An elderly male develops bradycardia and has a pacemaker surgically implanted.Although he was lucid preoperatively and has no history of dementia,at 10:00 PM on the night of his surgery,he becomes disoriented to place and time and insists on going home.When placed in soft restraints,he becomes hostile and is later caught trying to burn his way out of the restraints with a cigarette lighter.Which nursing response is most likely to be therapeutic?

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The patient is likely experiencing a postoperative delirium and is fearful because he is unable to recognize his surroundings and understand his situation.The presence of a recognized and trusted loved one will likely decrease the patient's anxiety more effectively than staff will be able to;he will be more likely to accept information from those he trusts than from strangers about whom he is suspicious.It might seem unwise to remove the restraints,but in this case they are aggravating the situation by heightening his fear and mistrust,and the presence of family will likely be more effective at reducing his efforts to leave than will restraints.Dimming the lighting makes it more difficult for the patient to orient himself to his surroundings and situation and increases the risk of illusions.Asking orientation questions repeatedly,especially when orientation has improved,can be very aggravating;patients often feel as if they are being treated like children or as if they are incompetent.The end result is greater mistrust and anger towards staff.

An Elderly Male Develops Bradycardia and Has a Pacemaker Surgically