Alteration in Thought Processes
(Geriatrics)

(_)Actual (_) Potential

Related To:
[Check those that apply]
(_) Factors associated with aging.
(_) Other:_____________________________
____________________________________
____________________________________

 

As evidenced by:
[Check those that apply]
Major:
(
Must be present)
(_) Inaccurate interpretation of stimuli, internal and/or external.
Minor:
(
May be present)
(_) Cognitive defects, including abstraction, memory, suspiciousness, delusions, hallucinations, distractibility, lack of consensual validation, language, confusion/disorientation.

 

Date &
Sign.
Plan and Outcome
[Check those that apply]
Target
Date:
Nursing Interventions
[Check those that apply]
Date
Achieved:
The patient will:(_) Demonstrate optimum contact with reality.(_) Demonstrate an increase in self-care activities.

(_) Other:

 

(_) Assess for etiological and contributing factors:

  • physiological
  • situational

(_) Assess history of confusion (onset/duration).

(_) Determine the amount and type of stimuli needed by the patient in the context of his/her usual life style.

(_) Promote communication and sensory input.

(_) Promote a well role:

  • encourage ADL’s per patient as much as possible
  • meals out of bed yes/no_____
  • other:

(_) Other:________________
________________________
________________________
________________________

 

 

__________________________
Patient/Significant other signature

 

__________________________
RN signature