NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00173 |
|---|---|
| Label | Risk for acute confusion |
| Spanish label | Riesgo de confusión aguda |
| Domain | 5. Perception / cognition |
| Class | 4. Cognition |
| Type | Risk |
| Status | Current |
What it means
Over hours or days, the person may develop a state of confusion: they lose attention, become disoriented, and their level of alertness changes throughout the day. It hasn't happened yet, but the illness, the treatment or the hospital environment make it likely. Many cases can be prevented.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- Adults aged 65 or older hospitalized for an acute illness.
- Patients with sepsis or infections, especially urinary or respiratory infections in older adults.
- After surgery, particularly hip fracture repair and cardiac surgery.
- ICU patients on mechanical ventilation or sedation.
- People with dementia or preexisting cognitive impairment.
- After a stroke or repeated seizures, once the postictal period has passed.
What to assess
- Baseline cognitive status: ask the family how the patient was before admission (memory, orientation, independence).
- Attention and orientation every shift using a brief validated tool (CAM, 4AT, or CAM-ICU in the ICU) per protocol.
- Sedation or agitation level with the RASS when appropriate.
- Pain, using the scale that fits the patient's ability to communicate.
- Sleep: hours slept, awakenings, use of sedatives.
- Elimination: urinary retention (distended bladder) and days without a bowel movement.
- Hydration, intake, electrolytes and blood glucose from available results.
- Medications that affect the nervous system (sedatives, opioids, anticholinergics), and whether glasses or hearing aids are available.
Risk factors
What makes the problem more likely, and what nursing can monitor or modify.
- Sleep deprivation or a reversed sleep-wake cycle.
- Dehydration or inadequate intake.
- Uncontrolled pain.
- Urinary retention or constipation.
- Sensory deprivation: no glasses, no hearing aid, no natural light.
- Prolonged immobility and use of physical restraints.
- Devices that tether the patient to the bed: catheters, multiple IV lines.
- Unfamiliar environment, noise at night and frequent room changes.
- Isolation from family and lack of time cues (clock, calendar).
At-risk populations
- Adults aged 65 or older.
- People with dementia or preexisting cognitive impairment.
- Older adults with a hip fracture.
- ICU patients.
- People with vision or hearing impairment.
- People with regular alcohol use.
Associated conditions
- Sepsis and acute infections.
- Major surgery and general anesthesia.
- Stroke and seizures.
- Sodium, glucose or kidney function abnormalities.
- Treatment with sedatives, opioids or anticholinergic drugs.
- Alcohol or benzodiazepine withdrawal.
Risk factors are the ones nursing can prevent or correct: sleep, hydration, pain, mobility, environment. Associated conditions (sepsis, surgery, dementia, sedating medications) raise the risk but depend on medical treatment. If your program requires it, write them as “in a patient with…”.
How to write it (PES)
Risk for acute confusion related to sleep deprivation, dehydration, uncontrolled pain, and sensory deprivation from missing glasses and hearing aid, in an 82-year-old patient with urosepsis (associated condition).
There is no “as evidenced by.” If inattention with acute onset and a fluctuating course appears, it is no longer a risk: it is acute confusion, and the provider is notified to look for the cause.
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- The patient remains oriented with a negative delirium screen (CAM or 4AT) every shift throughout the hospital stay.
- Sleeps at least 5 hours at night starting on day 2.
- Maintains fluid intake as ordered with no signs of dehydration within 48 hours.
- Reports pain ≤3/10 during the day.
