The nurse is caring for an elderly female client who presents as being alert and oriented. In the late afternoon, the client becomes extremely agitated and confused. Which of the following responses by the nurse is most appropriate?

  1. call a family member to come and stay with the client
  2. call the health care provider and ask for an order for Xanax
  3. reorient the client and offer distraction and reassurance in a soft voice
  4. tell the client that if she does not cooperate, she will be placed in restraints
Number 3 is correct.
Rationale: This client is suffering from sundowning syndrome, in which some clients become increasingly confused and irritated late in the afternoon. It is common in clients with dementia or Alzheimer’s, but can occur outside those diagnoses. Reorienting and reassuring the client in a soft voice can help calm agitation. Distraction can help the client focus on something else and may calm the client. While asking a family member to stay may help, many clients do not have family that can stay around the clock due to work and other obligations. Xanax can help decrease anxiety and allow the client to rest, but less invasive measures are always preferable. Dosing a client simply to make her sleep or rest for the nurse’s convenience is a form of restraint (chemical). Threatening the client with restraints is more likely to escalate the situation, and the client may become physically violent. Some clients with sundowning syndrome may suffer hallucinations or mood swings. Being in the hospital interrupts normal patterns of sleep and rest, and certain medications or medical conditions may make the client more likely to have an episode.