Which patient problem is a significant risk factor for the development of delirium in the intensive care unit (ICU)?

Type 2 diabetes mellitus

Alcohol abuse

Anxiety

Impaired communication

Answer and Explanation

The Correct Answer is B

Choice A reason: Type 2 diabetes mellitus, while a serious chronic condition, does not directly predispose patients to delirium. Diabetes primarily impacts the body's ability to regulate blood glucose levels, leading to complications such as cardiovascular disease, neuropathy, and nephropathy. However, it is not directly linked to the acute cognitive disturbances seen in delirium unless it leads to severe metabolic derangements, which is less common.

Choice B reason: Alcohol abuse is a significant risk factor for the development of delirium, especially in ICU patients. Chronic alcohol use can lead to a condition known as delirium tremens (DTs) during withdrawal, characterized by severe agitation, confusion, hallucinations, and autonomic hyperactivity. Patients with a history of alcohol abuse may have altered brain chemistry and neurotransmitter imbalances that predispose them to delirium when stressed by illness or surgery. Moreover, alcohol abuse can lead to liver dysfunction, nutritional deficiencies (particularly thiamine), and other systemic issues that further exacerbate the risk.

Choice C reason: Anxiety can exacerbate stress and discomfort in a patient but is not a primary causative factor for delirium. Anxiety may contribute to an increased sense of fear or confusion, especially in an ICU setting. However, it does not cause the profound disruption in cognitive function, attention, and awareness that characterizes delirium.

Choice D reason: Impaired communication might be a consequence or symptom seen in patients with delirium, but it is not a root cause. Patients with pre-existing communication difficulties might struggle more to express symptoms or needs, which could complicate care, but it does not inherently lead to the onset of delirium. Effective communication strategies and aids can help manage these challenges but do not address the underlying neurological changes seen in delirium.

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Correct Answer is B

Explanation

Choice A reason: Asking the patient to try bearing weight on the injured ankle is not appropriate at this stage. Bearing weight can cause further injury or exacerbate the swelling and pain. The initial treatment should focus on reducing swelling and providing support.

Choice B reason: Elevating the ankle above heart level is appropriate because it helps to reduce swelling by promoting venous return and decreasing fluid accumulation in the affected area. Elevation is a standard first aid measure for managing acute injuries and swelling.

Choice C reason: Applying a warm moist pack to the ankle is not advisable immediately after an injury. In the acute phase, cold therapy (ice) is recommended to reduce swelling and pain. Warm therapy is more appropriate during the recovery phase, once swelling has subsided.

Choice D reason: Assessing the ankle's passive range of motion (ROM) may be necessary later, but not immediately upon arrival. The priority is to manage pain and swelling first. ROM assessments can be painful and might worsen the injury if conducted too soon.

A. Hypertension is usually asymptomatic until target organ damage occurs. B. Annual BP checks are needed to monitor treatment effectiveness. C. Increasing physical activity controls blood pressure (BP) for most people. D. Most people are able to control BP through dietary changes.

Correct Answer is A

Explanation

Choice A reason: Hypertension, often called the "silent killer," is usually asymptomatic until significant target organ damage has occurred. This means that many people with hypertension do not experience symptoms until their blood pressure has been high for a long time, leading to damage in organs such as the heart, kidneys, brain, and eyes. Therefore, it's crucial for patients to understand the importance of regular blood pressure monitoring and management even in the absence of symptoms.

Choice B reason: While annual BP checks are useful for monitoring treatment effectiveness, more frequent monitoring may be necessary for newly diagnosed patients or those with poorly controlled hypertension. This information is important but not the most critical point compared to understanding the asymptomatic nature of hypertension.

Choice C reason: Increasing physical activity can help control blood pressure for many individuals, but it is not universally effective for everyone. While important, this information is part of a broader lifestyle modification plan rather than the single most critical point to emphasize.

Choice D reason: Dietary changes can play a significant role in controlling blood pressure, but not all individuals can control their BP through diet alone. Emphasizing this may give a false sense of control without highlighting the importance of medication and other interventions when needed.

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Which patient problem is a significant risk factor for the development of delirium in the intensive care unit (ICU)?

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Correct Answer is A

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