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Careplan

Cognitive Impairment, Adult

Jan.13.2021

Cognitive Impairment (Adult Inpatient)

Clinical Description

  • Care of the hospitalized patient experiencing impairment related to cognitive skills that include attention, memory, orientation, judgment, reasoning, problem-solving and executive functioning with reasonable potential for improvement.

Key Information

  • Language and culture may affect results of standardized assessment tools. Choose tools appropriate for the patient to provide the most accurate cognitive assessment.
  • Hospitalization and illness stress cognitive abilities and exacerbate dysfunctional behaviors.
  • It is important to identify and address safety concerns related to cognitive dysfunction, such as medication adherence, decision-making capacity, safety with functional mobility tasks and wandering.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Optimal Cognitive Function

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Overview
  • Education: Self Management
  • Education: When to Seek Medical Attention

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • health literacy
    • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Cognitive Impairment

Signs/Symptoms/Presentation

  • aggression
  • agitation
  • apathy
  • concentration poor
  • difficulty learning or following instructions
  • disorientation
  • distractibility
  • forgetfulness
  • impulsive behavior
  • irritability
  • judgment impaired
  • memory impaired
  • problem-solving ability altered
  • reasoning ability impaired
  • word-finding difficulty

Problem Intervention

Optimize Cognitive Function

  • Assess cognitive function using a standardized tool to establish baseline and identify areas of deficit.
  • Establish rapport and trust; utilize unhurried and calm approach.
  • Utilize clear communication; address patient by name, speak slowly with simple directions and gestures; provide time for patient response, listen carefully and maintain eye contact.
  • Provide environmental adaptations to support cognitive function and safety; consider sensory exposure, hearing ability and distractions.
  • Establish familiarity using a structured routine congruent with home schedule, when possible, such as family presence, consistent caregiver, sleep and meal schedule, toileting schedule.
  • Provide conducive environment for sleep, such as uninterrupted sleep times and light therapy.
  • Optimize nutrition and fluid intake; encourage and offer fluid intake frequently and assist with meal set-up and feeding if needed.
  • Encourage multimodal physical activity, exercise and complementary interventions, such as mind-body exercise; consider combined exercise and cognitive activity.
  • Implement cognitive remediation or restorative techniques, such as training in direct attention, occupation, activity-based and functional communication strategies.

Associated Documentation

  • Environment Familiarity/Consistency
  • Self-Care Promotion
  • Sensory Stimulation Regulation

Education

CPG-Specific Education Topics

Overview

  • risk factors

  • signs/symptoms

Self Management

  • activity

  • assistive/adaptive devices

  • cognitive support measures

  • home safety

  • provider follow-up

  • rehabilitation therapy

When to Seek Medical Attention

  • unresolved/worsening symptoms

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support

References

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Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.

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