Nursing Diagnosis
Based on the symptoms listed in the scenario plan (demonstrating chronic confusion about times and places and forgetting important events like his wife’s passing away), the patient in question is demonstrating early signs of delirium. In more specific terms, the patient is demonstrating disturbed thought processes related to memory loss and possibly to neurological degeneration, possibly brought about by his 1) advanced age and 2) the fact that he lives alone (Harris, P. & 2006).
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"Nursing Board Discussion".
Outcomes
In light of this information, the nursing interventions will seek to 1) reduce the patient’s overall psychological stress and to 2) help the patient fight any further cognitive loss, given that early indications of delirium, if untreated, can rapidly degenerate within a matter of months (Fong et al., 2009) and lead to prolonged hospitalization stays. Upon discharge, nursing interventions will have to be routinely put into place, given that a generally mentally disordered patient who is easily confused can pose a danger both to himself and to his immediate surroundings (Fong, 2009). In general, the interventions listed below are preventive in nature to fight the onset of possible complications such as aspiration, pressure ulcers, pulmonary emboli, and decreased oral intake (Fong et al., 2009).
Interventions
Based upon the patient’s disordered attention and memory, the patient will need to be stimulated intellectually to activate and keep the mind busy, surrounded by friends and family to prevent isolation. It is important to recognize the presence of possible further complications, given that undiagnosed or untreated delirium cases can lead to permanent sequelae (Fong, 2009). As research has demonstrated, untreated cases can spiral into functional decline, loss of independence, and even death (Fong, 2009). In order to fight these possible complications, nursing interventions will be needed, given that 30-40% of delirium cases are preventable (Siddiqi, 2006). Upon discharge, changes will have to be made to the environment and to the patient’s routine.
1. The patient’s daughter may have to alter her house arrangements so that the environment remain calm and relaxing with soft lighting, night lights and limited noise levels. In order to limit the onset of further complications, the patient’s use of medications will have to be limited as much as possible, his needs pertaining to sleep, nutrition and fluids will have to be met and his hearing aid and eye glasses will have to be routinely checked. It is important to keep the patient as calm as possible at all times, given that the onset of confusion can rapidly lead to short-term memory loss, hallucinations, etc. This intervention is characterized as inter-dependent because the success of such an intervention will depend on the patient’s daughter, her immediate friends/family, the visiting nursing staff, etc.
2. A non-pharmacological sleep routine should be established that seeks to bring comfort and help the patient sleep at night, given that nighttime can be a particularly time due to nighttime confusion for delirium patients (Fong et al., 2009). As such, presenting the patient with a warm beverage such as a warm glass of milk or a herbal tisane, combined with relaxing/soothing music and a back massage or back rub, can help make the patient feel safe and at home in his daughter’s environment.
Conclusions
The chances are strong that the patient will feel safe and at home if the above-mentioned criteria are met. Research has indicated that patient care in a home setting can reduce delirium rates and/or duration (Inouye, 1993). That being said, immediate changes will have to be brought to the patient’s new home in terms of lighting, atmosphere, etc. so that the patient will always feel safe and undisturbed in his new surroundings. As mentioned above, it is important to maintain the patient’s sense of “normalcy” as much as possible by allowing his friends and social acquaintances to come visit him. That being said, it is always important to ensure that the patient feels safe and at ease, both physically and mentally, which includes not overwhelming him or contributing in any way to psychological distress.
- Fong, T. et al. (2009). Delirium in elderly patients: diagnosis, prevention and treatment. Nature Reviews Neurology, 5 (4), 210-220.
- Harris, P. (2006). The Experience of Living Alone with Early Stage Alzheimer’s Disease: What Are the Person’s Concerns? Alzheimer’s Care Quarterly, 7 (2), 84-94.
- Inouye, SK et al. (1993). A multicomponent intervention to prevent delirium in hospitalized older patients. New England Journal of Medicine, 340, 669-676.
- Siddiqi, N. (2006). Occurrence and outcome of delirium in medical in-patients: a systematic literature review. Age Ageing, 35, 350-364.
