Disturbed Thought Process — AIDS

Nursing Diagnosis: Thought Processes, disturbed

May be related to

• Hypoxemia, CNS infection by HIV, brain malignancies, and/or disseminated systemic opportunistic infection, cerebrovascular accident (CVA)/hemorrhage; vasculitis
• Alteration of drug metabolism/excretion, accumulation of toxic elements; renal failure, severe electrolyte imbalance, hepatic insufficiency

Possibly evidenced by

• Altered attention span; distractibility
• Memory deficit
• Disorientation; cognitive dissonance; delusional thinking
• Sleep disturbances
• Impaired ability to make decisions/problem-solve; inability to follow complex commands/mental tasks, loss of impulse control

Desired Outcomes

• Maintain usual reality orientation and optimal cognitive functioning.

Nursing Interventions	Rationale
Assess mental and neurological status using appropriate tools.	Establishes functional level at time of admission and provides baseline for future comparison.
Consider effects of emotional distress, e.g., anxiety, grief, anger.	May contribute to reduced alertness, confusion, withdrawal, and hypoactivity, requiring further evaluation and intervention.
Monitor medication regimen and usage.	Actions and interactions of various medications, prolonged drug half-life/altered excretion rates result in cumulative effects, potentiating risk of toxic reactions. Some drugs may have adverse side effects; e.g., haloperidol (Haldol) can seriously impair motor function in patients with AIDS dementia complex.
Investigate changes in personality, response to stimuli, orientation/level of consciousness; or development of headache, nuchal rigidity, vomiting, fever, seizure activity.	Changes may occur for numerous reasons, including development/exacerbation of opportunistic diseases/CNS infection. Note: Early detection and treatment of CNS infection may limit permanent impairment of cognitive ability.
Maintain a pleasant environment with appropriate auditory, visual, and cognitive stimuli.	Providing normal environmental stimuli can help in maintaining some sense of reality orientation.
Provide cues for reorientation, e.g., radio, television, calendars, clocks, room with an outside view. Use patient’s name; identify yourself. Maintain consistent personnel and structured schedules as appropriate.	Frequent reorientation to place and time may be necessary, especially during fever/acute CNS involvement. Sense of continuity may reduce associated anxiety.
Discuss use of datebooks, lists, other devices to keep track of activities.	These techniques help patient manage problems of forgetfulness.
Encourage family/SO to socialize and provide reorientation with current news, family events.	Familiar contacts are often helpful in maintaining reality orientation, especially if patient is hallucinating.
Encourage patient to do as much as possible, e.g., dress and groom daily, see friends, and so forth.	Can help maintain mental abilities for longer period.
Provide support for SO. Encourage discussion of concerns and fears	Bizarre behavior/deterioration of abilities may be very frightening for SO and makes management of care/dealing with situation difficult. SO may feel a loss of control as stress, anxiety, burnout, and anticipatory grieving impair coping abilities.
Provide information about care on an ongoing basis. Answer questions simply and honestly. Repeat explanations as needed.	Can reduce anxiety and fear of unknown; can enhance patient’s understanding and involvement/cooperation in treatment when possible.
Reduce provocative/noxious stimuli. Maintain bedrest in quiet, darkened room if indicated.	If patient is prone to agitation, violent behavior, or seizures, reducing external stimuli may be helpful.
Decrease noise, especially at night.	Promotes sleep, reducing cognitive symptoms and effects of sleep deprivation.
Maintain safe environment, e.g., excess furniture out of the way, call bell within patient’s reach, bed in low position/rails up; restriction of smoking (unless monitored by caregiver/SO), seizure precautions, soft restraints if indicated.	Provides sense of security/stability in an otherwise confusing situation.
Discuss causes/future expectations and treatment if dementia is diagnosed. Use concrete terms.	Obtaining information that ZDV has been shown to improve cognition can provide hope and control for losses.
Administer medications as indicated: Amphotericin B (Fungizone); ZDV (Retrovir) and other antiretrovirals alone or in combination; Antipsychotics, e.g., haloperidol (Haldol), and/or antianxiety agents, e.g., lorazepam (Ativan).	Antifungal useful in treatment of cryptococcosis meningitis. Shown to improve neurological and mental functioning for undetermined period of time. Cautious use may help with problems of sleeplessness, emotional lability, hallucinations, suspiciousness, and agitation.
Refer to counseling as indicated.	May help patient gain control in presence of thought disturbances or psychotic symptomatology.