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A 72-Year-Old Woman Is Sent to the Hospital After 2

Question 64

Multiple Choice

A 72-year-old woman is sent to the hospital after 2 days of agitation and combative behavior.  The patient has Alzheimer dementia and lives in a skilled nursing facility.  The nursing staff at the facility report that she is calm at baseline and spends most of her time in bed or in a wheelchair.  She is normally minimally interactive with staff members but reportedly brightens when her son comes to visit.  The patient has a history of generalized anxiety disorder but is currently not taking any medications for it.
In the emergency department, the patient is anxious and agitated.  She is disoriented to place and time and frequently tries to get out of bed.  She intermittently mumbles to herself and accuses the nurse of stealing her handbag.  Urinalysis is both leukocyte esterase and nitrite positive and contains 100 white blood cells/high-power field.  A urine culture has been sent to the laboratory.
In addition to empiric antibiotics for urinary tract infection, which of the following is the most appropriate management for this patient?


A) Administer intravenous haloperidol
B) Administer intravenous lorazepam
C) Apply soft restraints
D) Have a family member or sitter at bedside
E) Keep the patient in a dark, quiet room

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