Wandering Nursing Care Plans Diagnosis and Interventions
Wandering NCLEX Review and Nursing Care Plans
Wandering or becoming lost is typical in patients with cognitive problems. Even if the patient has never wandered before, this situation can happen in the early stages of different memory disorders. Wandering is also linked to several illnesses, including autism spectrum disorder, Down syndrome, and dementia caused by Alzheimer’s disease, stroke, head trauma, or Parkinson’s disease.
A person with a cognitive problem may be considered wandering if he or she returns from routine walks or drives later than expected, or forgets how to go to familiar surroundings. A person may wander for a variety of reasons, including:
- Fear or stress. The person with cognitive problems may wander due to anxiety in a complicated situation.
- Searching. The patient may become disoriented when looking for something or someone in an unfamiliar place.
- Looking for necessities. The patient may be looking for a restroom, food, or desires to go outside.
- Following previous routines. The patient may attempt to go to work or shop for groceries. He or she may be missing his or her usual routines.
Wandering is often not hazardous if it happens in a safe and regulated atmosphere. However, wandering can cause safety problems, especially in extreme heat and cold places or if someone with memory problems finds themselves in a remote area.
To avoid the danger of wandering, determine the times of day when risky roaming is likely to occur, plan relevant activities to keep the patient engaged, and avoid scolding the person if he or she is looking for a partner or wants to go home.
It is also necessary to consider strategies to acknowledge and understand the patient’s feelings. Lastly, if the individual feels neglected or confused, reassure him or her that he or she is protected, make sure that the patient’s fundamental requirements are provided regularly, and avoid going to busy or crowded places.
Warning Signs of Wandering
Anyone with cognitive impairments who can walk is in danger of wandering. Watch for the following warning indicators in family and friends:
- The patient returns home later than expected from a usual walk or drive.
- Attempts to fulfill previous commitments, such as going out to work.
- The patient tries or desires to go home even when he or she is actually at home.
- The patient is agitated, restless, or performs repetitive motions.
- The patient has trouble finding familiar places such as the restroom, bedroom, or dining area.
- The patient usually inquires about the whereabouts of present or former friends and family.
- The patient acts as if practicing a pastime or chore, but nothing is accomplished.
- The patient appears to be disoriented in a new or altered environment.
Common Causes of Wandering
- Changed surroundings. People with cognitive impairments may feel uncertain and confused in a new situation, such as a new residence or care facility. The individual may also desire to go away from a noisy or busy place. However, When they become adjusted to the change, they may quit wandering.
- Memory lapse. Wandering could be the result of a loss of short-term memory.
- The patient may be looking for the past. As people become increasingly perplexed, they may search for someone or something from their past. This might be a deceased lover, a lost acquaintance, or a childhood home.
- Boredom expression. People with cognitive problems find it increasingly difficult to focus most of the time. Wandering may be their means of keeping themselves occupied.
- Confusion between night and day. People with cognitive impairments may experience insomnia or wake up in the early hours feeling confused. They may mistakenly believe it is daylight and decide to go for a walk. Shadows and night sounds might become confusing and distressing if the patient has poor eyesight or hearing problems.
- Keeping a habit. People who are used to walking large distances may want to keep doing so.
- Agitation. Changes in the brain might result in feelings of uneasiness and anxiety. Some agitated individuals may pace up and down or wander off for no apparent reason. They may refuse to go since they may not recognize their own home.
- Pain or discomfort. Walking may alleviate discomfort. Thus it is critical to identify and treat any physical problems or medical conditions. Tight clothing, extreme heat, or the need to find a restroom can all be problems for patients at risk of wandering.
- Dreams. Inability to distinguish between dreams and reality may lead to a person responding to anything they dreamed, believing it to be real life.
Dangers of Wandering
- The repercussions of wandering can range from minor to severe bodily injury and death.
- Persistent wandering behavior and poor gait and balance have been linked to a higher risk of falls, fractures, and accidents.
- Patients who wander frequently and cannot sit down for meals may suffer from hunger, calorie restriction, and lethargy.
- Individuals who tend to wander are also reported to have edema and abrasions, soft tissue damage, and abnormal body temperature (hypothermia or hyperthermia).
- Fatal accidental hypothermia, orthopedic injuries, soft tissue injuries, hunger, weight loss, and accidents are the most prevalent causes of death in patients who wander or elope from a care home.
