# A nurse on a geriatric unit is implementing the Hospital Elder Life Program (HELP) bundle to prevent in-hospital delirium for an 82-year-old patient admitted with pneumonia. Which combination of interventions best reflects HELP? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=372803&lang=en > language: en > subject: Elimination > category: BCC ## Question A nurse on a geriatric unit is implementing the Hospital Elder Life Program (HELP) bundle to prevent in-hospital delirium for an 82-year-old patient admitted with pneumonia. Which combination of interventions best reflects HELP? ## Option 1. Continuous physical restraint and routine benzodiazepines for any agitation, with private quiet room and unlimited family presence. 2. Strict bedrest, deep sedation overnight, and tube feeding to ensure caloric goals. 3. Routine antipsychotic prophylaxis at admission, skipped sleep cycles, and minimization of family contact to reduce stimulation. 4. Daily reorientation cues and clocks, ensuring eyeglasses and hearing aids are used, early mobilization and ambulation, hydration support, sleep hygiene with reduced nighttime disruption, and minimization of psychoactive medications. **✔ Correct answer** **Correct answer: 4** ## Explanation The Hospital Elder Life Program (HELP) is the evidence-based, nurse-driven bundle for in-hospital delirium prevention in older adults. Components: daily reorientation, sensory inputs (eyeglasses, hearing aids), early mobilization and ambulation, hydration and nutrition, sleep hygiene with reduced overnight disruption, minimization of psychoactive medications, and reduction of physical restraints. HELP is associated with reduced delirium incidence, falls, length of stay, and post-discharge institutionalization. Choices 1, 2, 3 each contain practices (restraint, benzodiazepines, deep sedation, antipsychotic prophylaxis, bedrest, family minimization) that increase delirium risk and contradict the HELP bundle. ## In-depth explanation The Hospital Elder Life Program (HELP) is the most studied and effective bundle for preventing hospital-acquired delirium in older adults. Components are nurse-driven and largely non-pharmacologic: daily reorientation with clocks and calendars, ensuring eyeglasses and hearing aids are in place, early mobilization and ambulation, adequate hydration and nutrition, sleep hygiene with reduced overnight disruption (consolidating care, dimming lights, limiting noise), and minimization of psychoactive medications including benzodiazepines, anticholinergics, and unnecessary opioids. HELP reduces delirium incidence by approximately 40 percent, with downstream reductions in falls, length of stay, and post-discharge institutionalization. Practices that increase delirium risk include physical restraints (which paradoxically increase agitation and falls), benzodiazepines, deep sedation, anticholinergics, sleep deprivation, sensory deprivation (no glasses or hearing aids), tethering (Foley catheters, IV lines without indication), and immobility. The CAM (Confusion Assessment Method) is the standard screening tool: acute onset and fluctuation, plus inattention, plus either disorganized thinking or altered consciousness. ## Clinical scenario A nurse on a geriatric unit is implementing the **Hospital Elder Life Program (HELP) bundle** to prevent **in-hospital delirium** for an **82-year-old patient admitted with pneumonia**. ## Key concepts - **HELP Bundle Core Elements** — Daily reorientation; sensory aids (glasses, hearing aids); early mobilization/ambulation; hydration and nutrition; sleep hygiene with reduced overnight disruption; minimization of psychoactive medications; reduction of physical restraints. Evidence-based, nurse-driven, mostly non-pharmacologic. - **CAM Screening** — Confusion Assessment Method: positive when acute onset/fluctuating course PLUS inattention PLUS either disorganized thinking OR altered level of consciousness. Standard delirium screening tool used at admission and at each shift in high-risk older adults. - **Delirium Risk Multipliers** — Physical restraints, benzodiazepines, deep sedation, anticholinergics, immobility, sleep deprivation, sensory deprivation (no glasses/hearing aids), tethering (Foley, IV without indication), unrecognized pain, infection. HELP targets removable risk factors. ## Related questions - [The nurse assesses a 2-year-old child with vomiting and diarrhea. 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