Nanda Acute Confusion

Nanda - Acute Confusion Definition:

Abrupt onset of a cluster of global, transient changes and disturbances in attention, cognition, psychomotor activity, level of consciousness, or the sleep/wake cycle

Defining Characteristics:

Lack of motivation to initiate and/or follow through with goal-directed or purposeful behavior; fluctuation in psychomotor activity; misperceptions; fluctuation in cognition; increased agitation or restlessness; fluctuation in level of consciousness; fluctuation in sleep-wake cycle; hallucinations

Related Factors: 

60 years of age; dementia; alcohol abuse; abuse; delirium; uncontrolled pain; multiple morbidities and medications

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
  • Distorted Thought Control
  • Information Processing
  • Memory
  • Neurological Status: Consciousness
  • Safety Behavior: Personal
  • Sleep
Client Outcomes
  • Cognitive status restored to baseline
  • Obtains adequate amount of sleep
  • Demonstrates appropriate motor behavior
  • Maintains functional capacity
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
  • Delusion Management 
http://nursing-diagnosis-intervention.blogspot.com

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