Name : Yusuf Maulana Syafi'ulloh

NIM : 0121028

Domain 5. Perception-cognition
Class 1. Attention
Diagnostic Code: 00123
Nanda label: Unilateral neglect
Diagnostic focus: Unilateral neglect

NANDA Nursing Diagnosis Definition

The NANDA nursing diagnosis for unilateral neglect is defined as “an impaired ability to
orient toward or respond to stimuli or objects that are isolated to one side or direction of
space”. It includes a decrease in awareness of, and an inability to orient to, objects and/or
stimuli located entirely on one side of space.

Defining Characteristics

Subjective indicators of unilateral neglect include reports of decreased attention and

responsiveness to individuals, environments, or objects located exclusively on one side of
space. Objectively, patients will have poor performance on tests which require orientation
to, and response to, objects that are located in one direction or side of space. Examples of
such tests include drawing and matching objects, visual exploration tasks, focusing on
personal property tasks, spatial recognition tasks, and behavioral tests.

Related Factors

The related factors that contribute to unilateral neglect include a focal brain injury or
stroke, age-related changes, environmental distractions, and cognitive deficits. Focal brain
injuries such as stroke, tumor or trauma may impair the patient’s ability to process
information, orient to or respond to stimuli or objects on one side of space. Age-related
changes in cognitive processes, sensory perception, and motor skills can contribute to the
development of unilateral neglect. Environmental distractions, including noise or lighting,
can also contribute by limiting the patient’s ability to focus or concentrate. Finally,
comorbid cognitive deficits, particularly in executive functioning, have been associated
with increased risk of unilateral neglect.

Associated Conditions

In addition to unilateral neglect, other conditions may occur in association with it. These
include disorientation, confabulation, spatial illusions and delusions, visual field deficits,
balance deficits, and agnosia. Disorientation can occur due to damage to the frontostriatal
circuits of the brain, resulting in a decreased sense of direction and location. Confabulation,
the incorrect recollection of events or details, may occur in association with unilateral
neglect due to the patient’s distorted perception of space. Visual field deficits, such as
hemianopia, may be present when unilateral neglect is caused by a focal brain injury or
stroke. Balance deficits can also occur if the affected area of the brain controls
equilibrium. Finally, agnosia, an impairment of recognition or comprehension, may be
present if the patient has had an injury to the temporal lobes.

Suggestions For Use

In order to assist with the diagnosis and treatment of unilateral neglect, a number of
strategies can be employed. Assessment of attention span, spatial awareness,
concentration, orientation, and recall can provide valuable information regarding the
severity and extent of neglect. The use of compensatory strategies such as using rulers,
color-coding objects, and providing verbal cues can be used to reduce the impact of
neglectful behavior. Occupational and physical therapies may also be beneficial in assisting
the patient to regain some of their functional abilities. Finally, providing a supportive and
calming environment can help prevent further lapses in concentration or disease
progression.

Suggested Alternative NANDA Nursing Diagnoses

As part of the treatment and management of unilateral neglect, alternative or

supplemental care plans may be developed. Suggested alternatives for NANDA Nursing
Diagnoses include: impaired orientation; impaired spatial summation; impaired
understanding of instructions; impaired ability to perform sequential activities; impaired
recognition of others in environment; impaired perception of safety; and impaired cognition.
Each of these additional diagnoses will have their own intervention and evaluation
guidelines which must be taken into account.

Usage Tips

When implementing interventions for unilateral neglect, several tips should be kept in mind.
First, it is important to limit extraneous noise and visual stimuli to allow for more accurate
assessment of the patient’s degree of neglect. Second, break down tasks into smaller units
to make them more achievable by the patient and easier to measure progress. Third,
introduce simple cueing techniques and environmental prompts in order to call the patient’s
attention to stimuli on one side of their environment. Finally, develop comprehensive,
customized goals that are focused on improving quality of life and functioning.

NOC Outcomes

NOC Outcomes are a set of measurable goals that are utilized in the calculation of
appropriate levels of nursing care. The following NOC Outcomes can be used to assist in the
treatment and management of unilateral neglect.

 Attention Span: This outcome measures the patient’s ability to focus and maintain
the required focus in order to process the requested information and respond
correctly.
 Spatial Orientation and Awareness: This outcome measures the patient’s ability to
locate, locate and recognize objects and sensations in their environment.
 Concentration: This outcome measures the patient’s ability to maintain focus on
tasks over an extended period of time.
  Memory: This outcome measures the patient’s ability to accurately recall and store
information.
 Risk Management: This outcome measures the patient’s understanding of, and
ability to utilize, strategies that reduce the risk of injury or harm.
 Self-Care and Mobility: This outcome measures the patient’s ability to attend to
personal needs, such as dressing and grooming, with minimal assistance.

