Which finding would be most concerning for a nurse assessing Mr. Rogers during hospitalization?

• A. Reports a new onset of blurry vision
• B. Blood glucose rising from 120 to 125 mg/dL in 8 hours
• C. Washes hands before performing a chemstrip
• D. Relying on handwritten notes to recall last reading

Answer: (A)

A sudden new onset of blurry vision in an hospitalized older adult is the most concerning because it can be an early sign of an acute neurological event, such as a stroke, or another urgent metabolic issue. In the elderly, vision changes can be the first or only presenting symptom of a cerebrovascular event, and rapid assessment is needed to determine if there’s an urgent need for stroke protocol activation and neuro checks. This requires quick actions: assess other neurologic signs (speech, facial droop, weakness), check vital signs, confirm blood glucose status if not recently checked, and notify the team promptly for further evaluation.

The small rise in blood glucose over eight hours is a common, non-urgent fluctuation and can be monitored as part of routine glycemic management. Washing hands before a chemstrip shows good infection control, a positive safety practice. Relying on handwritten notes to recall the last reading highlights documentation issues but doesn’t indicate an immediate threat to the patient’s acute safety in the moment.