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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