Evaluation Objectives and Criteria

The evaluation objectives and criteria for unilateral neglect have been designed to
measure the patient’s ability to complete tasks while maintaining attention and
concentration. Examples of evaluation objectives can include the ability to orient to and
respond to stimuli on one side of space; to identify objects or letters on one side of space;
to independently perform self-care tasks; or to identify and remember objects located in a
particular area of the room. Evaluation criteria should include accuracy and speed of task
completion, and appropriate use of cueing and environmental prompts.

NIC Interventions

NIC Interventions are a set of standardized interventions that are utilized to attain the
desired outcome when treating patients with unilateral neglect. Examples of NIC
Interventions for unilateral neglect include: compensatory orientation interventions;
habilitation activities; vestibular stimulation; and compensatory sensory aids.
Compensatory orientation interventions involve activities designed to improve the patient’s
spatial orientation and awareness. Habilitation activities are designed to improve
functional abilities, such as ADLs, and to promote independence. Vestibular stimulation is
designed to reduce dizziness and correct perception of body position. Finally, compensatory
sensory aids, such as mirrors and tactile guides, are used to remind the patient of
forgotten information or to draw attention to relevant objects in the environment.

Nursing Activities

Nursing activities that are beneficial to patients suffering from unilateral neglect include:
monitoring symptoms and reactions while interacting with patients; providing technical
support as needed during activities of daily living; utilizing verbal and physical prompts to
orient the patient to relevant environmental cues; providing activities that build upon
previously mastered steps; implementing creative strategies to adjust and modify task
levels; and providing emotional support and therapeutic touch. Additionally, encouragement
and reinforcement should be provided upon the completion of individual tasks or activities.
Name : Yusuf Maulana Syafi’ulloh
NIM : 0121028

Domain 5. Perception-cognition
Class 5. Communication
Diagnostic Code: 00051
Nanda label: Impaired verbal communication
Diagnostic focus: Verbal communication

NANDA Nursing Diagnosis Definition

Impaired verbal communication nursing diagnosis is defined as difficulty expressing and

understanding verbal information communicated through speaking, writing, symbols, and
body language.

Defining Characteristics

Nurses use two categories to define impaired verbal communication. These are subjective
and objective assessments of communication difficulties observed by the nurse while
interacting with the patient.

Subjective Defining Characteristics

 Visible distress resulting from difficulty in communicating effectively

 Impaired ability to value and understand spoken language, writing, symbols, and
body language
 Difficulties in expressing thoughts, feelings, and unmet basic needs

Objective Defining Characteristics

 Inability to have a cohesive conversation and express ideas clearly

 Difficulty making appropriate eye contact
 Lack of general knowledge relating to learned language

Related Factors

There can be many underlying causes that contribute to impaired verbal communication.
Some of the related factors are:

 Cognitive impairment: Cognitive impairment due to aging, illness, or trauma may

lead to an impaired verbal communication.
 Presence of altered sensory perception: Alterations in the sense of hearing, sight,
touch, smell, and taste can lead to difficulty in verbal communication.
 Presence of changes in the level of consciousness: Changes in the level of
consciousness due to drug overdose, psychological conditions, or postoperative
complications can lead to decreased level of verbal communication.
 Use of unreliable language: If a person is using slang or dialect words, it can cause
 difficulty in verbal communication.

At Risk Populations

At risk populations include those individuals with certain preexisting conditions who are
more likely to be affected by impaired verbal communication:

 Aged patients: Elderly individuals are at a greater risk of developing impaired verbal
communication as they age.
 Patients with cognitive disabilities: Patients with any type of cognitive impairment
can experience verbal communication difficulties.
 Context-specific communication barriers: Patients living in an unfamiliar cultural
context may have difficulty communicating verbally due to confusion over accents
or dialects.
 Patients with intellectual impairments: Intellectual or developmental delays can
contribute to communication difficulties.

Associated Conditions

Patients with impaired verbal communication usually experience other physical and
psychological issues. The associated conditions include:

 Behavioral disturbances: Behavioral disturbances can range from agitation to

aggressive behaviors.
 Self-isolation: As a result of their verbal communication impairment, patients may
isolate themselves from social contacts and interactions.
 Anxiety and depression: Patients may feel overwhelmed by their inability to
communicate, leading to higher levels of anxiety and depression.
 Communication burnout: Patients may suffer from communication burnout due to
often being misunderstood or feeling frustrated when trying to communicate.

