Impaired Thought Process Nursing Diagnosis Care Plans

Last updated on May 16th, 2022 at 07:20 pm

Impaired Thought Process Nursing Care Plans Diagnosis and Interventions

Impaired Thought Process 5 Nursing Care Plans NCLEX Review

Impaired Thought Process is a NANDA nursing diagnosis in which a person has changed perspective and/or intellect that conflicts with daily living. Biochemical or psychological problems, such as depression and personality disorders, are the possible underlying causes.

The management of alteration in thought process aims to foster coping techniques and diminish disordered thinking. Moreover, uncertainty among older persons is frequently misattributed to aging. Ambiguity in elderly clients can be caused by mental issues such as depression, Alzheimer’s, pharmaceutical side effects, or metabolic diseases.

Depression is also a more common cause of cognitive impairment in older persons than dementia.

Causes of Impaired Thought Process

  1. Physiological Conditions

  • Old age
  • Head traumas
  • Oxygen deprivation
  • Infection
  • Malnourishment
  1. Biochemical Changes

  1. Psychological Issues

  • Panic
  • Despair
  • Mood swings
  • Fear
  • Grieving
  • Dissociative disorders

4. Circumstances (such as personal, social, or environmental)

  • Abusive behavior (physical, sexual, mental)
  • Traumatic experiences in childhood
  • Separation
  • Depression in old age
  • Cruelty

One of the distinguishing features of psychiatric disorders such as schizophrenia and psychosis is the impaired thought process. People are more likely to acquire a thinking impairment if they also have:

  • Uncontrolled anxiousness
  • Mood swings
  • Depression
  • Bipolar illness
  • Traumatic brain injury

The following may also be risk factors for the impaired mental process:

  • Pressure
  • Stress
  • Excessive or abusive use of mind-altering substances
  • Toxic chemical exposure before birth
  • Autoimmune or inflammatory diseases

Signs and Symptoms of impaired Thought Process

The following signs symptoms are associated with Impaired Thought Process:

  1. Significant Symptoms (Most typical)

  • Incorrect interpretation of stimuli, whether internal or external

2. Minor Symptoms (Less common)

  • Impairments in cognition (abstraction, problem-solving, memory deficits)
  • Uncertainty
  • Hallucinations
  • Easily distracted
  • Mood swings
  • Impulsive behavior
  • Unsuitable behavioral patterns
  • Consensual validation is lacking.
  • Obsessions
  • Persistent and excessive phobias
  • Observed compulsive behavior
  • Suspiciousness

Diagnosis of Impaired Thought Process

A healthcare practitioner diagnoses thought problems. A diagnosis is frequently made by asking open-ended questions to the patient and then examining their verbal responses.

To assess impaired thought process, a variety of assessment techniques are available, including:

  • The Rorschach inkblot test. This is a perception test in which participants are given a pattern of ambiguous inkblots. When evaluating vocal responses to the inkblots, mental health practitioners might use a scoring system to look for symptoms of disturbed thinking.
  • The Thought Disorder Index (TDI). In this assessment, a health practitioner’s dialogue with the patient is recorded and subsequently transcribed. The TDI, also called the Delta index, is then utilized to analyze the exchange that may suggest a mental impairment.
  • Assessment of Thought, Language, and Communication (TLC) Scale. This scale is one of the unique diagnosis methods used to examine thinking disorders. It entails making assessments and assigning severity and likelihood to them depending on classifications of various features of thought disorders.

Treatment for Impaired Thought Process

There are treatments available to assist patients in managing the symptoms of impaired thought process. Some possible treatment techniques are explained below.

  1. Psychotherapy. This therapy may be beneficial for patients who are also suffering from delusional or misguided ideas. Depending on the individual’s symptoms, the following types of interventions may be used:
  2. Cognitive-behavioral therapy (CBT) can aid in the identification and modification of mistaken ideas.
  3. Family therapy can assist families in learning how to support a loved one who has a thinking problem.
  4. Group therapy can be an effective treatment for honing skills and seeking assistance.

2. Medications. Medications are sometimes used to treat the symptoms of disturbed or impaired thought process, especially in schizophrenia or psychotic illnesses. Antipsychotics, antidepressants, and mood stabilizers are examples of such drugs.

