Nursing Student's Helpful Hints: How to Care for the Confused Client

Caring for the confused client can be challenging at best. These are tips for known confused clients. If someone is unexpected confused you should be checking vital signs, oxygen saturation, glucose levels etc. that is a different situation. Here are some ideas that may be helpfulfor the known confused client:

Cover any tubes if possible-that could be covering your IV site with gauze or coban tape, putting the gown over G-tube, etc. Out of sight out of mind.

Put tubing in places where the person cannot reach-the foot of the bed is a great place for chest tube containers, foley bags

Put items in unusual places-start IV's in the inner aspect of the upper arm, put telemetry patches and medication patches such as nitroglycerin on the client's upper back

Put items behind your patient-NGT, IV, and oxygen tubing can be neatly placed behind your patient and can be draped under a pillow

Prioritize your medication-Many confused clients may take one or two medications but not the three hundred that have been prescribed for him/her. Pick the most important ones i.e. cardiac meds and give them first. Save the vitamins for last. That way if the client says I don't want anymore, you've given the ones that are needed most.

Medication administration/ Activity schedule may need to be flexible-Since many confused clients have short-term memory loss and/or mood changes, assess their mood. If you experience resistance or if the patient takes one pill then refuses the rest stop and come back in 30 minutes. The same goes with activity such as bathing or eating. Some times a different staff member has better luck with that particular patient or maybe a family member can help. Disguising activities as something the patient is willing to do is another strategy. If a patient is willing to get their hair brushed suggesting it would be much easier to do if they were in the chair will help you accomplish getting them to sit in the chair.

Other things to keep in mind:
Confused clients can't always verbalize their needs or respond to signals from their body. Agitation can be a symptom, but not the problem. Agitation often occurs as a result of pain or elimination needs. Confusion doesn't make a client experience less pain. You want to provide medication as needed. It's sad to have a patient tell you their stomach hurts so bad and they don't know why because they dont' remember they have had gallbladder surgery and no pain med in 12 hours.

A lot of falls occur when patients try to get out of bed to go to the bathroom. Frequent toileting will help. This will also decrease incontinence as it often results from inability to verbalize the needs to eliminate not inability to control elimination. Check when their last bowel movement was documented and consider problems like urinary retention or infection.

If pain or elimination needs are ruled out movement or increasing/decreasing stimulation may help. Ambulating the patient helps to get rid of anxiety and is calming. Stimulation can be helpful or problematic. Having a scary movie on TV that a patient may think is real can be very scary for the patient. However, my most quiet hour with confused patients is when the Price is Right is on (Wheel of Fortune for evening shift). Addressing patients by name, stating who you are and what you are doing, and reassurance can also help these patients.

For health care professionals and family it is important not to take the behavior of confused patients personally. It is the result of a medical condition not a personal attack. It is not your fault or the patient's fault. Having a calm demeanor yourself and patience will go a long way in caring for a confused client.