6.4 Applying the Nursing Process
Open Resources for Nursing (Open RN)
This section outlines the steps of the nursing process when providing care for adults with cognitive impairments.
Assessment
Nurses provide care for older adults in a wide variety of settings including acute care facilities, clinics, adult day care facilities, retirement communities, long-term care facilities, private homes, and community-based residential facilities (CBRF). It is vital for nurses to notice any signs of changing mental status based on the client’s baseline. Any new or sudden changes that indicate possible delirium should be urgently reported to the health care provider for further assessment of potential underlying health conditions. See the following box to view a delirium evaluation tool used by hospitals.
View the Delirium Evaluation Bundle shared by the Agency for Healthcare Research and Quality (AHRQ).
When assessing an adult client with a previously diagnosed cognitive impairment, there are several assessments to include on admission. Their medical history should be reviewed and a medication reconciliation completed. A general survey provides a quick, overall assessment of the way an individual interacts with their environment and their overall mobility status. A comprehensive neurological assessment should be performed to establish a client’s baseline neurological status. After a baseline status is determined, routine focused neurological assessments are performed to monitor for changes, such as asking the client to state their name, place, and the date, as appropriate.
Read more information about performing a neurological exam in the “Neurological Assessment” chapter of the Open RN Nursing Skills, 2e textbook.
Additional assessments include functional status and the client’s ability to perform activities of daily living (ADLs). A decline in the ability to perform self-care and maintain ADLs can affect the individual’s well-being. Functional declines can bring about feelings of inadequacy and lead to depression. The ability to live independently relies on maintenance of self-care skills, including bathing, dressing, and toileting. Other factors that must be considered include the ability to adequately handle finances; maintain a clean, safe environment; and to shop and prepare meals. When deficits in these areas occur, resources should be recommended to assist the individual to meet these needs.
Cognitive changes, including disorientation, poor judgment, loss of language skills, and memory impairment, should be assessed objectively using standardized tools. Common standardized tools used to assess a client’s mental status include the Mini Mental State Exam (MMSE) and the Mini-Cog.[1] See Figure 12[2] for an image of one of the questions included on the MMSE.
Cultural Considerations
Nurses provide culturally competent care for all individuals. Being aware of personal biases related to ageism and cognitive impairments is necessary when providing care for o