Acute Confusion

Definition: Abrupt onset of a cluster of global, transient changes and disturbances inattention, cognition, psychomotor activity, level of consciousness, and/or sleep/wake cycle


RELATED FACTORS

  • Over 60 years of age
  • Dementia
  • Alcohol abuse, drug abuse
  • Delirium [including febrile epilepticus (following or instead of an epileptic attack), toxic and traumatic]


DEFINING CHARACTERISTICS

Subjective

  • Hallucinations [visual/auditory]
  • [Exaggerated emotional responses]

Objective

  • Fluctuation in cognition
  • Fluctuation in sleep/wake cycle
  • Fluctuation in level of consciousness

SAMPLE CLINICAL APPLICATIONS: brain injury/stroke, respiratory conditions with hypoxia,medication adverse reactions, drug/alcohol intoxication, hyperthermia/infectious processes, malnutrition/eating disorders, fluid and electrolyte imbalances, chemical exposure.

Client Will (Include Specific Time Frame)

  • Regain/maintain usual reality orientation and level of consciousness.
  • Verbalize understanding of causative factors when known as able.
  • Initiate lifestyle/behavior changes to prevent or minimize recurrence of problem.


ACTIONS/INTERVENTIONS

Sample NIC linkages:

  • Delirium Management: Provision of a safe and therapeutic environment for the patient who is experiencing an acute confusional state.
  • Reality Orientation: Promotions of patient’s awareness of personal identity, time, and environment.

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