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, Parkinsons disease Social History: Client has visual loss but didn't bring their glasses. The client is hard of hearing. Hearing aids in place.

This case focuses on identifying risk factors contributing to delirium in an older adult postoperative ICU client. Delirium is commonly triggered by acute illness, infection, surgery, and underlying chronic conditions that affect brain resilience. Sensory deficits and environmental changes also significantly increase susceptibility. Recognizing predisposing and precipitating factors is essential for early prevention and management of acute cognitive decline. Rationale for correct choices: • Older adult status with recent surgery, ICU admission, fever, hypotension, and hip arthroplasty Advanced age is a major risk factor for delirium due to decreased physiological reserve and brain vulnerability. Recent major surgery such as total hip arthroplasty increases risk due to anesthesia effects, pain, and immobility. The presence of fever and hypotension suggests systemic infection (likely sepsis), which is a strong precipitating factor for delirium. ICU admission further increases risk due to sleep disruption, invasive monitoring, and environmental stressors. • Past medical history (hypertension, congestive heart failure, Parkinson’s disease): Chronic neurological and cardiovascular conditions increase vulnerability to altered cerebral perfusion and cognitive dysfunction. Parkinson’s disease specifically affects dopamine pathways, making patients more susceptible to confusion and hallucinations. Congestive heart failure may reduce oxygen delivery to the brain, contributing to cognitive changes. These conditions collectively lower the threshold for delirium development. • Social history (visual loss, no glasses, hearing impairment): Sensory deprivation is a major modifiable risk factor for delirium. Visual and hearing impairments reduce environmental awareness and increase misinterpretation of stimuli. Not having glasses further worsens disorientation and confusion in a hospital setting. Even with hearing aids, older adults may still experience impaired processing, increasing vulnerability to cognitive decline. Rationale for incorrect finding: • Client is alert and oriented to person, place, and time: At baseline, this indicates intact cognitive function rather than a risk factor. While important for comparison, it does not contribute to delirium development. This statement reflects the client’s prior stable mental status before acute changes occurred.