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PlanofCarefor:
ChronicConfusion
NANDAI
Definition
Irreversible,longstanding,and/orprogressivedeteriorationofintellectandpersonalitycharacterizedby
decreasedabilitytointerpretenvironmentalstimulidecreasedcapacityforintellectualthoughtprocessesand
manifestedbydisturbancesofmemory,orientation,andbehavior
DefiningCharacteristics
Alteredinterpretationalteredpersonalityalteredresponsetostimuliclinicalevidenceoforganicimpairment
impairedlongtermmemoryimpairedshorttermmemoryimpairedsocializationlongstandingcognitive
impairmentnochangeinlevelofconsciousnessprogressivecognitiveimpairment
RelatedFactors(r/t)
AlzheimersdiseasecerebrovascularattackheadinjuryKorsakoffspsychosismultiinfarctdementia

NOC(NursingOutcomesClassification)
SuggestedNOCOutcomes
Cognition,CognitiveOrientation,DistortedThoughtSelfControl
ExampleNOCOutcomewithIndicators
Cognitionasevidencedbythefollowingindicators:Cognitiveorientation/Communicatesclearlyfor
age/Comprehendsthemeaningofsituations/Attentiveness/Concentration.(Ratetheoutcomeandindicatorsof
Cognition:1=severelycompromised,2=substantiallycompromised,3=moderatelycompromised,4=mildly
compromised,5=notcompromised[seeSectionI].)

ClientOutcomes
ClientWill(SpecifyTimeFrame):

Remaincontentandfreefromharm
Functionatmaximalcognitivelevel

NIC(NursingInterventionsClassification)
SuggestedNICInterventions
DementiaManagement,EnvironmentalManagement,Surveillance:Safety
ExampleNICActivitiesDementiaManagement
UsedistractionratherthanconfrontationtomanagebehaviorGiveonesimpledirectionatatime

NursingInterventionsandRationales

Determineclientsnormalroutinesandattempttomaintainthem.CEB:Activitiesthataredesignedtobe
consistentwithpastroutineswereeffectiveatprovidingengagementandinterestandenhancingquality
oflife(CohenMansfield&Jensen,2006).
Obtaininformationabouttheclientslifehistoryfromthefamilycollaboratewithfamilymembersto
provideoptimalcare.EBN:Knowingthehistory,interests,needs,andpreferencesoftheindividualis
essentialtopersoncenteredcareandhelpfulwheninitiatingconversation,activities,androutinesthe
familysuniqueknowledgeshouldbeincorporatedintotheplanofcare(Edvardsson,Fetherstonhaugh,&
Nay,2010).
Begineachinteractionwiththeclientbygainingandmaintainingeyecontact,identifyingyourselfand
callingtheclientbyname.Approachtheclientwithacaring,loving,andanacceptingattitude,andspeak
calmlyandslowly.EB:Dementiacausesalossoftheabilitytolearnnewthingsandrememberpeople
andplaces(episodicmemory)clientswillneedreassuranceandfrequentremindingoftheidentityof
caregivers(Yuetal,2009).
Toenhancecommunication,useacalmapproach,avoiddistractions,showinterest,keepcommunication
simple,giveclearchoices,givetheclienttimewithwordfinding,userepetitionandrephrasing,andutilize
gestures,prompts,andcuesorvisualaids.Listenattentivelytounderstandnonverbalmessages,and
engageintopicsofinteresttotheclient.EB:Thesecommunicationtechniquesassistinfocusing
attention,incorporatenonverbalmeansofcommunication,simplifymemorydemands,compensatefor
cognitiveslowing,andassistwithretrievalandcomprehension(Smithetal,2011).
Breakdownselfcaretasksintosimplesteps(e.g.,insteadofsaying,Takeashower,saytotheclient,
Pleasefollowme.Sitdownonthebed.Takeoffyourshoes.Nowtakeoffyoursocks.).Utilizegestures
whengivingdirectionsallowforadequatetimeandmodelthedesiredactionifneededorpossible.EB:
Assistanceinfocusingattention,modelingbehavior,andusingpromptsandcuesmaximizes
communicationwithindividualswithdementia(Smithetal,2011).
Usereminiscenceandlifereviewtherapeuticinterventionsforclientsintheearlytomiddlestagesof
dementiaaskquestionsabouttheclientspastactivities,importanteventsandexperiencesfromthepast
whileutilizingphotographs,videos,artifacts,musicornewspaperclippingsormultimediatechnologyto
stimulatememories.EB:InasmallpreliminarystudyutilizingYouTubevideos,itwasfoundthat
reminiscenceandlifereviewmayimprovewellbeingandsocialengagement(ORourkeetal,2011).
Memoriesfromchildhoodoryoungadulthoodaregenerallyintactintheearlyandmiddlestagesof
Alzheimers(Smithetal,2011).
Iftheclientisverballyagitated(repetitiveverbalizations,complaints,moaning,muttering,threats,
screaming),assessforandaddressunsatisfiedbasicneedsorenvironmentalfactorsthatmaybe
addressed.EB:Disruptivevocalizationsmaybeanindicationthattheclientwithdementiahastheneed
forcomfort,attention,ormoreorlessstimulation(Beedardetal,2011).Behaviorsarenotsolelydueto
cognitiveimpairmentandmaybeduetoanunmetneedorenvironmentalfactorsthatmaybe
overwhelmingorunderstimulating(Gitlinetal,2009).
Assistclientsinwayfinding,monitoringthemsothattheydonotgetlostinunfamiliarsettings.EB:
Dementiaandsomerelateddisorderscauseimpairedspatiallearningsecuritymeasuresshouldbe
unobtrusive,personalsurroundingsshouldincludefamiliarobjects,andfacilitiesshouldbedesignedto
haveahomelikeappearance(Fleming&Purandare,2010).
Usecues,suchaspictureboardsdenotingday,time,andlocation,tohelpclientwithorientation.EBN:
Realityorientation,usednotwhenclientsareagitated,butasoverallremindersoforientation,canhelp
someclientsremainmoreoriented(Yuetal,2009).
Multicultural

HomeCare
NOTE:Keepingtheclientasindependentaspossibleisimportant.Becausecommunitybasedcareisusually

lessstructuredthaninstitutionalcare,inthehomesettingthegoalofmaintainingsafetyfortheclienttakeson
primaryimportance.

Client/FamilyTeachingandDischargePlanning

NOTE:ThenursingdiagnosesImpairedEnvironmentalInterpretationSyndromeandChronicConfusionare

verysimilarindefinitionandinterventions.ImpairedEnvironmentalInterpretationSyndromemustbe
interpretedasasyndromewhenothernursingdiagnoseswouldalsoapply.ChronicConfusionmaybe
interpretedasthehumanresponsetoasituationorsituationsthatrequirealevelofcognitionofwhichthe
individualisnolongercapable.
REFERENCES

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