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Careplan

Cognitive Impairment, Adult

Dec.17.2019

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 Functional Independence

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
  • concentration poor
  • confusion
  • crying
  • difficulty learning or following instructions
  • disorientation
  • distractibility
  • fatigue
  • forgetfulness
  • impulsive behavior
  • inappropriate behavior
  • judgment impaired
  • labile mood
  • lack of awareness of present events
  • problem-solving ability altered
  • speech difficulty

Diagnostic Results

  • imaging study abnormalities

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.
  • Refrain from correcting or contradicting the patient’s perception for optimal interaction.
  • Promote a safe and calm environment (e.g., supervision, assistance); avoid sensory overload or deprivation.
  • Promote use of personal vision and auditory aids; provide orientation cues (e.g., calendar, clock, pictures).
  • Establish familiarity using a structured routine congruent with home schedule, when possible, to decrease risk of confusion and agitation (e.g., family presence, consistent caregiver, sleep and meal schedule, toileting schedule).
  • Encourage multimodal physical activity, exercise and complementary interventions, such as mindfulness, meditation, yoga and tai chi; consider combined exercise and cognitive activity.
  • Facilitate participation in activities, such as word games, discussion of current events and reminiscing to stimulate cognitive function and promote enjoyment.
  • Implement cognitive remediation or restorative techniques, such as training in direct attention, occupation, activity-based and functional communication strategies.

Associated Documentation

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

Education

CPG-Specific Education Topics

Overview

  • description

  • signs/symptoms

Self Management

  • activity

  • assistive/adaptive devices

  • cognitive support measures

  • home safety

  • prevent skin breakdown

  • 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.