Causative factors for the development of delirium include which of the following? Select all that apply.

Choice A reason: Observing for signs of hypotension is not typically a primary concern for patients with Cushing syndrome. These patients are more likely to experience hypertension due to increased cortisol levels, which cause sodium and water retention, rather than hypotension. Therefore, while monitoring blood pressure is important, focusing specifically on hypotension is not relevant to the typical presentation of Cushing syndrome.
Choice B reason: Monitoring blood glucose levels is a crucial intervention for patients with Cushing syndrome. Increased cortisol levels lead to hyperglycemia and glucose intolerance. Patients may develop diabetes mellitus as a result of chronic hypercortisolism. Regular monitoring of blood glucose levels helps in managing and controlling hyperglycemia and adjusting medication as necessary to maintain stable glucose levels.
Choice C reason: Protecting the patient from exposure to infection is essential in caring for patients with Cushing syndrome. Elevated cortisol levels suppress the immune system, making patients more susceptible to infections. Implementing infection control measures, such as hand hygiene, using personal protective equipment, and monitoring for signs of infection, are vital to prevent complications and ensure patient safety.
Choice D reason: Restricting protein intake is not a recommended intervention for patients with Cushing syndrome. In fact, these patients often require a diet high in protein to counteract the muscle wasting and weakness caused by excessive cortisol levels. Adequate protein intake helps in maintaining muscle mass and overall health, making restriction counterproductive.

Choice A reason: Asking the nursing assistant to determine if Marvin can safely sit in a bedside chair is not appropriate. Safety assessments, especially for patients with recent neurological events, should be done by a registered nurse or a physical therapist. This ensures that any nuanced clinical signs indicating instability or risk are recognized and addressed promptly.
Choice B reason: Passive range of motion (ROM) exercises are essential for patients with hemiplegia to prevent complications such as muscle atrophy, joint contractures, and decreased circulation. Regularly performing these exercises can maintain the health of the muscles and joints, promote better blood flow, and help in maintaining some degree of flexibility in the affected limbs.
Choice C reason: Assessing neurologic status is crucial in patients who have had a recent stroke and received tPA treatment. Frequent neurologic assessments help in monitoring for any changes or signs of deterioration. This includes checking consciousness, pupil response, motor function, and sensory perception. Changes in these parameters can indicate complications or the need for immediate medical interventions.
Choice D reason: Coordinating with speech therapy for a swallowing evaluation is essential because Marvin has dysphagia. Swallowing assessments by a speech therapist can determine the patient's ability to swallow safely and the appropriate dietary modifications needed to prevent aspiration, a common risk in patients with dysphagia. This is vital to prevent pneumonia or other respiratory complications.
Choice E reason: Using pillows and positioning devices to maintain proper body alignment is important in preventing complications such as pressure ulcers, muscle contractures, and discomfort. Proper positioning can also assist in maintaining better respiratory function and overall comfort. It also prevents the development of deformities and promotes functional posture, which is especially important for patients with hemiplegia.
Choice F reason: Pulling on his arm to position him on his side is inappropriate and can cause injury, especially in a patient with hemiplegia. This technique can lead to shoulder dislocations or increased pain. Instead, proper repositioning techniques using assistive devices and help from additional staff members should be employed to ensure safe and effective movement of the patient.