An elderly man is admitted to the hospital for surgery. A day later, he seems confused and disoriented. He imagines there is a trapdoor in the ceiling above his bed

Question

His wife panics, telling a nurse that several of her husband's relatives have had Alzheimer's disease but that until now he has seemed "sharp as a tack.". What should the nurse do first? A) Control environmental temperatures and noises.
B) Check the patient's chart for medications that can cause delirium.
C) Have the patient evaluated for Alzheimer's disease.
D) Tell the wife there is nothing to worry about.

Answer 1

B
Feedback:
The rapid onset and the delusion make it likely that this is delirium rather than dementia. The man's medication should be checked immediately, as painkillers used after surgery may have this effect. Controlling the environment may be helpful, but removing the cause of delirium is of the most importance. The wife is quite right to be concerned, but she should be told about the likelihood of delirium in this situation. Evaluation for Alzheimer's disease can take place later if that seems desirable.