What is the priority nursing diagnosis for a patient experiencing fluctuating levels of consciousness, disturbed orientation, and visual and tactile hallucinations?
A) Bathing/hygiene self-care deficit related to altered cerebral function as evidenced by confusion and inability to perform personal hygiene tasks
B) Risk for injury related to altered cerebral function, misperception of the environment, and unsteady gait
C) Disturbed thought processes related to medication intoxication as evidenced by confusion, disorientation, and hallucinations
D) Fear related to sensory perceptual alterations as evidenced by hiding from imagined ferocious dogs

Question

Quizplus · Accepted Answer

The physical safety of the patient is the highest priority among the diagnoses given. Many opportunities for injury exist when a patient misperceives the environment as distorted, threatening, or harmful; when the patient exercises poor judgment; and when the patient's sensorium is clouded. The other diagnoses may be concerns but are lower priorities.

What Is the Priority Nursing Diagnosis for a Patient Experiencing