- Other expected outcomes of wandering include a more significant caregiver load, increased care costs, and increased unpleasant feelings.
Nursing Considerations on Patients who are at Risk of Wandering
- The nurse should determine who is at risk of wandering.
- The nurse must provide an individual care plan to patients to deal with wandering.
- Maintain appropriate staffing to ensure the safety of all patients.
- The nurse should make lounge rooms available for patients to pause and rest while walking.
- Keep the walking paths of the patients clear and well-lit.
- To fulfill each patient’s particular needs, the nurse should provide sensory stimulation through a range of meaningful interactions.
- The nurse must assign wandering patients to rooms distant from exits.
- Place signs and drawings around the outside of the patient’s room to help him discover it.
- The nurse should provide healthful little meals and beverages that the patient can carry with him or her while securely walking.
- The nurse must assess and meet the patient’s basic needs, including pain management, personal care, and appropriate food and fluids.
- In coordination with the physician, diagnose and treat depression, which typically accompanies dementia and raises the chances of wandering.
Prevention of Wandering
- Establish supervision. Never lock the patient in the house. Do not abandon him or her alone in a car.
- Avoid congested areas that might be disorienting and create confusion for the patient.
- Make sure that the patient always carries an identification card. Keeping an ID in a patient’s wallet is insufficient since they may remove it, either intentionally or unintentionally. Medical ID jewelry is a good idea, such as a bracelet or pendant.
- Carry out daily tasks. A routine and daily schedule might help to create structure.
- Take note of the most likely times of day for wandering. Plan the activities of the patient during that time.
- Activities, exercise, and adequate rest are all important. All of these can help to alleviate stress, restlessness, and discomfort.
- Display signage. Put up a sign on the outside of a door that says “Stop” or “Do Not Enter.”
- Doors and door knobs should be camouflaged. Use childproof knobs or paint them the same color as the walls. Try putting a black carpet at the front of the door, which will be viewed as a whole and discourage people from looking for an exit.
- Utilize gadgets that alert the caregiver when a door or window is unlocked. This gadget might be as simple as a doorbell or as complex as an electric house alarm.
- Keep the automobile keys hidden. Patients with cognitive disorders may become disoriented and endanger themselves or others.
- If night roaming is an issue, make sure the person has limited fluids two hours before going to bed and has used the restroom. Use night lights as well.
Nursing Diagnosis Wandering
Nursing Care Plan for Wandering 1
Nursing Diagnosis: Wandering related to disorientation, disease advancement, dementia, chronic sickness, disease progression that exhausts the health care provider or his family, and growing patient reliance on others secondary to Alzheimer’s disease as evidenced by tiredness, anxiety, tension, and social isolation.
Desired Outcome: The patient will have improved coping abilities with his or her cognitive condition, risk of wandering, and care demands.
| Nursing Interventions for Wandering Patients | Rationale |
| Redirect the patient’s pacing or restless behavior into productive activities or exercise. | This technique seeks to refocus the patient’s attention so that he can prevent wandering. In patients at risk of wandering, redirecting one’s energy to another meaningful activity is beneficial. |
| Reduce the amount of noise and confusion. Turn off the TV or radio, close the blinds, or relocate the patient to a more peaceful environment. | Some Alzheimer’s patients tend to wander in noisy areas. Therefore, establish a quiet environment for the patient to avoid confusion and limit the chances of wandering. |
| To assist with patient monitoring, the nurse should collaborate with other nursing personnel. | Taking care of people at risk of wandering might be challenging at times. Thus, collaborating with other staff members may be beneficial. |
| The nurse should ensure that the patient’s room is near the nurse’s station. | The goal of this intervention is to constantly and closely monitor the patient. |
| The nurse should guarantee that the area around the patient is clutter-free and that any potentially harmful things are kept away from the patient. | This intervention intends to prevent injury or accident from occurring if the patient becomes disoriented and begins to wander. |
| Examine the patient’s medication list to see whether the disorientation is due to pharmaceutical adverse reactions, drug-to-drug interactions, or over-medicating. | If this is the case, notify his doctors immediately to prevent the situation from worsening. |
| If the patient appears disoriented, reassure them. | This method intends to assist the patient when they become perplexed. This strategy will also give them the impression that they are not being disregarded. |
| Distract the individual with another activity when wandering is most prevalent. | The nurse is responsible for determining what time of day the patients frequently wander. Similarly, offering patients additional activities to perform during specific periods will keep them from wandering. |
Nursing Care Plan for Wandering 2
Nursing Diagnosis: Wandering related to cognition and recall difficulties, confusion, poor visuospatial abilities, and language (particularly expressive) faults secondary to dementia as evidenced by continuous or persistent movement from one location to another, frequently returning to the same places, and relentless locomotion in search of “lost” or unattainable individuals or places.
