Reference no: EM133423110

You are a nurse working on a medical unit. You recently admit an elderly woman with pneumonia. She had influenza about a month ago. She went to her primary care provider last week and was treated with a course of oral antibiotics but it did not improve. She has a history of HTN, hypothyroidism, and osteoarthritis. She is independent in activities of daily living (ADLs) and instrumental activities of daily living (IADLs), and walks with a steady gait. She is alert and oriented. She is widowed and lives independently in the community. She is a retired nurse. She is easily engaged and talkative. She tells you that you remind her of her granddaughter, who is also a nurse. She tells you that she usually wears eyeglasses but that she dropped them and broke them yesterday and that her daughter is taking them to be repaired. She also has a hearing aid in place. You orient her to the unit, insert her intravenous (IV) line, and administer her first dose of antibiotics. After you give report to the oncoming shift, you stop to say goodbye to her, and she tells you that she will see you tomorrow.

When you get the report from the night shift at 7:00 am the following morning, you are surprised. The night nurse reports that the woman has been up all night long, was agitated, climbed out of bed, and sustained a fall. In addition, she is incontinent of urine. You immediately go to see her. She is sitting up in bed and has pulled out her IV line. She thinks that you are her daughter and states, "Please get me out of here. There are bad people here, and they stand and look at you and laugh at you. They tried to poison me." She is not wearing her hearing aid and will not allow you to insert it. You attempt to reorient her with little success.

1. What has happened to the woman? Provide a rationale for your answer.

2. What are some possible precipitating factors in her case?

3. What is the first priority for this patient?

4. How do you assess for delirium in an older adult?