypervigilance. Which is the priority for the nurse to address when caring for this client?

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.

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.