Suggestions of Use

In order to best serve an individual with impaired verbal communication, it is important to

understand the individual’s needs and how to meet them. Here are a few suggestions of use
when working with these patients:

 Allow more time for answering questions.

 Ask the patient in simple, direct, and concrete language to clarify any
misunderstandings.
 Provide alternate forms of communication such as pictures, drawings, gestures, and
sign language.
 Use a variety of methods including music, art, and physical activities to supplement
communication.
 Encourage the use of device-based communication tools (e.g., voice recognition or
speech to text) that can help overcome the barrier of verbal communication.

Suggested Alternative NANDA Nursing Diagnoses

The following are alternative NANDA nursing diagnoses to guide the assessment and
management of clients with impaired verbal communication:

 Readiness for enhanced verbal communication: This diagnosis reflects the patient’s
need to strengthen their communication skills.
 Noncompliance with therapeutic regimen: Patients unable to verbally communicate
can easily lack understanding and compliance with prescribed treatments and
therapies.
 Decisional conflict: Patients may not be able to express their choices due to
communication difficulties.
 Impaired social interaction: Social interactions with friends, family, and care staff
may be reduced due to the verbal communication impairments.

Usage Tips

When assessing a patient for impaired verbal communication, nurses must pay attention to
their communication patterns and look out for potential red flags. Also, nurses must be
aware of the potential risk factors and always open to learning new skills and techniques
that may help them better assess, diagnose, and manage patients with impaired verbal
communication.

NOC Outcomes

NOC outcomes related to impaired verbal communication include:

 Communication: A measure of the effectiveness of communication with others.

 Interpersonal Relationships: A measure of the quality of relationships with family
and other significant people.
 Psychosocial Adaptation: A measure of adaptability to physical, emotional and
social stressors.
 Social Interaction: A measure of effectiveness in establishing and maintaining
social contacts.

Evaluation Objectives and Criteria

Evaluation objectives and criteria allow nurses to measure progress and check whether
patients are achieving improved verbal communication skills. Evaluation objectives must
be tailored to the individual’s needs and goals while criteria must be measurable and
realistic. Some examples of evaluation objectives and criteria include:

 Objective: To increase the patient’s ability to communicate needs and receive

support.
Criteria: Patient will demonstrate increased ability to communicate needs, be able
to initiate conversations, and express feelings with less apprehension.
 Objective: To enable the patient to form meaningful interpersonal
relationships. Criteria: Patient will display an understanding of communication
protocols, express appropriate feelings, and build trust in relationships.
NIC Interventions
NIC interventions related to impaired verbal communication include:

 Alternative Communication Strategies Training: This intervention focuses on

teaching alternative strategies to facilitate communication. These strategies may
include sign language, use of drawings and pictures, talking boards, and partner-
assisted scanning.
 AAC Device Programing: This intervention is aimed at helping patients develop their
skills in using assistive devices to communicate.
 Communication Rights Advocacy: This intervention is intended to help educate and
inform patients about their right to communicate and the services available to
them.
 Cognitive-Linguistic Enhancement: This intervention focuses on improving language
and comprehension skills.

Nursing Activities

Nursing activities related to impaired verbal communication include:

 Assess the patient’s level of verbal communication.

 Formulate goals for therapy and interventions.
 Implement therapeutic interventions to improve patient’s verbal communication.
 Collaborate with interdisciplinary team to assess the patient’s capacities and level
of assistance needed.
 Refer the patient to other specialists as appropriate.
 Include family and caregivers in the treatment plan meetings.
 Provide emotional support and guidance to the patient.
 Monitor the patient’s progress and response to therapy.
Name : M. Farizal Maulana
NIM : 0121031

Domain 5. Perception-cognition
Class 4. Cognition
Diagnostic Code: 00131
Nanda label: Impaired memory
Diagnostic focus: Memory

Nursing Diagnosis Definition

The definition of impaired memory according to the NANDA nursing diagnosis taxonomy is a
reduced ability to recall past experiences and/or learn new information. In nursing
diagnosis, impaired memory is characterized by diminished ability of capabilities related to
retaining information, such as decreased learning and impaired thinking. It also includes a
lack of interest or motivation to remember or focus on what has been learned.

