The nurse is reviewing the client's admission assessment to determine contributing factors to the client's change in mental status. Click to highlight the findings that are risk factors. To deselect a finding click on the finding again. An older adult client was transferred to the ICU after they developed fever and hypotension. The client was initially admitted 4 days ago with a left hip fracture and subsequently underwent total left hip arthroplasty. The client is alert and oriented to person, place, and time. Past Medical History: hypertension, congestive heart failure. Parkinson's disease Social History: Client has visual loss but didn't bring their glasses. The client is hard of hearing. Hearing aids in place.

Rationale for correct choices • Older adult client was transferred to the ICU after developing fever and hypotension: Advanced age is a significant risk factor for delirium and altered mental status due to decreased physiological reserve, increased susceptibility to infection, and changes in cognitive function. Older adults are more vulnerable to hospital-associated stressors, medications, and sensory deficits, all of which can contribute to acute confusion. Critical illness, sepsis, and hemodynamic instability increase the risk of cerebral hypoperfusion and delirium. Fever and hypotension indicate systemic infection or shock, both of which impair oxygen delivery to the brain and can precipitate acute changes in mental status. • Admitted 4 days ago with a left hip fracture and underwent total left hip arthroplasty: Recent surgery and immobility increase risk for delirium due to pain, anesthesia effects, infection, blood loss, and metabolic stress. Orthopedic procedures in older adults are especially high risk for postoperative cognitive changes and acute confusion. • Past medical history: hypertension, congestive heart failure, Parkinson’s disease: Chronic cardiovascular and neurological conditions impair cerebral perfusion and neural resilience. Parkinson’s disease may already cause cognitive changes, and CHF can reduce cardiac output, increasing the likelihood of delirium during acute illness or infection. • Visual loss without glasses: Sensory deprivation, including impaired vision, increases disorientation and confusion. Without corrective lenses, the client cannot effectively interpret environmental cues, heightening the risk of delirium and misperceptions (e.g., seeing spiders on the bed). • Hard of hearing, hearing aids in place: Hearing impairment limits communication and environmental awareness, contributing to misinterpretation of stimuli and agitation. Even with hearing aids, the hospital environment can amplify confusion due to unfamiliar sounds and reduced auditory input. This sensory deficit is a risk factor for acute mental status changes. Rationale for incorrect choices: • Client is alert and oriented to person, place, and time: While this indicates baseline cognitive function, it does not contribute as a risk factor. Mental status at the time of transfer was normal, so this finding does not predispose the client to delirium. Only changes in orientation or acute stressors increase risk.