Nursing diagnosis – CHRONIC CONFUSION

CHRONIC  CONFUSION

DEFINITION

Irreversible, long-standing, and/or progressive deterioration of intel-

lect and personality characterized by decreased ability to interpret

environmental stimuli; decreased capacity for intellectual thought

processes; and manifested by disturbances of memory, orientation,

and behavior

DEFINING CHARACTERISTICS

• Altered interpretation, response to stimuli, and/or personality

• No change in LOC

• Clinical evidence of organic impairment

• Short- and long-term memory loss

• Progressive or long-standing impaired cognition or socialization

RELATED FACTORS

• Alzheimer’s disease

• Korsakoff’s psychosis

• Cerebral vascular accident

• Multi-infarct dementia

• Head injury

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Neurocognition

• Role/relationships

• Self-care

EXPECTED OUTCOMES

The patient will

• Remain free of injury caused by confusion.

• Exhibit no signs of depression.

• Maintain weight.

• Have an environment structured for maximum functioning.

• Participate in selected activities to fullest extent possible.

• Receive adequate emotional support.

Family members will

• Discuss strategies to provide care and help patient cope.

• Maintain safety of patient’s home environment.

• Receive information on the options available for long-term care.

• Assist patient to prepare for relocation to long-term care facility.

SUGGESTED NOC OUTCOMES

Client Satisfaction: Safety; Cognition; Cognitive Orientation

INTERVENTIONS AND RATIONALES

Determine: Assess patient’s cognitive abilities and changes in behav-

ior to provide baseline data.

Weigh patient and include instructions for regular weighing as

part of care plan to monitor patient’s nutritional status.

Perform: Take steps to provide a stable physical environment and

consistent daily routine for patient. Stability and consistency enhance

functioning.

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Inform: Teach family members or caregiver strategies to help patient

cope with his condition: Place an identification bracelet on patient to

promote safety; touch patient to convey acceptance; avoid unfamiliar

situations when possible to help ensure consistent environment; provide

structured rest periods to prevent fatigue and reduce stress; refrain from

asking questions patient can’t answer to avoid frustration; provide

finger foods if patient won’t sit and eat to ensure adequate nutrition;

select activities based on patient’s interests and abilities and praise him

or her for participating in activities to enhance his or her sense of self-

worth; use television and radio carefully to avoid sensory overload;

limit choices patient has to make to provide structure and avoid confu-

sion; label familiar photos to provide a sense of security; use symbols,

rather than written signs, to identify patient’s room, bathroom, and

other facilities to help patient identify surroundings; place patient’s

name in large block letters on clothing and other belongings to help

him recognize his belongings and prevent them from becoming lost.

Attend: Encourage family members to watch mental status

assessments to provide a more accurate view of patient’s abilities.

Evaluate patient’s ability to perform self-care activities, including

ability to function alone and drive a car. Safety is a primary concern.

Ask family members about their ability to provide care for patient

to assess the need for assistance.

Project an attentive, nonjudgmental attitude when listening to

them to help ensure that you receive accurate information.

Manage: Assist family members in contacting appropriate community

services. If necessary, act as an advocate for patients within health-

care system to help secure services needed for ongoing care.

Provide family members with information concerning long-term

healthcare facilities. If patient is to be moved to a long-term care

facility, explain the decision to him in as simple and gentle terms as

possible to facilitate comprehension.

Allow patient to express feelings regarding the move to facilitate

grieving over loss of independence. Provide psychological support to

patient and family members to alleviate stress they may experience

during relocation.

Communicate all aspects of discharge plan to staff members at

patient’s new residence. Documenting a discharge plan and commu-

nicating it to caregivers help ensure continuity of care. Interventions

should ensure patient’s dignity and rights.

SUGGESTED NIC INTERVENTIONS

Cognitive Stimulation; Dementia Management; Family Involvement

Promotion; Reality Orientation

Reference

Rader, J., et al. (2006, April). The bathing of older adults with dementia.

American Journal of Nursing, 106(4), 40–48.

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