Chronic Confusion, Chronic Confusion Nursing Assessments, Chronic Confusion Nursing Interventions, and Chronic Confusion Nursing Care Plans.

Chronic Confusion, Chronic Confusion Nursing Assessments, Chronic Confusion Nursing Interventions, and Chronic Confusion Nursing Care Plans.
Chronic Confusion

This study guide is about chronic confusion, chronic confusion nursing assessments, chronic confusion nursing interventions, and chronic confusion nursing care plans. It can help you develop educational nursing care plans for chronic confusion.

Chronic Confusion

What is chronic confusion?

Medical dictionaries define confusion as a state of disturbed consciousness, with disruption of thought and decision-making capacity. In overview, chronic confusion or dementia is a term used to describe a cluster of symptoms that affects various mental processes (i.e. memory, decision-making, social skills) that can have grave impacts to a person’s activities of daily living. Also, it is a subtype of confusion that is correlated as a long-term and degenerative state that could develop and occur from a few months to years. It can manifest from any age, gender or underlying clinical problem.

Confusion can be classified into two categories: acute confusion also called delirium and chronic confusion also called dementiaAcute confusion often has an abrupt onset, over hours or days and is associated with an identifiable risk factor or cause. Chronic confusion, in contrast, is a long-term, progressive, and possibly degenerative process and occurs over months or years. Both categories can befall in any age group, gender, or clinical problem.

Chronic confusion is progressive and variable in nature and may usually involve problems with memory recall, problem-solving, language, and attention. Also, there can be difficulties with perception, rationalizing, judgment, abstract thinking, communication, emotional expression, and the performance of routine tasks. Depression, brain infections, tumors, head trauma, multiple sclerosis, abnormalities resulting from hypertension, diabetes, anemia, endocrine disorders, malnutrition, and vascular disorders are examples of illnesses that may be linked with chronic confusion.

With chronic confusion, the patient experiences a gradual but progressive decline of cognitive function. Patients also encounter problems in communication, ADLs, and emotional stability. Chronic confusion can have a great impact on family members and family processes as the patient needs more direct supervision and care. Nurses need to be knowledgeable regarding the needs of patients experiencing chronic confusion and also learn more about its characteristics, risk factors, causes and strategies to assist families in dealing with this growing population of patients.

Goals and Outcomes

What are the expected outcomes for chronic confusion nursing diagnosis?

  • Patient remains content and free from harm.
  • Patient functions at a maximal cognitive level.
  • Patient participates in activities of daily living at the maximum of functional ability.
  • Family members or significant others verbalize understanding of disease process and prognosis and the patient’s needs, recognize and engage in interventions to deal completely with the situation, and provide for maximal independence while meeting safety needs of the patient.

Chronic Confusion Nursing Assessments

How do you assess if a patient is confused?

 

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Assessment Rationale
Collect information about patient functioning, including social situation, physical condition, and psychological functioning. Knowing the patient’s background can help the nurse identify agenda behavior and use validation therapy, which will provide guidance for reminiscence. Background information may help the nurse to understand the patient’s behavior if the patient becomes delusional and hallucinates.
Evaluate the level of impairment: The level of confusion will determine the amount of reorientation and intervention the patient will need to evaluate reality accurately. The patient may be awake and aware of his or her surroundings.
  • Review responses to diagnostic examinations (e.g., memory impairments, reality orientation, attention span, calculations).
Using a standard evaluation tool such as the Mini-Mental State Examination (MMSE) can help determine the patient’s abilities and assist with planning appropriate nursing interventions. The Confusion Assessment Method (CAM) is a valid and reliable instrument that can help monitor changes in the patient’s cognitive function.
  • Examine the ability to receive and send effective communications.
Ability/readiness to reply to verbal direction/limits may vary with the degree of orientation.
  • Observe decline and variations in personal hygiene or behavior.
This information assists in promoting a particular program for grooming and hygiene activities.
  • Communicate with family members or significant others regarding the progression of the problem, prognosis, and other concerns.
These determine areas of physical care in which the patient needs support. These areas include nutrition, elimination, sleep, rest, exercise, bathing, grooming, and dressing. The patient may have the ability and minimal motivation, or motivation and minimal ability.
Assess the patient for signs of depression: insomnia, poor appetite, flat affect, and withdrawn behavior. Patients with chronic confusion may have depressive symptoms.
Assess for sundown syndrome. This phenomenon associated with confusion happens in the late afternoon. The patient displays increasing restlessness, agitation, and confusion. Sundowning may be a manifestation of sleep disorders, hunger, thirst, or unmet toileting needs.
Determine the patient’s anxiety level in connection with the situation. Observe behavior that may be suggestive of a potential for violence. Confusion, disorientation, suspiciousness, impaired judgment, and loss of social inhibitions may result in socially inappropriate/harmful behaviors to self or others. The patient may have poor impulse behavior control.

