Reporting new confusion

Question

A nursing assistant is helping Mr. Okafor, age 84, get ready for breakfast. He is usually alert and knows the day and where he lives, but today he cannot say what facility he is in and keeps asking for a brother who died years ago. His oral temperature is 36.8 °C and he has no complaints. What should the nursing assistant do?

1. ATell the nurse about the new confusion promptly✓ Correct

   Correct. A sudden change from his usual thinking is reported even when he has no fever.

2. BRe-orient him and report only if he is still confused after lunch✗ Incorrect

   Waiting delays an assessment that a sudden change already calls for.

3. CChart it as a normal part of aging and mention it at the next care conference✗ Incorrect

   New confusion is a change from baseline and is not written off as aging.

4. DWait to report it until he develops a fever, since confusion alone is not a concern✗ Incorrect

   Older adults with an infection may have no fever, and new confusion can be the only sign.

Answer

A. Tell the nurse about the new confusion promptly

Rationale

A resident who is normally oriented and is suddenly not has had a significant change, and the nurse should hear about it promptly. Older residents do not always run a fever when they are ill, and a sudden drop in clear thinking may be the only clue, so a normal thermometer reading is no reason to wait. The aide describes what changed and the nurse works out why.