Nursing Diagnosis for Impaired Thought Process

Nursing Care Plan for Impaired Thought Process 1


Nursing Diagnosis: Impaired Thought Process related to altered perception of the surroundings secondary to schizophrenia as evidenced by delusions and hallucinations.

Desired outcome: The patient will learn to recognize delusional thoughts if they continue and appropriately perceive the environment.

Nursing Interventions for Impaired Thought ProcessRationale
Collaborate with patients based on what is going on around them. Try to divert the client’s attention away from their hallucinations by engaging them in activities such as arts and crafts or card and board games.  When the client’s thoughts are concentrated on reality-based activities, he or she is free of deluded thinking. It also aids in externally focusing attention.    
If a patient believes they need to defend themselves from a specific person, use safety measures to safeguard them or others. Precautions must be taken.  During the acute period, the client’s delusional thinking may lead them to believe that they must harm others or themselves to be safe. External controls may be required.  
Put effort into comprehending the significance of these beliefs to the patient during their presentation.  The patient’s seemingly nonsensical hallucinations contain significant insight into their underlying concerns and issues.  
Recognize feelings associated with delusions.        For example: The patient may feel afraid if he or she thinks that someone will harm him or her. It will help to reorient the patient.If the patient believes that someone or something is directing their thoughts, they may feel helpless.  Anxiety may decrease when people believe they are understood. As a result, this technique is a beneficial intervention for schizophrenia.    
with patients based on what is going on around them. Try to avert the patient’s attention away from their hallucinations by participating in reality-based activities (e.g., card games, simple arts and crafts projects).  When the patient’s thoughts are concentrated on actual life activities, he or she is free of fallacious beliefs. It aids in objectively focusing attention.  

Nursing Care Plan for Impaired Thought Process 2

Eating Disorders (Anorexia and Bulimia)

Nursing Diagnosis: Impaired Thought Process related to deranged body image and severe low self-esteem secondary to eating disorder as evidenced by even if they have average body weight or are severely emaciated, they perceive themselves to be overweight.

Desired outcome: The patient will develop a more authentic body image and accept himself as unique.

Nursing Interventions for Impaired Thought ProcessRationale
Encourage active participation in a personal improvement program, specifically in a group environment. Deliver information on correct cosmetics and grooming applications.  Understanding how to improve one’s look may benefit one’s long-term feeling of self-esteem and reputation. Other people’s opinions might boost one’s self-esteem.  
Help the patient in confronting puberty-related changes and sexual anxieties. As needed, conduct sex education.  Adolescents experience significant physical and psychological changes, contributing to eating disorders. Feelings of impotence and inability to control feelings (especially sexual sensations) result in a subconscious urge to desexualize oneself. The patient frequently assumes that these worries may be resolved by controlling body and physical growth and function.    
Declares the regulations for weighing, remaining in sight during medicine and feeding times, and the consequences for not adhering to the rules. Be thorough in enforcing regulations without making unnecessary comments.Building rapport requires consistency. As a component of the behavioral therapy program, the patient is aware of the potential risks of not adhering to specified norms (decrease in privileges). Failure to meet regulations is considered a patient’s decision and is matter-of-factly acknowledged by personnel so that bad behavior is not reinforced.    
Be mindful of personal reactions to a patient’s conduct. Arguing should be avoided.When dealing with these individuals, feelings of revulsion, hatred, and frustration are common. Even with weight increases, the prognosis is frequently poor because other disorders may persist. Many patients continue to perceive themselves as overweight, and there is a significant prevalence of affective disorders, specific anxiety, obsessive-compulsive symptoms, substance misuse, and psychosexual dysfunction. The nurse must deal with her reactions and feelings to not compromise with the treatment.      
Encourage the patient to take responsibility for her or his own life more healthily by making her or his judgments and embracing herself or himself as she or he is at this time (including inadequacies and strengths).  The patient frequently does not know what she or he wants for himselF. Parents (usually the mother) frequently make decisions on behalf of the patient. The patient may also think that he must be the greatest at anything and keep himself accountable for being perfect.  

Nursing Care Plan for Impaired Thought Process 3

Major Depression

Nursing Diagnosis: Impaired Thought Process related to stressful life situations secondary to major depression as evidenced by the inadequate capacity to understand concepts or organize thoughts.