- The family takes part in reorientation and keeps the patient company at least once a day.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Use the delirium screening tool on admission and every shift, and document the result. | Hypoactive delirium (quiet, drowsy) goes unnoticed unless you actively look for it. |
| Reorient at every contact: introduce yourself, state the day and place, and keep a clock and calendar in view. | Time and place cues help maintain orientation in an unfamiliar setting. |
| Make sure the patient is wearing their glasses and hearing aid. | Correcting sensory deprivation is one of the simplest preventive measures. |
| Protect sleep: dim lights and quiet at night, cluster care and avoid waking the patient unnecessarily; natural light during the day. | Maintaining the sleep-wake cycle reduces the onset of delirium. |
| Offer fluids frequently if there is no restriction and monitor intake. | Dehydration is a common trigger and easy to correct. |
| Mobilize early: get the patient up to the chair and walking with assistance when safe. | Immobility promotes delirium and other complications. |
| Monitor for bladder distention and bowel movements; remove catheters as soon as they are no longer needed. | Urinary retention, constipation and devices are correctable causes of agitation and confusion. |
| Avoid physical restraints and review sedating or anticholinergic medications with the provider. | Restraints and certain drugs increase the risk and severity of delirium. |
| Invite the family to stay with the patient, bring familiar objects and speak up if they notice any change. | The family knows the patient's usual state and picks up subtle changes before anyone else. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 0900Cognition
- 0901Cognitive Orientation
- 0907Information Processing
NIC interventions
- 2620Neurologic Monitoring
- 4820Reality Orientation
Linkages drawn from care plans published by health services, universities and nursing journals. Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: Older adult with urosepsis
Patient. An 82-year-old woman who lives with her daughter and is independent and oriented at home. She is admitted to the medical floor for urosepsis and has been in the hospital for 24 hours.
Assessment
- Oriented to person, place and time; 4AT score of 0.
- Temperature 38.1 °C (100.6 °F), HR 104 bpm, BP 108/64 mmHg.
- Slept about 3 hours last night because of noise and vital sign checks.
- Fluid intake of 600 mL in 24 hours.
- Suprapubic pain 5/10.
- Doesn't have her glasses or hearing aid; she left them at home.
- Indwelling urinary catheter placed in the ED.
Nursing diagnosis
Risk for acute confusion related to sleep deprivation, inadequate fluid intake, uncontrolled pain, and sensory deprivation from missing glasses and hearing aid, in an 82-year-old patient with urosepsis and an indwelling urinary catheter (associated conditions).
Goal
The patient will maintain a negative 4AT every shift throughout the hospital stay.
Interventions
- Ask her daughter to bring her glasses and hearing aid that same day.
- Offer fluids every hour during the day and record intake.
- Give the prescribed analgesic and reassess pain.
- Cluster nighttime care and keep the lights dim.
- Discuss removing the urinary catheter with the provider.
- Get her up to the recliner and reorient her at every contact.
Evaluation
At 72 hours her 4AT is still 0, she sleeps about 6 hours, drinks 1,400 mL a day and her pain is 2/10. The catheter was removed on day 2. The risk persists while the infection continues, so the diagnosis stays active until discharge.
How it differs from similar diagnoses
- Acute confusion (00128): Confusion is already present: inattention with acute onset and a fluctuating course. Resolve the risk diagnosis and work on the actual problem.
- Chronic confusion (00129): The decline is progressive and long-lasting, as in dementia. A person with chronic confusion is still at risk for acute confusion.
- Impaired memory (00131): Limited to difficulty remembering, without changes in attention or level of alertness.
- Ineffective sleep pattern (00337): Describes the sleep disturbance itself. It is often one of the factors behind the risk of delirium.
Common mistakes
- Assuming confusion is “normal for their age” and not looking for the cause.
- Not documenting baseline cognitive status: without it, you can't detect a change.
- Using restraints or sedatives as the first response to restlessness.
- Keeping the risk diagnosis when the delirium screen is already positive.
- Mistaking postictal drowsiness for delirium without allowing time for recovery and reassessing.
Used in these conditions
Other diagnoses in the Cognition class
Domain 5, Perception / cognition. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for risk for acute confusion?
00173. It belongs to Domain 5 (Perception/cognition), Class 4 (Cognition), and is still current in the 2024-2026 edition.
Is acute confusion the same as delirium?
They describe the same thing from two disciplines: delirium is the medical term, and acute confusion is the response nursing diagnoses.
What tool should I use to screen for delirium?
Whichever your protocol specifies. The most common are the CAM on medical-surgical units, the CAM-ICU in intensive care, and the 4AT, which is quick and doesn't require lengthy training.
Can acute confusion be prevented?
Partly, yes. Nonpharmacological measures (reorientation, sleep, hydration, mobility, glasses and hearing aids, family presence) reduce its onset in hospitalized older adults.
Can a patient with dementia have this diagnosis?
Yes. Dementia is one of the conditions that most increases the risk of delirium, and delirium superimposed on dementia is common and often detected late.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Risk for acute confusion (00173) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1, source 2. Reviewed November 2, 2026.