Desired Outcomes:
- The patient will have a reduced risk of elopement.
- The patient who has wandering tendencies will be placed in a secure environment.
| Nursing Interventions for Wandering Patients | Rationale |
| Over three days, assess and describe the amount (frequency and duration), pattern (random, lapping, or pacing), and 24-hour distribution of wandering behavior. | The timely assessment offers a baseline against which behavior change can be measured. This type of evaluation can also identify the times of day when wandering is most common and when surveillance or other preventative measures are most important. |
| Examine neurocognitive strengths and weaknesses, especially language, attention, visuospatial skills, and perseveration. | Patients with dementia and those who wander may have expressive language deficiencies that make it challenging to explain their needs. Perseveration may suggest that the wanderer is unable to voluntarily discontinue his or her behavior, necessitating nursing judgment as to when wandering should be stopped to improve the patient’s security, comfort, or well-being. |
| Assess for the existence of potential adverse effects of wandering, such as weight change, poor social skills, falls or injuries, and elopement. | Wanderers are more likely to fall compared to other cognitively disabled people. They also lose more social skills with time. |
| Examine wandering episodes for causes and effects. | People, events, or situations around the onset or conclusion of wandering patterns may provide clues concerning triggers that stimulate or reinforce wandering behavior. |
| Acquire a history of personality traits and stress-related behavioral responses. | Long-standing behavioral patterns may disclose situations under which wandering will occur and can aid in evaluating both positive and negative connotations of the patient’s wandering tendency. |
Nursing Care Plan for Wandering 3
Amnestic Disorder or Amnesia
Nursing Diagnosis: Risk for Wandering related to chronic confusion secondary to amnestic disorder or amnesia.
As a risk nursing diagnosis, the Risk for Wandering is entirely unrelated to any signs and symptoms since it has not yet developed in the patient, and safety precautions will be initiated instead.
Desired Outcomes:
- The patient will remain satisfied and protected.
- The patient will function at his or her peak cognitive level.
- The patient will engage in activities of daily living to the extent of his or her ability.
| Nursing Interventions for Wandering Patients | Rationale |
| Gather data about patient functioning, such as social position, physical state, and psychological health. | Knowing the patient’s history can assist the nurse in identifying behavior and using validation therapy to assist recollection. Background information may assist the nurse in understanding the patient’s behavior if the patient becomes confused at times and wanders. |
| Examine the patient for indicators of depression, such as sleeplessness, loss of appetite, apathy, and withdrawn behavior. | Patients suffering from prolonged confusion may have psychological distress. |
| Determine the degree of the patient’s impairment. | The level of confusion will determine the degree of reorientation and intervention required by the patient to interpret reality appropriately. |
| Examine the patient for sundown syndrome. | This confusion-related phenomenon occurs in the late afternoon. The patient is becoming increasingly restless, agitated, and confused. Sundown syndrome can be caused by sleep problems, starvation, thirst, or unfulfilled toileting demands. |
| Ensure that the patient has an identification jewelry bracelet. | Patients suffering from persistent disorientation may wander and become disoriented; thus, having identification bracelets improves patient safety. |
| Determine the patient’s level of anxiety concerning the situation. Keep an eye out for conduct that could indicate a risk of violence. | Confusion, wandering, uncertainty, suspiciousness, impaired thinking, and an absence of social inhibitions can lead to socially inappropriate or harmful behavior toward oneself or others. The patient may exhibit poor impulse control. |
| As much as possible, minimize the patient’s exposure to unexpected settings and individuals, maintain caregiver consistency, and maintain care routines such as feeding times, bathing, and sleeping regimens. When a patient is going for diagnostic tests or into a strange setting, bring a familiar person with them. | Situational anxiety caused by environmental, interpersonal, or structural change can lead to prolonged confusion, dysfunctional conduct, and wandering. |
| Make repeated hand activities available. | Allowing the patient to make appropriate and repetitive motions, such as folding towels and washcloths, occupies the patient’s thoughts and hands. The activities may help to alleviate confusion and agitation and release energy. |
| Present one simple direction at a time, just repeat it as needed. | People who suffer from chronic confusion require extra time to absorb and comprehend directions. |
| Allow the patient to eat in a peaceful setting with fewer people. | A large dining room’s noise and confusion might be overpowering for a confused patient, resulting in disturbing behavior. |
Nursing Care Plan for Wandering 4
Nursing Diagnosis: Risk for Wandering related to disturbed thought processes secondary to Parkinson’s disease.