Defining Characteristics

Subjective

 Reports difficulty remembering details

 Decreased concentration
 Agitation or confusion
 Difficulty coping with daily routine

Objective

 Reduced attention span

 Difficulty following instructions
 Poor judgement
 Increased forgetfulness
 Inability to follow conversations

Related Factors

 Asphyxia: Asphyxia is a condition caused by lack of oxygen which often leads to

impaired ability of the brain to encode, store, and retrieve memories.
 Medication Side Effects: Certain medications may have side effects that can lead to
impairment in cognitive function, including memory.
 Substance Abuse: The use of drugs and alcohol can affect the individual’s ability to
remember.
 Stress: Stress and anxiety can negatively impact memory recall.
 Injuries: Traumatic brain injury or other physical injuries can cause memory loss.

At Risk Population
Certain populations are more at risk for developing a diagnosis of impaired memory. These
include:

 Older adults
 People who have experienced a stroke
 Patients with Alzheimer’s disease
 Patients with head trauma
 Patients diagnosed with dementia
 Individuals with learning disabilities
 Individuals who experience long-term psychological distress

Associated Conditions

In addition to having impairments in memory, people with nursing Diagnosis Impaired

Memory may also display one or more of the following associated conditions:

 Problems with reasoning

 Problems with communication
 Difficulty with learning
 Difficulty understanding social cues
 Apathy
 Irritability

Suggestions for Use

Nurses can use various strategies when assessing patients with a diagnosis of impaired
memory. These strategies may include:

 Assess the patient’s ability to remember information, using various tests and
assessments.
 Monitor the level of agitation or confusion that the patient is exhibiting.
 Pay attention to changes in patient behavior, as these may be indicative of
cognitive problems.
 Ask questions that require the patient to think critically.
 Ask meaningful questions that allow the nurse to assess the patient’s response to
their environment and gauge how receptive they are to information being presented.
 Listen carefully to the patient’s answers, as this can help identify patterns of
incorrect responses.

Suggested Alternative Nursing Diagnosis

 Delirium
 Dementia
 Disturbed Sleep Pattern
 Impaired Verbal Communication
 Risk for Injury
 Ineffective Coping
 Acute Confusion
  Chronic Confusion

Usage Tips

When working with patients diagnosed with impaired memory, it is important to:

 Allow ample time to ensure that the patient has processed and understood
information presented to them.
 Explain instructions step-by-step, using simple language that is easy to understand.
 Utilize visual cues to help the patient remember key concepts.
 Have a family member, friend, or caregiver present to provide extra support and
assistance.
 Encourage the patient to ask questions as needed and provide clarifications as
required.

NOC Outcomes

Nursing Outcomes Classification (NOC) is a standardized method for assessing patient

outcomes. In cases of nursing diagnosis impaired memory, the following NOC outcomes are
often sought after:

 Orientation: This outcome focuses on how well the patient is oriented to the
environment and how well they are able to process information.
 Comprehension: This outcome focuses on the patient’s ability to understand
information presented to them.
 Memory: This outcome evaluates the patient’s ability to recall recent information.
 Learning: This outcome evaluates the patient’s ability to learn new things.
 Problem Solving: This outcome focuses on the patient’s ability to logically solve
problems.

Evaluation Objectives and Criteria

For evaluating a patient’s ability to alert them of their impairment and make appropriate
decisions, the criteria include:

 Recognizing personal deficits

 Making appropriate decisions
 Understanding safety risks
 Taking action to maintain personal safety
 Making changes to lifestyle to address the impairment

NIC Interventions

Nursing Intervention Classification (NIC) is a standardized way of classifying nursing

interventions. In cases of nursing diagnosis impaired memory, the following NIC
interventions may be used:

 Patient Centered Care: This intervention prioritizes the patient’s needs, preferences
 and values, focusing on their individual strengths and abilities.
 Environmental Management: This intervention helps create a safe, supportive
environment for the patient which limits avoidable risks and encourages
independent living.
 Education: This intervention focuses on providing information about the diagnosis,
expected treatment and potential long-term effects.
 Physical Assistance: This intervention helps assist the patient with walking,
maintaining cleanliness and basic self-care tasks.
 Intercessory Prayer: This intervention involves providing spiritual support and
comfort to the patient.
 Cognitive Stimulation: This intervention provides activities to stimulate the patient’s
memory, increasing the chances of positive outcomes.
 Social Support: This intervention provides support from family and friends, helping
the patient feel valued and loved.

Nursing Activities

When working with patients diagnosed with nursing diagnosis impaired memory, nurses need
to perform several activities. These activities include:

 Assessing the patient’s cognitive ability

 Evaluating the patient’s ability respond to given stimuli
 Facilitating therapeutic conversations between the patient and family
 Engaging in activities designed to reduce cerebral stress
 Assisting the patient with exercises designed to improve memory-recall abilities
 Providing education to the patient and their family concerning the diagnosis and
treatment options