Chronic Confusion Nursing Interventions

How do nurses treat confusion?

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The following are the therapeutic nursing interventions for Chronic Confusion nursing diagnosis and care plan:

Nursing Interventions Rationale
Place an identification bracelet on the patient. Patients with chronic confusion may wander and can become lost; identification bracelets increase patient safety.
Prevent further deterioration and maximize level of function:
  • Avoid exposing the patient to unusual situations and people as much as possible. Maintain continuity of caregivers. Maintain routines of care through established mealtimes, bathing, and sleeping schedules. Send a familiar person with a patient when the patient goes for diagnostic testing or into unfamiliar environments.
Situational anxiety associated with environmental, interpersonal, or structural change can intensify into disturbed behavior.
  • Provide a calm environment.
Any extraneous noise and stimuli can be misinterpreted by the confused patient. Images on walls may be threatening for the patient.
  • Promote reality-oriented relationships and environment (e.g., display clocks, calendars, personal items, seasonal decorations).
Orientation to one’s environment increases one’s ability to trust others.
  • Encourage the patient to check the calendar and clock often to orient himself or herself.
Familiar personal possessions increase the patient’s comfort level.
  • Talk to the patient using simple, concrete nouns in positive terms.
This method can reduce anxiety. Saying “stay sitting on the chair” is more positive than saying “Don’t get up.”
  • Allow family members to orient the patient about current news and family events.
A confused patient may not completely understand what is happening. Increased orientation promotes a greater degree of safety for the patient.
  • Keep the environment quiet and non-stimulating; avoid using buzzers and alarms if possible. Reduce sights and sounds that have a high potential for misinterpretation such as buzzers, alarms, and overhead paging systems.
Sensory overload can result in agitated behavior in a patient with chronic confusion. Misinterpretation of the environment can also contribute to agitation.
  • Avoid challenging illogical thinking.
This can be threatening for the patient and can result in a defensive reaction.
  • Approach patient with a caring, friendly, and accepting attitude and talk calmly and slowly.
Patients can sense feelings of compassion. A calm, slow manner projects a feeling of comfort to the patient.
  • Promote participation in resocialization groups.
This promotes a sense of responsibility and independence.
  • Ensure that the patient is in a safe environment by eliminating possible hazards such as pointed objects and harmful liquids.
Patients with chronic confusion lose the ability to make good judgments and can easily harm self or others.
  • Allow the patient to reminisce, existing in his or her own reality if not detrimental to the patient’s well-being.
Depending on the cause, long-term memory is usually retained longer than short-term memory. This approach can be enjoyable for the patient.
Provide repetitive hand activities. Involving the patient in safe, repetitive activities occupies the patient’s mind and hands. The activities may reduce agitation and provide release of energy (e.g., fold and refold towels and washcloths).
Present one simple direction at a time and repeat as necessary. People with chronic confusion need time to understand and interpret directions.
Break down self-care tasks into simple steps. Confused patients are incapable to follow complicated instructions; breaking down an activity into simple steps makes completing the activity more achievable.
Let the patient eat in a peaceful environment with a smaller number of people. The noise and confusion in a large dining room can be overwhelming for a confused patient and can result in agitated behavior.
Give finger food if the patient has difficulty using eating utensils or if unable to sit to eat. Feeding oneself is a complicated task and may prove challenging for someone with chronic confusion.
Help the family and significant others in developing coping strategies.
  • Determine family members’ resources and their availability and eagerness to participate in meeting the patient’s needs.
The family members need to let the patient do all that he or she is able to do. This approach will maximize the patient’s level of functioning.
  • Refer family to social services or other supportive services.
To assist with meeting the demands of caregiving for older patients.
  • Encourage family to make use of support groups or other service programs.
Community resources provide support, assist with problem-solving, and reduce the demands associated with caregiving.
  • Validate the family members’ feelings with regard to the impact of patient behavior on family lifestyle.
Validation lets the patient understand that the nurse has heard and realizes what was said, and it improves the nurse-patient relationship.
  • Encourage family to include patient in family activities when desirable.
These steps help the patient maintain dignity and lead to familiar socialization of the patient.

