Chronic Confusion Nursing Diagnosis and Nursing Care Plan

Chronic Confusion Nursing Care Plans Diagnosis and Interventions

Chronic Confusion NCLEX Review and Nursing Care Plans

Confusion can be defined as a condition of altered thought and mental processes. It can be categorized into two: acute confusion, otherwise known as delirium, and chronic confusion, which is interchangeable with the term dementia.

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.

Signs and Symptoms of Chronic Confusion

The signs and symptoms of chronic confusion or dementia could be categorized into cognitive and psychological changes.

  1. Cognitive Changes

  • Memory loss
  • Problems with communication (i.e. finding/communicating the words to say)
  • Problems with visual and spatial concepts (i.e. getting loss navigating)
  • Problems of reasoning, critical thinking
  • Problems in dealing with complex concepts, tasks
  • Problems in organization of tasks, planning concepts
  • Problems with motor coordination
  • Marked confusion and disorientation
  1. Psychological Changes

  • Personality changes
  • Depression
  • Anxiety
  • Inappropriate behavior
  • Paranoia
  • Agitation
  • Hallucinations

Causes of Chronic Confusion

Dementia is caused by the loss of connection or damage to the interconnections of neurons in the brain. The location of these damages plays a role in the clinical manifestations of the condition. In relation to this, below are some causes of chronic confusion.

  1. Progressive dementias

  • Alzheimer’s disease – A subtype where beta-amyloid plaques crowd and tangle the brain.
  • Vascular dementia – A subtype wherein blood supply to the brain is impeded.
  • Lewy body dementia – Another subtype wherein there is the presence of balloon-like, clustered proteins in the nerve pathways.
  • Frontotemporal dementia – The subtype wherein there is breakdown of nerve cells of the location in the brain associated with language and behavior.
  • Mixed dementia
  1. Other disorders linked to dementia

  • Huntington’s disease – A genetic condition wherein tissue degradation of the nerves and neurons happens at around 30 to 40 years old.
  • Traumatic brain injury (TBI) – This is associated with repetitive injury to the brain, as is the case with some sports like boxing.
  • Creutzfeldt-Jakob disease – A brain infection caused by prions.
  • Parkinson’s disease – Patients with Parkinson’s usually develop dementia in the latter stages of the condition.
  1. Reversible dementia-like conditions

  • Infections and immune disorders – Conditions that attack the immune system may give rise to dementia-like symptoms.
  • Metabolic problems and endocrine abnormalities – Problems with blood sugar control, thyroid conditions, or deficiencies in calcium, sodium and the absorption of Vit. B12 can give rise to dementia-like symptoms.
  • Nutritional deficiencies – Dehydration, diet low in vitamin B-complexes (Vit. B1, B6 and B12), copper and vitamin E are also associated with dementias.
  • Side effects of medications
  • Subdural hematoma
  • Brain tumors  
  • Normal-pressure hydrocephalus

Related Factors to Chronic Confusion

A variety of factors may contribute to chronic confusion, and they are categorized by either modifiable or non-modifiable factors.

  1. Non-modifiable risk factors

  • Age – Though risks increase as the person ages, it is not a part of the normal aging process and may develop in younger people as well.
  • Family history – Genetics has played a role in the development of conditions, an example of which is chronic confusion.
  • Down Syndrome – patients with Down Syndrome may usually develop early-onset Alzheimer’s disease by middle age.
  1. Modifiable risk factors

  • Diet and exercise
  • Excessive alcohol intake
  • Cardiovascular risk factors
  • Depression
  • Diabetes
  • Smoking
  • Air pollution
  • Head trauma
  • Sleep disturbances
  • Vitamin and nutritional deficiencies
  • Medications that may affect and worsen memory

Chronic Confusion Nursing Diagnosis

Chronic 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.

Nursing Interventions for Chronic ConfusionRationale
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.

Chronic Confusion 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.

Nursing Interventions for Chronic ConfusionRationale
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.

Chronic Confusion 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.

Nursing Interventions for Chronic ConfusionRationale
Encourage verbalization of feelingsActive 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.

Chronic Confusion 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.

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.

Nursing Interventions for Chronic ConfusionRationale
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 precautionsPatients 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.

Chronic Confusion 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.

Nursing Interventions for Chronic ConfusionRationale
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.
        Present instructions or ideas one at a time and repeat as needed.People with this condition would need time to comprehend instructions and directions.
          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.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Nursing Stat Facts
Nursing Stat Facts

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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