A 72-Year-Old Woman Is Brought to the Emergency Department After

A 72-year-old woman is brought to the emergency department after a fall.  The patient landed on her side and has extensive bruising over the right hip area.  She was able to reach her phone and call an ambulance to bring her to the hospital.  She says, "I lost my balance on the way to the bathroom.  I usually have to get up to go to the bathroom once or twice a night."  The patient has no history of lightheadedness, dizziness, or syncope.  She leads an active lifestyle and walks 2 miles every day.  Her medical problems include type 2 diabetes mellitus, urge incontinence, chronic insomnia, transient ischemic attacks, and osteoarthritis.  Her daily medications include aspirin, glyburide, lorazepam, and naproxen.  The patient lives alone.  She does not use tobacco, alcohol, or illicit drugs.  Vital signs are within normal limits.  Physical examination and subsequent x-rays reveal a right-sided femoral neck fracture.  Neurological examination is normal. The patient is admitted to the hospital and undergoes a hemiarthroplasty of her right hip.  Her medications in the hospital include aspirin, insulin, calcium, vitamin D, subcutaneous heparin for deep venous thrombosis prevention, and oxycodone for pain control.  Lorazepam was discontinued as it was thought to have contributed to her fall.  Following surgery, the patient appears to be recovering well.  On day 3 of hospital admission, however, she becomes very restless and agitated.  She is oriented to person only and insists that she is in her own home.  The patient demands to know "who stole my clothes and jewelry" and is verbally abusive toward the nursing staff.  She is observed to be talking to her herself and says she sees her deceased father and hears his voice.  Temperature is 37.8 C (100 F) , blood pressure is 160/90 mm Hg, pulse is 106/min, and respirations are 24/min.  Pulse oximetry is 98% on room air.  Physical examination shows generalized tremors and is otherwise unchanged.  All laboratory studies are normal.  Which of the following is the most appropriate next step in management of this patient?

A) Decrease oxycodone
B) Diazepam
C) Frequent reorientation
D) Haloperidol
E) Patient-controlled analgesia (self-administered pump)