I think the delirium is primarily the result of overmedication. She was given 50% more oxy than her max dose. She was given 4 times the recommended daily dose of Ativan for someone over age 65. Benzos are second or third-line treatments for delirium in the geriatric population; they can paradoxically increase s/s of dementia. Haldoperidol is the drug of choice. Age over 65 years increases the risk for post-op dementia.
Additionally, the patient probably has had sleep disturbance related to the cholecystitis that necessitated her surgery. Surgery and the hospital environment has probably exacerbated this. However, this is not explicitly stated in the prompt so I'm thinking I shouldn't comment on facts not in evidence... including pain which I would expect to be a primary concern. (Maybe not so much given her drug dosages.)
Similarly, I would be concerned about risk of impaired breathing pattern due to the high level of opiates and the potentiating effects of the benzo... but again, the prompt says nothing about respiration so I'm again thinking I shouldn't go there. On the other hand, that is a RISK diagnosis, so I don't need defining characteristics. The type of surgery and her meds would be risk factors for this. I'm thinking that using knowledge of drug actions and effects in an assignment like is not the same as making up assessment data that is not explicitly stated.
I also like risk for trauma r/t impaired mobility secondary to upper GI surgery, effects of pain medication and sedatives, impaired sensorium and visual hallucinations, faulty judgment secondary to cognitive defects, and upper abdominal incision secured w/ steri-strips and gauze.
Pulmonary complications are certainly a concern with upper GI surgery but the prompt doesn't indicate any preop risks or post op complications like pneumonia, pneumonitis, atelectasis, bronchitis, pulmonary emboli and/or acute respiratory failure. Along the same line, I'd expect acute pain, impaired physical mobility, and other issues... but again, no assessment data in the prompt.
Risk for infection, another one I'd normally put high on the list because it was GI surgery and she's resisting assessment of the wound site. But is that enough?
I have been told (I believe correctly) that I overthink things so I am really trying to focus on "just the facts, Ma'am!"
Would I be okay with acute confusion, risk for trauma and risk for ineffective breathing pattern? These last two would not be my highest common sense priorities but trying to use only the prompts, they seem like the strongest.
Thank you so much for your help. You would not believe all the time I've spent on this! It's embarrassing.
