Altered thought process

Presented to:
•Maj Sadia Kanwal
Presented by:
•N/C Fakhra Shabir
 Altered thought process
The state in which an individual experiences a
disruption in such mental activities as conscious
thought, reality orientation, problem-solving,
judgment, and comprehension related to coping,
personality, and/or mental disorder.
Causes
Causes are biochemical or psychological
disturbances like depression and
personality disorders.

Physiological changes
 Aging
 Head injuries
 Hypoxia
 Infections
 Malnutrition
 Biochemical changes
 Alcohol
 Medications
 Substance abuse

Maturational
 Isolation
 Late-life depression
 Situational (Personal, Environmental)
 Abuse (physical, sexual, mental)
 Childhood trauma
 Torture

Psychological conflicts
 Anxiety
 Depression
 Emotional changes
 Fear
 Grieving
 Mental disorders
SIGN AND SYMPTOMS
Major (Must Be Present)
Inaccurate interpretation of stimuli, internal or external

Minor (May Be Present)

Cognitive deficits (abstraction, problem-solving, memory deficits)
Confusion/disorientation
Delusions
Distractibility
Hallucinations
Impulsivity
Inappropriate social behavior
Lack of consensual validation
Obsessions
Phobias
Ritualistic behavior
Suspiciousness
 Assessment
Identify factors present [acute/chronic brain
syndrome (recent stroke, Alzheimer’s disease),
brain injury or increased intracranial pressure,
anoxic event, acute infections, malnutrition, sleep
or sensory deprivation, chronic mental illness
(schizophrenia)].
Determine alcohol/other drug use.
Review laboratory values for abnormalities such
as metabolic alkalosis, hypokalemia, anemia,
elevated ammonia levels, and signs of infection.
Assess dietary intake/nutritional status.
Rationale
Identifying factors present is important to know
the causative/contributing factors.
Drugs can have direct effects on the brain, or have
side effects, dose-related effects, and/or
cumulative effects that alter thought patterns and
sensory perception.
Monitoring laboratory values aids in identifying
contributing factors.
This helps in identifying contributing factors.
 Assessment Rationale
Assess attention span/distractibility and ability This determines the ability of the patient to
to make decisions or problem solve. participate in planning/executing care.

Assist with testing/review results evaluating This is to assess the degree of impairment
mental status according to age and
developmental capacity.

Interview caregiver to determine patient’s usual This is to provide baseline for comparison.
thinking ability, changes in behavior, length of
time problem has existed, and other pertinent
information.
Perform periodic neurological/behavioral Early recognition of changes promotes
assessments, as indicated, and compare with proactive modifications to plan of care.
baseline.
 Nursing Diagnosis
The diagnosis Disturbed Thought Processes describes an individual
with altered perception and cognition that interferes with daily living.
 Goals and Outcomes
The following are the common goals and expected outcomes for Disturbed Thought
Processes:

 Patient maintains reality orientation and communicate clearly with others

 Patient recognizes changes in thinking/behavior.
 Patient recognizes and clarifies possible misinterpretations of the behaviors and
verbalization of others.
 Patient identifies situations that occur before hallucination/delusions.
 Patient uses coping strategies to deal effectively with hallucinations/delusions.
 Patient participates in unit activities.
 Patient expresses delusional material less frequently.
 Patient appropriately interacts and cooperates with staff and peers in therapeutic
community setting.
 Interventions Rationale
Assist with treatment for underlying problems, Cognition/thinking often improves with
such as anorexia, brain injury/increased treatment/correction of medical/psychiatric
intracranial pressure, sleep disorders, problems.
biochemical imbalances.

Reorient to time/place/person, as needed. Inability to maintain orientation is a sign of

deterioration.

Have patient write name periodically; keep this These are important measures to prevent further
record for comparison and report differences. deterioration and maximize level of function.

Provide safety measures (e.g., side rails, It is always necessary to consider the safety of
padding, as necessary; close the patient.
supervision, seizure precautions), as indicated.
 Interventions
Schedule structured activity and rest periods
.
Maintain a pleasant and quiet environment and
approach patient in a slow and calm manner.
Present reality concisely and briefly and do not
challenge illogical thinking. Avoid vague or evasive
remarks.
Be consistent in setting expectations, enforcing
rules, and so forth.
Do not flood patient with data regarding his or her
past life.
Rationale
This provides stimulation while reducing fatigue.
Patient may respond with anxious or aggressive
behaviors if startled or overstimulated.
Delusional patients are extremely sensitive about
others and can recognize insincerity. Evasive
comments or hesitation reinforces mistrust or
delusions.
Clear, consistent limits provide a secure structure for
the patient.
Individuals who are exposed to painful information
from which the amnesia is providing protection may
decompensate even further into a psychotic state.
 Interventions Rationale
Identify specific conflicts that remain Unless these underlying conflicts are resolved,
unresolved, and assist patient to identify any improvement in coping behaviors must be
possible solutions. viewed as only temporary.
Provide nutritionally well-balanced diet,
incorporating patient’s preferences as able.
These enhance intake and general well-being.
Encourage patient to eat. Provide pleasant
environment and allow sufficient time to eat.
Recognize and support the patient’s
Recognizing the patient’s accomplishments can
accomplishments (projects completed,
lessen anxiety and the need for delusions as a
responsibilities fulfilled, or interactions
source of self-esteem.
initiated).
Encourage patient to participate in
resocialization activities/groups when available. This is to maximize level of function.
 Interventions
Identify problems related to aging that are
remediable and assist patient to seek appropriate condition rather that accept the present status.
assistance/access resources.
Assist patient and caregiver develop plan of
care when problems are progressive/long term.
Refer to community resources (e.g., day-care
programs, support groups, drug/alcohol
rehabilitation, mental health treatment
programs).
Assist in identifying ongoing treatment
needs/rehabilitation program for the individual.
Rationale
These encourage problem-solving to improve
Advance planning addressing home care,
transportation, assistance with care activities,
support and respite for caregivers, enhance
management of patient in home setting.
These measures are necessary to promote
wellness.
This measure is important to maintain gains and
continue progress if able.