Amnestic Disorders Nursing Care Plan and Management (Study Guide)

Amnestic disorders are about memory failing in one of three ways: old memories are lost, new memories cannot be formed, or new information cannot be taken in at all. On the floor you rarely see them in isolation. They usually ride inside the bigger syndromes of delirium or dementia, and your job is keeping the patient safe while the team hunts the underlying cause.

What are Amnestic Disorders?

The core defect is an inability to learn new information (short-term memory deficit) despite normal attention, plus an inability to recall previously learned information (long-term memory deficit). Know the types:

• Retrograde amnesia: loss of memory for events before the lesion or condition.
• Anterograde amnesia: inability to acquire new information or experiences during the period of impairment.
• Transient global amnesia: confusion or agitation that comes and goes repeatedly over several hours.
• Infantile amnesia: the normal phenomenon where most people cannot remember the first three to five years of life.

Causes

Amnestic disorders come from structural or chemical damage to the brain. The DSM-V lists two etiology categories:

• Due to a general medical condition. Head trauma, cerebrovascular disease, cerebral neoplastic disease, cerebral anoxia, herpes simplex encephalitis, poorly controlled insulin-dependent diabetes, and brain surgery. Transient amnestic syndromes can also follow epileptic seizures, electroconvulsive therapy, severe migraine, and drug overdose.
• Substance-induced persisting amnestic disorder. Tied to the lasting effects of alcohol, sedatives, hypnotics, anxiolytics, other medications, and environmental toxins. "Persisting" means the symptoms outlast intoxication or withdrawal.

Clinical Manifestations

Disorientation to place and time with profound amnesia. Inability to recall recent and remote events. Confabulation, where the patient invents events to fill the memory gaps. Apathy, lack of initiative, and emotional blandness are common.

Assessment and Diagnostic Findings

Labs rule diagnoses in or out:

• ABG. Oxygen saturation, or ABG with carbon monoxide level, may be diagnostic.
• Drug and toxin levels. When alcohol, drugs, or toxins are suspected, check serum ethanol, salicylate, acetaminophen, carbon monoxide, and other specific levels as indicated.
• CT scan. A head CT without intravenous contrast if CNS infection, trauma, or a cerebral vascular accident is suspected.

Medical Management

Safety first. Crews transporting an acutely confused, combative, or delirious patient protect both patient and staff. Treat suspected overdose-induced delirium off the ingestion history and toxidromes; this ranges from observation and supportive care, activated charcoal, gastrointestinal lavage, and sedation to specific antidotes and life support. Treatment hinges on identifying the underlying cause, which may not be pinned down during an ED stay. Specific cases need neurosurgery, neurology, or medicine subspecialty consults.

Pharmacological Management

• Sedatives. Calm acute agitation, control combative patients, and facilitate procedures.
• Glucose supplements. PO dextrose is absorbed from the intestine and raises blood glucose fast.
• Neuroleptics. Stronger calming effect than benzodiazepines in acutely agitated patients, and they act fast IV.
• Atypical antipsychotics. Newer neuroleptics with lower extrapyramidal risk and better efficacy against negative symptoms, thanks to enhanced serotonergic activity.
• Antidotes. Used when the toxic agent is known and has one, or as a coma cocktail in stuporous or comatose patients.

Nursing Management

Nursing Assessment

• Psychiatric interview. Describe mental status fully: behavior, flow of thought and speech, affect, thought processes and content, sensorium and intellectual resources, cognitive status, insight, and judgment.
• Serial assessment. Repeat assessments to catch the fluctuating course and acute changes. Interview family; with infants and young children, that history can be crucial.

Nursing Diagnosis

• Risk for trauma related to chronic alteration in brain tissue from aging, multiple infarcts, HIV disease, head trauma, chronic substance abuse, or a deteriorating physical condition.
• Chronic confusion related to alteration in brain tissue from long-term drug or toxic substance abuse.
• Self-care deficit related to cognitive impairment.
• Low self-esteem related to lost memory capacity.

Nursing Care Planning and Goals

The patient will voluntarily spend time with staff and peers in day-room activities, and will show increased self-worth through voluntary participation in self-care and interaction with others.

Nursing Interventions

• Encourage expression of feelings. Have the patient voice honest feelings about the lost level of functioning; acknowledge the pain and support them through grieving.
• Assist with memory deficit. Build memory aids so the patient functions more independently, which raises self-esteem.
• Encourage communication. Support attempts to communicate; if speech is unclear, restate what you think they meant.
• Reminisce. Use life review and present-day events; photo albums help.
• Encourage group participation. A caregiver may need to sit in at first until the patient feels the group will accept them despite communication limits.
• Provide support. Offer empathy when the patient is embarrassed at not remembering people, events, or places.
• Encourage independence. Push self-care, backed by a written schedule of tasks.

Evaluation

The patient initiates self-care on the written schedule and accepts help when needed, and interacts in group activities while keeping anxiety manageable.

Documentation Guidelines

Document individual findings (affecting factors, interactions, nature of social exchanges, specific behaviors), cultural and religious beliefs and expectations, the plan of care, the teaching plan, responses to interventions and teaching, and progress toward the desired outcome.