00129 Chronic Confusion

Domain 5: perception/cognition
Class 4: cognition
Diagnostic Code: 00129
Nanda Tag: chronic confusion
Diagnostic focus: confusion
Approved 1994 • Revised 2017, 2020 • Level of evidence 3.1

NANDA Nursing Diagnosis Definition

The Nanda nursing diagnosis « chronic confusion ” is defined as: gradual, progressive and irreversible alteration of consciousness, attention, cognition and perception, which has a duration of more than 3 months. P>

Definite characteristics

  • Personality alteration
  • Difficulty in recovering information when speaking
  • Difficulty in decision making
  • Deterioration of executive function skills
  • Deterioration of psychosocial functioning
  • Inability to perform at least one daily activity
  • Incoherent speech
  • Loss of long -term memory
  • Notable change of behavior
  • Loss of short -term memory

Related factors

  • Chronic affliction
  • Sedentary lifestyle
  • Inappropriate use of substances

Risk population

  • People> 60 years of age

Associated problems

  • Central nervous system diseases
  • Human immunodeficiency virus (HIV)
  • Mental disorders
  • Neurocognitive disorder
  • stroke

Suggestions of use

See the suggestions of use of Acute confusion . For patients with self -care deficiencies, ensure to include this diagnosis in the care plan (for example, total self -care deficit related to chronic confusion). It is difficult to distinguish between chronic confusion and deterioration syndrome in the interpretation of the environment.

Suggested alternative diagnostics

Other examples

The patient will be able to:

  • Respond to visual and auditory stimuli, draw a circle, keep attention
  • Identify the relevant information and choose between several alternatives
  • Interact properly with others
  • Formulate coherent messages
  • Obey simple instructions and orders
  • Do not pay attention to hallucinations or delusions
  • Attend, perceive and interpret the stimuli of the environment correctly
  • correctly identify objects and people
  • Balance rest and activity
  • Show less restlessness and agitation
  • Participate to the maximum of their abilities in the therapeutic environment or
  • Not be aggressive
  • Feel satisfied and less frustrated by environmental stress factors

NIC Interventions

  • Support in decision making: provide information and support to a patient who is making a decision regarding their health
  • Memory training: facilitate memory
  • Cognitive stimulation: Promote the alert and understanding of the environment through the use of planned stimuli
  • Dementia management: Provide a therapeutic and safe environment for a patient who is in a state of chronic confusion
  • Halling of hallucinations: foster safety, comfort and orientation to the reality of a patient suffering from hallucinations
  • Delirium management: Promote comfort, safety and orientation to the reality of a patient who presents false and fixed ideas that have little or no basis in reality
  • Reality orientation: Promote the patient’s awareness of his personal identity, time and environment
  • Promotion of family participation: foster family participation in the emotional and physical care of the patient
  • Anxiety reduction: minimize apprehension, fear, omen or discomfort related to the anticipation of an unknown danger of origin
  • Memories therapy: Use of the memory of events, feelings and thoughts of the past to facilitate pleasure, quality of life, or adaptation to current circumstances

Nursing Activities

  • In general, nursing activities for this diagnosis focus on identifying previous behaviors, using methods and procedures with low levels of stress, controlling environmental stimuli, providing comfort, guaranteeing safety and encouraging the patient, but without forcing it beyond its functional capacity.

Valuations

  • Obtain information about past and present behavior patterns, as well as functional capacity (such as sleep, use of medicines, sphincter control, food, communication, hygiene, social interaction)
  • Look for signs of depression (insomnia, affection off, social retraction, anorexia)
  • (NIC) Dementia management:
    • Monitor cognitive functioning through a standardized evaluation tool (for example, MINI-EXAMINE OF THE MENTAL STATE)
    • Determine the physical, social and psychological history of the patient, as well as its customs and habits
    • Determine the expectations of behavior appropriate to the cognitive state of the patient
    • Monitor nutrition and weight
    • Carefully seek possible physiological causes of the increase in confusion that can be acute and reversible

Patient and family education

  • Instruct the patient and close people about patient medications
  • Explain the effect of patient’s disease on their mood (depression, premenstrual syndrome, etc.)
  • If necessary, explain to relatives that the shower or bathtub are not the only ways to prime, and that forcing a patient to bathe when resisting can be dangerous and cause violent behaviors

Collaboration activities

  • Manage mood stabilizer medications
  • Channel to the Department of Social Services to refer to extrahospital care programs, home food services, palliative care, etc.

Others

  • If the patient has delusions or hallucinations, consult nursing activities in the diagnosis of acute confusion
  • In the initial phases of dementia, when the main symptom is memory loss, consult the nursing activities of the diagnosis of memory deterioration
  • Give opportunities for physical activity
  • Alternate the activity with programmed periods of tranquility and relaxed activities (one hour on a sofa or recliner, quiet music, etc.) at least twice a day to allow the relief of anxiety and tension
  • Provide appropriate means for the expression of patient’s feelings (for example, artistic therapy and physical exercise)
    • Help in reality orientation (provide watches, calendars, personal objects, seasonal ornaments, etc.)
    • Maintain an environment as quiet as possible (for example, avoid bells, alarms and noisy search systems)
    • Consider the use of a bath with sponge or towel instead of tub or shower; Do not force a patient to bathe if it resists
    • Avoid all possible changes (in routines, the environment, caregivers, etc.) (NIC) Dementia management:
    • Include relatives in the planning, administration and evaluation of care, as well as wish
    • Provide an environment with little stimulation (for example, slow and relaxing music, simple and family decoration with non -bright colors, performance expectations that do not exceed their cognitive processing capacity and meals in small groups)
    • Identify and eliminate possible dangers around the patient
    • Place an identification bracelet to the patient
    • Prepare the interaction touching the patient and establishing visual contact, if necessary
    • Go to the patient clearly, by name, when the interaction begins; Talk slowly
    • Present with the patient when starting contact
    • Give a simple instruction at the same time and repeat if required (for example, “come with me”, or “feel in that chair” or “put the slippers”)
    • Use distraction, instead of confrontation, to control behavior
    • Orient the patient generally in the season of the year through adequate keys (Christmas decorations, ornaments and activities of the season, and access to a safe outdoor area)
    • Mark photos of family members with the names of the people who appear
    • Limit the amount of alternatives that the patient must choose, so as not to cause anxiety
  • Avoid the use of mechanical subjection
  • Help with self -care, if necessary (specify the methods)
  • Provide limits, with red or yellow ribbon on the floor, when not available units of low stimulation

At home

  • The activities described are also appropriate for the home: instruct the family and other caregivers, if necessary
  • Evaluate the patient’s functional and self -care capacity and assess the impact on their safety
  • Assess the need for auxiliary devices, channel an occupational therapist if necessary
  • Instruct family members about the tiredness of the caregiver role, give emotional information and support
  • Channel to home services, if necessary
  • Teach the family to communicate more effectively with the patient (for example, give a simple instruction at the same time)
  • Evaluate the patient to participate in foreign care programs

Older people

  • Promote the memory of past events (for example, ask about the patient’s work and family: “Looking back, what was really important for you?”)
  • Cognitive deterioration is not part of normal aging.
    • Most older people do not show cognitive impairment, except as a result of diseases
  • Institute case management when various services are required
  • Older people suffer more frequently side effects of medicines, which can contribute to confusion
  • Keep in mind that older people do not usually refer to the pain they feel: treat pain to prevent agitation