CHRONIC CONFUSION Nursing Care Plan

Ms. Mcgyver, 58 years old, retired teacher, sells flowers as a hobby, diagnosed with Alzheimer’s disease. Ms. Mcgyver was a valedictorian with honors in her grade school time. She was also a salutatorian in her highschool and again, a valedictorian in college with a lot of medals and honors from different quiz bees and competitions. She was top 3 in her licensure exam and immediately hired from two different prestigious schools. Below is a sample of nursing care plan for chronic confusion of Ms. Mcgyver.

Assessment:

Subjective:

"I always forgotten what happen yesterday," as verbalized by the patient.

Objectives:

- Loss of memory

- Loss of time sense
- Altered perceptions
- Poor judgment
- Loss of affect
- Loss of recognition to others and environment
- Increasing self-preoccupation
- Purposeful wandering

- Incontinence

Diagnosis:

Chronic confusion related to progressive degeneration of the cerebral cortex secondary to:

Alzheimer’s disease.

Check the related diagnosis Acute Confusion.

Planning:

After 8 hours of nursing intervention, the patient will participate to the maximum level of independence in a therapeutic milieu as evidenced by the decreased frustration, diminished episodes of combativeness, increased hours of sleep at night, stabilized or increased weight.

Interventions:

- Assess who the person was before the onset of confusion. Ask her educational level, her career, her hobbies and lifestyle styles.

- Observe Ms. Mcgyver to determine baseline of her behaviors by checking the response time to a simple question. Amount of distraction tolerated, judgment, insight into disability, signs and symptoms of depression, and routine.

- Adapt communication to Ms. Mcgyver’s level. Avoid “baby talk” and a condescending tone of voice. Use simple sentences and present one idea at a time. If Ms. Mcgyver does not understand, repeat the sentence using the same words. Use positive statements; avoid “don’ts.” Unless a safety issue is involved, do not argue. Avoid general questions, such as, “What would you like to do?” Instead, ask, “Do you want to go for a walk or work on your rug?” Be sensitive to the feelings of Ms. Mcgyver is trying to express. Avoid questions you know the she cannot answer. If possible, demonstrate to reinforce verbal communication. Use touch to gain her attention or show her concern unless a negative response is elicited. Maintain good eye contact to her and pleasant facial expressions. Determine which sense dominates Ms. Mcgyver’s perception of the world. Communicate through her preferred sense.

- Promote Ms. Mcgyver’s safety. Ensure that she carries identification. Adapt the environment so that Ms. Mcgyver can pace or walk if she desired. Keep the environment uncluttered. Reevaluate whether treatment is needed. If needed, provide the following to promote safety.
- Camouflage tubing with loose gauze. Consider an intermittent access device instead of continuous IV therapy. If dehydration is a problem, institute a regular schedule for offering oral fluids. Use the least restrictive sites.

- Evaluate causes of incontinence. Institute a specific treatment depending on type. Place urinary collection bag at the end of her bed with catheter between rather than draped over her legs. Velcro bands can hold the catheter against her leg.

- Enlist the aid of her family or her friends to watch Ms. Mcgyver during confused periods. Give her something to hold like her favorite stuffed animals.

If Combative, determine the source of the fear and frustration, check for her fatigue, misleading or inappropriate stimuli, change in routine, environment, caregiver, pressure to exceed functional capacity, and physical stress.

Evaluation:

After 8 hours of nursing intervention, the patient was participated to the maximum level of independence in a therapeutic milieu as evidenced by the decreased frustration, diminished episodes of combativeness, increased hours of sleep at night, stabilized or increased weight.

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