Chronic Confusion Nursing Care Plans

How do you manage confusion?

Nursing Care Plan 1

Alzheimer’s Disease

Nursing Diagnosis: Chronic confusion related to Alzheimer’s disease as evidenced by personality changes and decreased capacity to interpret one’s environment and response to stimuli.

Desired Outcome: The patient will be able to have minimal confusion and cognitive impairment through maintaining a safe and stable environment, allowing for active participation in activities of daily living.

Intervention Rationale
Ensure that the patient wears an identification bracelet, or anything similar, with them. Patients with chronic confusion are prone from wandering around. They are prone to being lost and having some form of identification will increase their safety.
Avoid the unnecessary exposure of the patient to unusual scenarios and people as much as possible. Ensure and maintain continuity of caregivers. Maintain activities of daily living by establishing mealtimes, bath times, etc. in schedules. Ensure that the patient is accompanied by a familiar person whenever they are sent to new and unfamiliar environments. Situational anxiety brought about by unfamiliar environments, persons not known to the patient, and exposure to sudden changes in routine can intensify the confusion.
Keep the environment free from distractions and unnecessary stimuli. Reduce the presence of buzzers, alarms, paging systems that produce unwarranted disturbances. Sensory overload may cause agitation to the patient already having confusion. The compromised ability to interpret their surroundings may further compound the agitation of the patient.
Ensure safety of the patient by removing possible hazards such as harmful substances, etc. Due to the compromised thought processes, patients with confusion are at risk in inducing harm to themselves and others.
Communicate with significant others and/or family members of the concerns regarding the patient, particularly the progression of prognosis. This ensures the determination of the actual and potential caregiving needs of the patient. It covers addressing situations that the patient may need support like in their nutrition, bathing, grooming, sleep, recreation, etc. Furthermore, it may determine if the patient has the ability but limited motivation or limited ability but with motivation to perform tasks.

Nursing Care Plan 2

Dementia

Nursing Diagnosis: Chronic confusion related to Dementia as evidenced by personality changes and decreased capacity to interpret one’s environment and response to stimuli.

Desired Outcome: The patient will be able to have minimal confusion and cognitive impairment through maintaining a safe and stable environment, allowing for active participation in activities of daily living.

Intervention Rationale
Maintain a consistent schedule of the patient’s activities of daily living. Ensuring a clear and patterned schedule prevents agitation and erratic behavior. Also, this allows for patient independence and maintenance of dignity and self worth.
Avoid exposing the patient to emotionally-draining conversations, topics or situations with the patient. (ex. completing tasks more than the patient is comfortable doing). Failure in doing tasks or responding inappropriately or inaccurately to conversations may trigger emotional flare-ups for a patient with confusion. Responding calmly to patients ensures validation of their feelings and thereby reduces unnecessary stress.
Limit unnecessary sensory distractions as much as possible. Due to the altered ability of patients in response to stimuli, limiting distractions prevents mitigating factors that may cause anxiety episodes. It also decreases the patient’s stress levels, thereby promoting a sense of security.
Identify significant others and the support system of the patient. Since patients with dementia would need consistent care, ensuring and determining able caregivers will help the patient with coping with the condition.
Educate the patient’s family to utilize distraction techniques such as music therapy, visual imagery, use of pictures, etc. during episodes of delusions. Involving the patient’s significant others on how to approach delusion episodes will help calm the patient and promote better bonding and understanding for the family.
Educate the family to avoid arguments with the patient. Because of the altered thought patterns of the patient, it is expected that the patient will be prone to emotional outbursts. Educating the family with the condition promotes safety for the patient and others.

Nursing Care Plan 3

Amnestic Disorder

Nursing Diagnosis: Chronic confusion related to alterations to the brain tissues’ structure or function secondary to long-term drug abuse as evidenced by personality changes and decreased capacity to interpret one’s environment and response to stimuli

 

Desired Outcome: The patient will be able to express increased feelings of self-worth and self-becoming as evidenced by active participation in own self-care and interaction with others.

