Cognitive impairment is a condition characterized by difficulties with memory, learning, concentration, and decision-making that impacts a person’s daily life. This nursing diagnosis focuses on identifying and managing cognitive decline while promoting safety and maintaining optimal function.
Causes (Related to)
Cognitive impairment can develop from various factors that affect brain function and cognitive processing:
- Neurological conditions:
- Alzheimer’s disease
- Dementia
- Stroke
- Traumatic brain injury
- Multiple sclerosis
- Medical conditions:
- Delirium
- Depression
- Thyroid disorders
- Vitamin B12 deficiency
- Sleep disorders
- Environmental factors:
- Medications (particularly anticholinergics)
- Substance use
- Electrolyte imbalances
- Poor nutrition
- Social isolation
Signs and Symptoms (As evidenced by)
Cognitive impairment presents various manifestations that nurses must recognize for accurate assessment and intervention.
Subjective: (Patient reports)
- Memory loss or difficulty remembering recent events
- Confusion about time or place
- Trouble finding words
- Difficulty following instructions
- Problems with decision-making
- Feeling overwhelmed by simple tasks
- Difficulty concentrating
Objective: (Nurse assesses)
- Decreased attention span
- Impaired problem-solving abilities
- Disorientation to time, place, or person
- Poor judgment
- Altered thought processes
- Memory deficits
- Changes in behavior
- Difficulty following commands
- Impaired social interaction
Expected Outcomes
The following outcomes indicate successful management of cognitive impairment:
- The patient will maintain optimal cognitive function
- The patient will demonstrate safe behaviors
- The patient will follow simple instructions
- The patient will use compensatory techniques effectively
- The patient will maintain social interactions
- The patient will express an understanding of cognitive limitations
- Caregivers will demonstrate understanding of patient needs and management strategies
Nursing Assessment
Evaluate Cognitive Status
- Perform Mini-Mental State Examination
- Assess orientation level
- Monitor attention span
- Evaluate memory function
- Check problem-solving abilities
Assess Safety Risks
- Evaluate fall risk
- Check medication management
- Assess home environment
- Monitor wandering potential
- Evaluate judgment capacity
Review Physical Status
- Monitor vital signs
- Check nutritional status
- Assess sleep patterns
- Evaluate activity level
- Monitor for pain
Assess Support Systems
- Evaluate family involvement
- Check available resources
- Assess caregiver stress
- Review social support
- Monitor living arrangements
Document Baseline Function
- Record current abilities
- Note areas of deficit
- Track changes over time
- Document safety concerns
- Monitor progression
Nursing Care Plans
Nursing Care Plan 1: Impaired Memory
Nursing Diagnosis Statement:
Impaired Memory related to neurological changes as evidenced by inability to recall recent events and difficulty learning new information.
Related Factors:
- Neurological disorders
- Age-related changes
- Medication effects
- Sleep disturbances
Nursing Interventions and Rationales:
- Establish consistent daily routines
Rationale: Promotes familiarity and reduces confusion - Use memory aids (calendars, notes)
Rationale: Provides visual cues and supports memory function - Break tasks into simple steps
Rationale: Reduces cognitive load and improves success
Desired Outcomes:
- The patient will use memory aids effectively
- The patient will maintain a daily routine
- The patient will demonstrate improved recall of recent events
Nursing Care Plan 2: Risk for Injury
Nursing Diagnosis Statement:
Risk for Injury related to cognitive deficits as evidenced by impaired judgment and decreased safety awareness.
Related Factors:
- Altered mental status
- Poor judgment
- Impaired physical mobility
- Environmental hazards
Nursing Interventions and Rationales:
- Implement safety precautions
Rationale: Prevents accidents and injuries - Monitor medication administration
Rationale: Ensures proper medication management - Provide supervision during activities
Rationale: Maintains safety while promoting independence
Desired Outcomes:
- The patient will remain free from injury
- The patient will demonstrate safe behaviors
- Caregivers will implement safety measures effectively
Nursing Care Plan 3: Impaired Social Interaction
Nursing Diagnosis Statement:
Impaired Social Interaction related to cognitive decline as evidenced by withdrawal from social activities and difficulty maintaining relationships.
Related Factors:
- Communication difficulties
- Memory impairment
- Anxiety in social situations
- Decreased comprehension
Nursing Interventions and Rationales:
- Encourage social engagement
Rationale: Maintains cognitive function and emotional well-being - Facilitate structured group activities
Rationale: Provides opportunities for safe social interaction - Support family involvement
Rationale: Maintains important relationships and support systems
Desired Outcomes:
- The patient will participate in social activities
- The patient will maintain meaningful relationships
- The patient will demonstrate improved social engagement
Nursing Care Plan 4: Self-Care Deficit
Nursing Diagnosis Statement:
Self-Care Deficit related to cognitive impairment as evidenced by inability to perform activities of daily living independently.
Related Factors:
- Impaired memory
- Decreased organizational skills
- Poor problem-solving
- Physical limitations
Nursing Interventions and Rationales:
- Assist with ADLs as needed
Rationale: Maintains hygiene and function while ensuring safety - Establish simple routines
Rationale: Promotes independence through familiar patterns - Provide environmental cues
Rationale: Supports self-care activities through visual reminders
Desired Outcomes:
- The patient will maintain an optimal level of independence
- The patient will complete self-care activities safely
- The patient will use adaptive devices effectively
Nursing Care Plan 5: Disturbed Thought Processes
Nursing Diagnosis Statement:
Disturbed Thought Processes related to cognitive decline as evidenced by difficulty with decision-making and impaired reasoning.
Related Factors:
- Neurological changes
- Psychological stress
- Sensory deprivation
- Medical conditions
Nursing Interventions and Rationales:
- Provide reality orientation
Rationale: Maintains connection with environment and current situation - Use clear, simple communication
Rationale: Facilitates understanding and reduces confusion - Implement validation therapy
Rationale: Acknowledges feelings and reduces anxiety
Desired Outcomes:
- The patient will demonstrate improved decision-making
- The patient will maintain orientation to the situation
- The patient will express thoughts clearly
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
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- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
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