PGIMER Sangrur NO - 2023
Medical & Surgical Nursing
Hard
A patient develops an acute confusion (delirium) state. What would be the priority nursing Intervention?
Appeared in: PGIMER Sangrur NO - 2023
Explanation
- The priority for a patient with delirium is safety and reducing cognitive-perceptual disturbances.
- A well-lit environment during the day helps the patient distinguish reality from illusion by minimizing shadows that can be misinterpreted.
- Adequate lighting promotes orientation to the environment and the normal day-night cycle, which can help reduce the severity of 'sundowning'.
- Good visibility is a critical safety measure that directly reduces the high risk of falls and injury in confused, restless patients.
Why Other Options Were Wrong
- Option A: Dim lighting during the day is contraindicated. It creates shadows, which can lead to frightening illusions and visual misperceptions, worsening the patient's confusion and agitation.
- Option C: Patients with delirium have a diminished capacity to process stimuli. Providing extra stimulation (e.g., loud TV, multiple visitors) leads to sensory overload, which increases agitation and confusion.
- Option D: While maintaining hygiene is a fundamental part of nursing care, it does not address the immediate and high-risk problems of confusion, disorientation, and potential for injury that define acute delirium. Safety interventions are the top priority.
Related Visual
Clinical Relevance
- Nursing practice connection: Safe nursing care depends on performing The core concept is the prioritization of nursing interventions for a patient experiencing acute delirium. It specifically tests the nurse's understanding of environmental management as a key strategy to ensure patient safety and promote orientation in the correct sequence, documenting the action clearly, and monitoring for the expected response.
- The first-line management for delirium is non-pharmacological. Nurses play a crucial role in manipulating the environment to create a therapeutic and safe space, which can reduce the need for chemical or physical restraints.
- Recognizing and managing delirium promptly is a key patient safety goal, as delirium is associated with increased mortality, longer hospital stays, and long-term cognitive decline.
- What if it is nighttime? The principle of promoting a normal sleep-wake cycle still applies. The intervention would change to creating a quiet, dark environment to encourage sleep. However, a soft night-light should be used instead of complete darkness to reduce fear and prevent falls if the patient gets out of bed.
How to Approach the Question
- First, identify the question type: This is a priority-setting question in a clinical scenario.
- Identify the patient's core problem: The patient has 'acute confusion (delirium)'. Key features of delirium are disorientation, fluctuating mental status, and risk of harm.
- Analyze the options based on the immediate needs of a delirious patient. The highest priority is always safety and managing the acute symptoms.
- Evaluate each option's effect on a confused patient: Does it increase or decrease safety? Does it orient or disorient? Does it calm or agitate?
- Option A (dim light) increases risk. Option C (stimulation) increases agitation. Option D (hygiene) is important but not the priority for acute confusion.
- Option B (well-lit environment) directly addresses safety (prevents falls) and orientation (reduces illusions), making it the priority intervention.
Concept Tested & Keywords
- Concept Tested: The core concept is the prioritization of nursing interventions for a patient experiencing acute delirium. It specifically tests the nurse's understanding of environmental management as a key strategy to ensure patient safety and promote orientation.
- Stem keywords: acute confusion, delirium, priority nursing intervention
- Lead-in keywords: priority
- Negative lead-in flag: false
Question ID
Q4jsFAoOQBYe57vO-n8f_h
Reference Book
E6 Medicine Harrison 22e Part 1 p. 226-228
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 13840-13842
E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 157-159
Practise the full PGIMER Sangrur NO - 2023
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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