NCP Nursing Diagnosis: Chronic Confusion

Nursing Diagnosis: Chronic Confusion
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Cognitive Orientation
* Decision Making
* Distorted Thought Control
* Safety Behavior: Home Physical Environment

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Dementia Management
* Environmental Management: Safety
* Family Involvement Promotion

NANDA Definition: An irreversible, long-standing and/or progressive deterioration of intellect and personality characterized by decreased ability to interpret environmental stimuli, decreased capacity for intellectual thought process and manifested by disturbances of memory, orientation, and behavior

Chronic confusion is not limited to any one age group, gender, or clinical problem. Chronic confusion can occur in a variety of settings including the home, hospital, and long-term care facilities. While often associated with older adults with dementia, younger adults with chronic illnesses may also be affected. Depression, multiple sclerosis, brain infections and tumors, repeated head trauma (as seen in athletes), abnormalities resulting from hypertension, diabetes, anemia, endocrine disorders, malnutrition, and vascular disorders are examples of illnesses that may be associated with chronic confusion. Chronic confusion can have a profound impact on family members and family processes as the patient requires more direct supervision and care. This care plan discusses the management of chronic confusion in any setting. It also identifies the importance of addressing the needs of the caregivers.

* Defining Characteristics: Clinical evidence of organic impairment
* Altered interpretation/response to stimuli
* Progressive/long-standing cognitive impairment
* No change in level of consciousness
* Impaired memory (short-term, long-term)
* Altered personality

* Related Factors: Alzheimer’s disease (dementia of the Alzheimer’s type)
* Multiinfarct dementia
* Cerebrovascular accident (CVA)
* Acquired immune deficiency disease
* Chronic hepatic encephalopathy
* Chronic drug intoxication
* Chronic subdural hematoma
* Parkinson’s disease
* Huntington’s chorea
* Creutzfeldt-Jakob disease

* Expected Outcomes Patient will remain safe and free from harm.
* Family or significant other will verbalize understanding of disease process/prognosis and patient’s needs, identify and participate in interventions to deal effectively with situation, and provide for maximal independence while meeting safety needs of patient.

Ongoing Assessment

* Assess degree of impairment:
o Evaluate responses on diagnostic examinations (e.g., memory impairments, reality orientation, attention span, calculations).
o Test ability to receive and send effective communications. Ability and/or willingness to respond to verbal direction and/or limits may vary with degree of reality orientation.
o Note deterioration/changes in personal hygiene or behavior. This information will assist in developing a specific plan for grooming and hygiene activities.
o Talk with significant other(s) regarding baseline behaviors, length of time since onset/progression of problem, their perception of prognosis, and other pertinent information and concerns for the patient. Assessment can identify areas of physical care in which the patient needs assistance. These areas include nutrition, elimination, sleep, rest, exercise, bathing, grooming, and dressing. It is important to distinguish ability and motivation in the initiation, performance, and maintenance of self-care activities. Patients may either have the ability and minimal motivation, or motivation and minimal ability.
This will determine the amount of reorientation and intervention the patient will need to evaluate reality accurately.
* Evaluate response to care providers/receptiveness to interventions. A patient who has developed trust in a care provider, as well as a relationship with him or her, may be able to accept direction.
* Determine anxiety level in relation to situation. Note behavior that may be indicative of potential for violence. Confusion, disorientation, impaired judgment, suspiciousness, and loss of social inhibitions may result in socially inappropriate and/or harmful behaviors to self or others.

Therapeutic Interventions

* Prevent further deterioration/maximize level of function.
o Provide calm environment, eliminate extraneous noise/stimuli.
o Ascertain interventions previously used/tried and evaluate effectiveness.
o Avoid challenging illogical thinking because defensive reactions may result.
o Encourage family/significant other(s) to provide ongoing orientation/input to include current news and family happenings. Increased orientation ensures a greater degree of safety for the patient.
o Maintain reality-oriented relationship/environment (e.g., display clocks, calendars, personal items, seasonal decorations). Orientation to one’s environment increases one’s ability to trust others. Encourage patient to check calendar and clock often to orient himself or herself. To decrease the sense of alienation the patient may feel in an environment that is strange, familiar personal possessions increase the patient’s comfort level.
o Encourage participation in resocialization groups. Encouraging the patient to assume responsibility for own behavior will increase his or her sense of independence. It is important for the patient to learn socially appropriate behavior through group interactions. This provides an opportunity for the patient to observe the impact his or her behavior has on those around him or her. It also facilitates the development of acceptable social skills.
o Allow patient to reminisce, exist in own reality if not detrimental to well-being.
o Provide safety measures (e.g., close supervision, identification bracelet, medication lockup, lower temperature on hot water tank).

Education/Continuity of Care

* Assist family/significant other(s) to develop coping strategies.
o Determine family resources, availability and willingness to participate in meeting patient’s needs. Referral of the family for often needed legal and financial guidance may be necessary.
o Identify appropriate community resources (e.g., Alzheimer’s or Brain Injury support groups, respite care). This will provide support, assist with problem solving, and help the family cope with the long-term stress in caring for the patient.
o Evaluate attention to own needs, including the grieving process.
o Provide written information for the SO(s) on living with chronic confusion. This will assist them with understanding the disorder and its impact on their lives.
* Promote wellness (teaching/discharge considerations).
o Determine ongoing treatment needs and appropriate resources. All these interventions should maximize the patient’s level of functioning and quality of life for both the family and the caregivers.
o Develop plan of care with family to meet patient’s and families’ individual needs. Instruct family to let patient do all that he or she is able to do and encourage the family to increase the patient’s activities.
o Provide appropriate referrals (e.g., Meals on Wheels, adult home care, home care agency, respite care).