Purpose

• Confusion has many causes. Diseases, infections, hearing and vision loss, drug side effects, and brain injury are some causes.
• Acute confusion (delirium) occurs suddenly and is usually temporary. Causes include infection, illness, injury, drugs, and surgery. Treatment is aimed at the cause.
• Confusion from physical changes cannot be cured. Some measures help improve function. You must meet the person’s basic needs.
• Dementia is the loss of cognitive function that interferes with routine personal, social, and occupational activities. It is not a normal part of aging. Early warning signs include:
  • Recent memory loss that affects job skills
  • Problems with common tasks, such as dressing, cooking, and driving
  • Problems with language, such as forgetting simple words
  • Getting lost in familiar places
  • Misplacing things and putting things in odd places
  • Personality changes
  • Poor or decreased judgment
  • Loss of interest in life
• If brain changes have not occurred, some dementias can be reversed. Treatable causes include drugs, alcohol, delirium, depression, tumors, head injuries, infection, vision and hearing problems, and heart, lung, and blood vessel problems.
• Delirium and depression can be mistaken for dementia.
  • Delirium is a state of sudden, severe confusion and rapid changes in brain function. Usually temporary and reversible, it occurs with physical or mental illness. It is an emergency.
  • Depression is the most common mental health problem in older persons. It is often overlooked.

Equipment

Roll cursor over items to see labels. For the purposes of clearly depicting the equipment, a barrier is not shown in this photo. When providing care, a barrier should always be placed on the surface before placing the equipment.

Large calendar

Clock with large numbers

Eyeglasses

Hearing aids

Framed family photograph

Family photo album

Magazines

Radio/CD player

Standard nightlight

Sensor nightlight

Plastic cup with lid

Plastic eating utensils

Wheelchair

Delegation

• Follow delegation guidelines. Before caring for the person with confusion and dementia, obtain this information from the nurse and care plan:
  • Specific types of care noted in the care plan
  • What observations to report and record
  • When to report observations
  • What patient or resident concerns to report at once

Preparation

• Observe quality-of-life measures.
• Review the information under Delegation and Safety and Comfort.
• Practice hand hygiene.
• Collect the equipment.
• Identify the person. Check the ID bracelet against the assignment sheet. Also call the person by name.
• Focus on PRIDE:
  • Personal and professional responsibility
  • Rights and respect
  • Independence and social interaction
  • Delegation and teamwork
  • Ethics and laws

Safety

• Always provide for safety.
• Because delirium is an emergency, observe for its signs and symptoms, including:
  • Changes in alertness, sensation, and awareness
  • Slow movement or inactivity
  • Drowsiness
  • Confusion about time or place
  • Decreased memory
  • Thinking and behavior that are without purpose
  • Difficulty concentrating
  • Speech that does not make sense
  • Emotional changes, such as anger, anxiety, apathy, depression, euphoria, or irritability
  • Incontinence
  • Restlessness

Comfort

• Provide a calm, relaxed, and peaceful setting. Prevent loud noises, rushing, and congested hallways and dining rooms.
• Follow the person’s routine. Meals, bathing, exercise, TV, bedtime, and other activities have a schedule. This promotes a sense of order and what to expect.

Follow-up Care

• Provide for comfort.
• Place the call light within reach.
• Raise or lower bed rails. Follow the care plan.
• Complete a safety check of the room.
• Practice hand hygiene.

Reporting/Recording

• Report and record your observations, including any changes in the person’s condition.