The nurse is caring for a hospitalized elderly client who is admitted with pneumonia. Which assessment finding is most consistent with the diagnosis of delirium?

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The Confusion Assessment Method (CAM) is used to determine delirium. The signs are acute mental status changes that fluctuate and inattention with disorganized thinking and/or altered level of consciousness. The disorganized thinking includes hallucinations. Risk factors for delirium include older age, prior cognitive impairment, presence of infection, severe illness or multiple comorbidities, dehydration, psychotropic medication use, alcoholism, vision impairment, and pain. Delirium has an abrupt onset and is a symptom of other problems. Up to 60% of hospitalized elderly clients have delirium prior to or during hospitalization, but it is often missed by nursing. (Option A) This can be due to dementia or just an acute mental status change. Further assessment would be necessary. However, fluctuating mental status changes and inattention that are characteristic of delirium are not present in this client. (Option C) This is a sign of depression. Two simple screening questions for depression include the following: "During the past month, have you often been bothered by feeling down, depressed, or hopeless?" "During the past month, have you often felt minimal interest or pleasure in doing things you used to enjoy?" (Option D) This describes dementia. Its onset is slow and insidious, and family members usually notice it first. The client's attention level is usually normal. Educational objective: Delirium has a sudden onset and involves fluctuating mental status and inattention with disorganized thinking and/or altered level of consciousness. Dementia has a slow onset, usually with normal attention. Depression involves loss of interest in previously pleasurable activities.

The Nurse Is Caring for a Hospitalized Elderly Client Who