Nursing diagnosis – IMPAIRED ENVIRONMENTAL INTERPRETATION SYNDROME

IMPAIRED  ENVIRONMENTAL

INTERPRETATION  SYNDROME

DEFINITION

Consistent lack of orientation to person, place, time, or

circumstances over more than 3 to 6 months necessitating a

protective environment

DEFINING CHARACTERISTICS

• Chronic confusion

• Consistent state of disorientation to environment

• Inability to reason, concentrate, or follow simple instructions

• Loss of occupation or social function resulting from memory decline

• Slow response to questions

RELATED FACTORS

• Dementia

• Depression

• Huntington’s disease

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Knowledge

• Communication

• Sensory perception

EXPECTED OUTCOMES

The patient will

• Acknowledge and respond to efforts by others to establish

communication.

• Identify physical changes without making disparaging comments.

• Remain oriented to the environment to the fullest possible extent.

• Remain free from injuries.

The caregiver will

• Describe measures for helping the patient cope with disorientation.

• Demonstrate reorientation techniques.

• Describe ways to make sure that the home is safe for the patient.

• Identify and contact appropriate support services for the patient.

SUGGESTED NOC OUTCOMES

Cognitive Orientation; Concentration; Fall-Prevention Behavior;

Memory; Safe Home Environment

INTERVENTIONS AND RATIONALES

Determine: Assess cultural status, functional ability and coordination,

interaction with others in social settings, and presence of vision or

hearing deficits. Assessment of these factors will help in identifying

appropriate interventions.

Perform: Orient patient to reality, as needed: call patient by name;

tell patient your name; provide day, date, year, and place; place a

photograph or patient’s name on the door; keep all items in the

same place. Consistency and continuity will reduce confusion and

decrease frustration.

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Place patient in a room near the nurse’s station to provide imme-

diate assistance from staff, if needed.

Clear patient’s room of any hazardous materials, and accompany

patient who wanders to prevent injury.

Work with patient and caregivers to establish goals for coping

with disorientation. Practice with coping skills can prevent fear.

When speaking to the patient, face him and maintain eye contact

to foster trust and communication.

Promote independence while performing ADL measures patient is

unable to perform to reduce feelings of dependence.

Inform: Provide written information to caregivers on reorientation

techniques. Demonstrate reorientation techniques to caregiver to

prepare caregiver to cope with the patient when he or she returns

home.

Teach caregivers to assist patient with self-care activities in a way

that maximizes patient’s potential to encourage patient’s independence.

Attend: Be attentive to the patient when you are with him. Be aware

that patient may be sensitive to your unspoken feelings about him in

order to inspire confidence in the caregiver.

Help patient and caregivers cope with feelings associated with the

disease. Understanding promotes affective coping.

Have patient perform ADLs. Begin slowly and increase daily, as

tolerated to assist patient to regain independence and enhance self-

esteem. Provide reassurance and praise for completing simple tasks.

Focus on patient’s strengths.

Involve caregiver and patient in planning and decision making as

a cooperative effort supports patient’s needs.

Encourage patient to engage in social activities with people of

all age groups once a week to help relieve the patient’s sense of

isolation.

Manage: Refer patient to case manager/social worker to ensure

that patient receives longer term assistance to ensure continued

care.

Refer caregiver to a support group. Caregivers need continuous

support from others to cope with the need to provide constant

supervision to the patient.

SUGGESTED NIC INTERVENTIONS

Anxiety Reduction; Behavior Management; Dementia Management;

Emotional Support; Mood Management; Reality Orientation

Reference

Patton, D. (2006). Reality orientation: Its use and effectiveness within older

person health care. Journal of Clinical Nursing, 15(11), 440–449.

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