Desired Outcome: The patient will learn to accurately recall recent and distant knowledge and have a well-organized mental process.

Nursing Interventions for Impaired Thought Process Rationale
Use plain, concrete language.  Cognition is hampered by delayed thinking and trouble concentrating.  
Allow adequate time for the patient to ponder and frame responses.    Slower thinking needs more time to consider a response.
Allow the patient more time than average to complete their usual activities of daily living (ADL) (e.g., eating, dressing).    Typical tasks may take quite a long time; requests that the patient hurry heightens the tension and impede the patient’s ability to think effectively.
  Assist the patient in deferring critical major life decisions.    Making sound life decisions necessitates excellent psychophysiological functioning.
Reduce the patient’s duty while he is significantly depressed.  This approach reduces feelings of guilt, anxiety, and stress.

Nursing Care Plan for Impaired Thought Process 4


Nursing Diagnosis: Impaired Thought Process related to physiological effects, including higher CNS activation and more significant cognitive activity secondary to hyperthyroidism as evidenced by modifications in thinking and distortions in external cues.

Desired outcome: The patient will be deemed to be at ease and the anxiety will be decreased to a reasonable level.

Nursing Interventions for Impaired Thought ProcessRationale
Examine the thought process of the patient. Determine the attention span and alignment to a location, person, or time.    This method determines the degree of sensory integration interference.
Take note of any behavioral changes of the patient.    This approach reveals if the patient may become hypervigilant, restless, excessively sensitive, or cry or acquire a full-blown psychosis.
Determine the level of anxiety of the patient.    Anxiety can cause changes in cognitive processes. That is why this approach is necessary to manage impaired thought processes.
Provide a peaceful atmosphere for the patient, including fewer stimuli, a cold room, and dark lighting. Restriction of techniques and personnel is also advised.    External stimulus suppression may reduce hyperactivity or reflexes, CNS irritability, hearing, and visual delusions.
Encourage family members to visit patients. As needed, offer assistance.  This intervention aids in the maintenance of socialization and orientation. Family issues may arise due to the patient’s restlessness and schizophrenic behavior.

Nursing Care Plan for Impaired Thought Process 5

Cushing’s Disease

Nursing Diagnosis: Impaired Thought Process related to insufficient knowledge and chemical modifications in the brain due to excessive cortisol secondary to Cushing’s disease, as evidenced by complications requiring multiple hospitalizations, anxiety, and depression.

Desired outcome: The patient will comprehend Cushing’s illness and treatment requirements and carry out proper treatment.

Nursing Interventions for Impaired Thought ProcessRationale
Examine the patient’s understanding of Cushing’s disease and its effective treatments.A tailored instructional strategy starts with evaluating the patient’s pre-existing knowledge of the illness. The patient or family must acknowledge the disease process and be given detailed guidance on therapies, symptom management, signs of infection, comorbidities, and when to inform the physician immediately. Because of the effects of cortisol on hippocampal neurons, Cushing’s disease may cause changes in consciousness. The patient’s memory may be impacted. This modification may restrict the patient’s ability to learn new relevant data.      
Explain to the patient and his family what is causing the emotional changes.  The body might experience high cortisol levels as anxiety and insomnia are quite prevalent in patients on corticosteroids and high cortisol levels.
Assist the patient with his psychotherapy sessions.  Psychotherapy can help Cushing’s disease-related sadness, mood swings, and anxiety. This approach helps manage the condition.    
Make a referral to a local support group for the patient once consent is gained.  Being acquainted with others who have had similar situations provides support networks. Members of a support group may offer tried-and-true coping mechanisms.    
Taper down corticosteroid medications gradually as the patient’s condition improves.    Treatment focuses on stopping the medication when Cushing’s disease is caused by long-term corticosteroid use. This method necessitates a steady reduction in dose over time to reduce the risk of the nephrotic syndrome if the medicine is abruptly discontinued. If the company’s situation does not allow for glucocorticoid discontinuation, efforts will be made to alter the dose and interval of delivery to reduce the disruption of normal hypothalamic-pituitary-adrenal function.                    

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

Gulanick, M., & Myers, J. L. (2017). 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


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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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Anna Curran. RN, BSN, PHN

Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.

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