Disturbed Thought Processes | Nursing Diagnosis for Renal Failure

Nursing diagnosis: Disturbed Thought Process related to physiological changes—accumulation of toxins, such as urea, ammonia; metabolic acidosis; hypoxia; electrolyte imbalances;
calcifications in the brain

Possibly evidenced by
Disorientation to person, place, time, situation
Memory deficit, altered attention span, decreased ability to grasp ideas
Impaired ability to make decisions, problem-solve
Changes in sensorium—somnolence, stupor, coma
Changes in behavior—irritability, withdrawal, depression, psychosis

Desired Outcomes/Evaluation Criteria—Client Will
Cognition
Regain or maintain optimal level of mentation.
Identify ways to compensate for cognitive impairment and memory deficits.

Nursing intervention with rationale:
1. Assess extent of impairment in thinking ability, memory, and orientation. Note attention span.
Rationale: Uremic syndrome’s effect can begin with minor confusion or irritability and progress to altered personality, inability to assimilate information or participate in care. Awareness of changes provides opportunity for evaluation and intervention.

2. Ascertain from significant other (SO) client’s usual level of mentation.
Rationale: Provides comparison to evaluate progression or resolution of impairment.

3. Provide SO with information about client’s status.
Rationale: Some improvement in mentation may be expected with restoration of more normal levels of BUN, electrolytes, and serum pH.

4. Provide quiet, calm environment and judicious use of TV, radio, and visitation.
Rationale: Minimizes environmental stimuli to reduce sensory overload and confusion while preventing sensory deprivation.

5. Reorient to surroundings, person, and so forth. Provide calendars, clocks, and outside window.
Rationale: Provides clues to aid in recognition of reality.

6. Present reality concisely and briefly, and do not challenge illogical thinking.
Rationale: Confrontation potentiates defensive reactions and may lead to client mistrust and heightened denial of reality.

7. Communicate information and instructions in simple, short sentences. Ask direct, yes or no questions. Repeat explanations as necessary.
Rationale: May aid in reducing confusion and increases possibility that communications will be understood and remembered.

8. Establish a regular schedule for expected activities.
Rationale: Aids in maintaining reality orientation and may reduce fear and confusion.

9. Promote adequate rest and undisturbed periods for sleep.
Rationale: Sleep deprivation may further impair cognitive abilities.

10. Prepare for dialysis.
Rationale: Marked deterioration of thought processes may indicate worsening of azotemia and general condition, requiring prompt intervention to regain homeostasis.