Physiologic Aspects of CONFUSION

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Abstract
The articles prior to January 2008 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here Mary Opal Wolanin, RN, MPA Introduction Any discussion of confusion requires beginning with a definition, but there are no neat, firm definitions of confusion that separate it from absolutely everything else. No one can say: "This and only this is confusion." So often the meaning is relevant to the situation. Confusional behavior includes a constellation of behaviors that are given the label "confusion" because they baffle the caregiver, as much as anyone. What is confusion in one situation may seem quite right and proper in another. The behaviors usually included in a definition of confusion are: Loss of memory - first for recent events and later for remoteevents, and easy distractibility, or an inability to concentrate on anything for a sufficient length of lime to be productive. This may be more an inability to organize one's efforts. Communication that often borders on incoherence so far as logical thinking processes are concerned. This is one of the first really apparent signs, for it interferes with the staff's ability to work with the client in an effective way. Communication problems may not be the first sign, but they may be first that catch and hold the caregiver's attention. Lack of judgment. This is a subjective evaluation on the part of the caregiver, and is based on the caregiver's expectations and particular sense of values. It is undoubtedly linked to inability to use past judgments. It is another function of memory loss by which the past is denied access to the present. An inability to put cues together to form a meaningful pattern, e.g., the confused person who sees hot sunshine is unable to associate it with daylight, or summer. Uniformed nurses and hospital wards are not associated with illness or hospitals. There is a difference between not knowing, or not having access to information, and being unable to tap into the storage places of the mind for the process of retrieving the right memory bits and assembling the whole into meaning. Add to the above an inability to maintain control over one's possessions and routines, and you have a picture of confusion. Confusion, then, is shorthand for a number of behaviors that render a person unable to use the mind in its usual way. It represents a change in mental status from a state in which the client seemed a relatively whole person in control of life. Baseline information is important, and should be gathered on admission rather than after strange behavior forces the issue. Remember, there are people who have never expressed a coherent thought in their lives. It is their normal, natural state - normal for them. And we all know totally disorganized people who accept disorganization as normal, for they have never known another way of thinking. Unfortunately, humans are not made of little compartments neatly labeled physiology, mental health, social being, etc. We are a unity. Some of us prefer to see the human being as a physiologic process; others prefer to see the human being as a social interactional process. As humans we are both, and much more. Desmond Cormack1 took the FANAPES model I adapted from June Abbey's work2 and explained · this. Cormack states that, in any physiologic problem, the physiologic needs are primary, that is, the need for adequate air, fluid, nourishment, elimination and pain relief. Secondary to these there is always the need for communication, activity, sexuality, dependency, and psychomotor and interpersonal social skills. And there are secondary nonphysical problems, including trust, hostility, reality orientation and perception, affect, anxiety, selfesteem, cognition, and intellectual processes. In mental health problems, the last named problems become primary. The physical problems are… 10.3928/0098-9134-19810401-09

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