Intervention Rationale
Encourage verbalization of feelings Active verbalization by the patient promotes self-realization of the loss of level of functioning prior to the condition. It also allows for the support of the patient’s grief of the loss of optimum function.
Assist with memory deficit by devising methods to address the patient’s concerns. (ex. locating the bathroom) Assisting with memory aids helps the patient to move independently and consequently allowing for maintenance and increased self esteem.
Encourage participation in group dynamics or activities. Encouraging the patient to participate in familiar scenarios with other people promotes independence and feelings of acceptance regardless of limitations.
Reminisce, together with the patient, their history through picture albums, etc. Assisting the client in reviewing their life, including present day events, will help the patient in the recollection of  memories, and consequently increasing their self-worth.
Encourage independence, especially in self-care activities. Patients with amnestic disorders are generally in need of assistance every time. Allowing for them to take charge gradually of some aspects of their activities ensures retention of the patient’s self-worth and independence.

Nursing Care Plan 4

Delirium

Nursing Diagnosis: Chronic confusion related to cognitive impairment secondary to delirium as evidenced by personality changes and decreased capacity to interpret one’s environment and response to stimuli.

 

Intervention Rationale
Assess the patient’s anxiety levels. Early recognition of any changes in the patient’s anxiety levels will help the caregiver to timely interventions. This is especially crucial in determining when the client is becoming a threat to personal and other people’s safety.
Ensure in providing a calm and therapeutic environment. Sensory overload may cause agitation to the patient already having confusion. The compromised ability to interpret their surroundings may further compound the agitation of the patient.
Stay calm, ensuring constant reassurance for the patient. Using calm words and relaxed body language when dealing with the client, especially during episodes of agitation, promotes safety for both the patient and his caregivers.
Reorient patient to reality during episodes of confusion. Consistent correction of misinterpretations of reality enhances the patient’s self-esteem, and dignity. It also upholds safety for everyone, especially the patient.
Observe and ensure suicide precautions Patients with confusion are at a higher risk in self-harm due to problems with perception that may otherwise decrease feelings of self-worth. Paying special attention to patients at risk will mitigate attempts for self-harm.
Use restraints and medications as indicated. Timely use of restraints ensures for safety of everyone, especially the patient. Compliance with treatment regimen ensures continuous control of the patient’s mood and mitigate episodes of agitation.

Nursing Care Plan 5

Brain Tumor

Nursing Diagnosis: Chronic confusion related to alterations to the brain tissues’ structure or function secondary to presence of brain tumor as evidenced by personality changes and decreased capacity to interpret one’s environment and response to stimuli

Desired Outcome: The patient will be able to have minimal confusion and cognitive impairment through maintaining a safe and stable environment, allowing for active participation in activities of daily living.

Intervention Rationale
Evaluate the level of impairment and functional capabilities. Patients with confusion due to brain tumors would have problems depending on the affected region of the brain. Careful assessment and evaluation of this data can help the caregiver to develop better approaches of care for the patient.
Assess the patient for signs and symptoms of depression such as: insomnia, poor appetite, etc. Patients with chronic confusion are prone to developing depression. Early detection and recognition of depression ensures for early treatment and prevention of complications.
Help the patient maximize optimal function through: Orientation to the reality of the environment (ex. calendars, personal items, etc.) Involve family members in orienting the patient in current events. Avoid challenging the patient’s way of thinking, no matter how illogical it may seem.     Orienting the patient to a familiar environment promotes patient trust to others and increases comfort level. This promotes safety for the patient and a sense of belongingness with his family. Challenging the patient’s perception would trigger defensive reactions that may contribute to safety risks.
        4.   Present instructions or ideas one at a time and repeat as needed. People with this condition would need time to comprehend instructions and directions.
          5.    Ensure that the patient eats in a calm environment, with minimal distractions. The task of eating may come across as complicated for the confused patient. Ensuring a conducive and quiet environment allows for concentration and prevention of anxiety episodes.

References and Sources

The following are the recommended sources for Chronic Confusion nursing diagnosis:

  • Ackley, B. J., Ladwig, G. B., Msn, R. N., Makic, M. B. F., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care. Mosby.
  • Carpenito-Moyet, L. J. (2006). Handbook of nursing diagnosis. Lippincott Williams & Wilkins.
  • Urden, L. D., Stacy, K. M., & Lough, M. E. (2006). Thelan’s critical care nursing: diagnosis and management (pp. 918-966). Maryland Heights, MO: Mosby.

Chronic Confusion, Chronic Confusion Nursing Assessments, Chronic Confusion Nursing Interventions, and Chronic Confusion Nursing Care Plans.

 

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