Desired Outcomes:
- The patient will discover elements that trigger depressive reactions and employ ways to minimize the volume and recurrence of these episodes effectively.
- The patient will follow the treatment regimen.
| Nursing Interventions for Wandering Patients | Rationale |
| Assess the patient for depressive tendencies and causal events, and orient the patient to reality as needed. | Depression is prevalent in Parkinson’s disease patients; there are no recent studies that explain if depression is a reaction to the disorder or a biochemical defect. |
| Identify particular problems and permit the development of a care plan. | Reality orientation enables patients to become more aware of themselves and their environment, reducing the likelihood of wandering. |
| Approach the patient a nonjudgmental manner and attentively listen to his thoughts and worries. | This intervention promotes a trustworthy relationship and allows the patient to address things that will assist the patient in dealing with problems in suitable ways. Physical slowness and the significant effort required for even minor tasks can cause Parkinson’s disease patients to feel ashamed, indifferent, bored, and lonely. Encourage and help the patient complete the chores required to satisfy their daily needs and remain independent. |
| Determine the medications that the patient is currently taking. | This intervention assists in detecting drug abuse and adverse effects that may result in a disturbed thought process and an increased risk of wandering. |
| Examine the patient for suicidal thoughts and suicide risk. | Patients who are profoundly depressed and have already considered suicide require immediate attention. |
| Vital signs should be checked every 4 hours. | Antidepressants and other psychotropic medicines can cause cardiovascular and cerebrovascular dysfunction. These medicines can also cause disturbing thoughts, mood swings, hallucinations, and wandering. |
Nursing Care Plan for Wandering 5
Autism Spectrum Disorder (ASD)
Nursing Diagnosis: Wandering related to a diminished sense of danger and impulsive behavior secondary to Autism Spectrum Disorder (ASD), evidenced by attempting to run away from an uneasy situation and escape unpleasant sensory stimuli such as loud and irritating noise.
Desired Outcomes:
- The patient will be able to know what triggers the wandering tendencies.
- The patient will have the best ability to convey their requirements and have the best personal relationships.
| Nursing Interventions for Wandering Patients | Rationale |
| Recognize the patient’s wandering triggers. | Patients with ASD can be aggressive, wandering or bolting from a safe environment to get to something of interest, such as water, the park, or railroad tracks—or to get away from an unpleasant or terrifying situation, such as one with loud noises, bustle, or flashing lights. |
| Regardless of the patient’s age, secure the patient’s home. | Close and lock any doors that lead outdoors. Consider installing door sensors to notify caregivers whenever a door opens. |
| Practice communication and behavioral strategies. | Teaching the patient how to self-calm when overwhelmed and respond appropriately to “no” can make a significant difference. Assure that the patient’s family members understand how critical it is to keep the patient occupied and busy to decrease the patient’s desire or possibility to wander. |
| Set the patient’s expectations. | Discuss the strategy with the patient and other family members before going out in public, including the following schedule and regulations. If loud noise is a trigger, consider noise-canceling headphones, and employ the “tag-team” strategy to ensure a trustworthy caregiver constantly watches the patient. |
| Consider monitoring and identifying technology. | This treatment is favorable to pediatric patients. More than one-third of children with ASD who wander cannot convey their name, address, or phone number. GPS gadgets, medical alert bands, and even having their name written on clothing may be helpful. |
| Encourage the patient to get enough rest or sleep. | If a patient with ASD has a sleep management strategy and a healthy sleeping routine, they may be less hyperactive and less likely to wander throughout the night. Caregivers who get enough sleep are more alert as well. Many ASD patients may have sleep issues. If the patient is experiencing difficulty falling or staying asleep, consult a doctor for additional evaluation and therapy. |
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. (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. (2020). 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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