A 78-year-old client is admitted to the Emergency Department who has an unsteady gait and appears to be confused. For which event should the nurse assess if this client has recently experienced?
1. A respiratory infection
2. A death of a loved one
3. Difficulty swallowing
4. Diarrhea
Answer: 4
1. There is no evidence that the client has experienced a respiratory infection, which usually does not affect an elderly client's gait and thinking.
2. The nurse would expect the client to be sad if a death had occurred.
3. Difficulty swallowing does not cause an unsteady gait or confusion.
4. Diarrhea is a reason for fluid volume deficit. An elderly client can become dehydrated very quickly with only a 1% to 2% fluid loss. Symptoms seen would be confusion and physical performance such as an unsteady gait.
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