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UNIT 3 ■ Care of Patients With Psychiatric Disorders
Table 15–2 | CARE PLAN FOR THE PATIENT WITH SCHIZOPHRENIA—cont’d
NURSING DIAGNOSIS: SOCIAL ISOLATION RELATED TO: Inability to trust, panic anxiety, delusional thinking, regression, lack of interest or skills in interpersonal interaction EVIDENCED BY: Withdrawal, sad, dull affect, preoccupation with own thoughts, expression of feelings of rejection or of aloneness imposed by others OUTCOME CRITERIA NURSING INTERVENTIONS RATIONALE
Short-Term Goal ■■ Patient will willingly attend therapy activities accom- panied by trusted staff member within 1 week. Long-Term Goal ■■ Patient will voluntarily spend time with other patients and staff mem- bers in group therapeutic activities.
1. An accepting attitude increases feel- ings of self-worth and facilitates trust. 2. This conveys a belief in the patient as a worthwhile human being. 3. The presence of a trusted individual provides emotional security for the patient. 4. Positive reinforcement enhances self-esteem and encourages repetition of acceptable behaviors.
1. Convey an accepting attitude by making brief, frequent contacts. 2. Show unconditional positive regard. 3. Offer to be with patient during group activities that the patient finds frightening or difficult. 4. Give recognition and positive reinforce- ment for patient’s voluntary interactions with others.
NURSING DIAGNOSIS: RISK FOR VIOLENCE: SELF-DIRECTED OR OTHER-DIRECTED RISK FACTORS: Extreme suspiciousness, panic anxiety, catatonic excitement, rage reactions, command hallucinations, overt and aggressive acts, goal-directed destruction of objects in the environment, self-destructive behavior or active
aggressive suicidal acts OUTCOME CRITERIA
NURSING INTERVENTIONS
RATIONALE
Short-Term Goals ■■ Within [a specified time], patient will recognize signs of increasing anxiety and agitation and report to staff (or other care pro- vider) for assistance with intervention. ■■ Patient will not harm self or others. Long-Term Goal ■■ Patient will not harm self or others.
1. Anxiety level rises in a stimulating environment. A suspicious, agitated patient may perceive individuals as threatening. 2. Observation during routine activities avoids creating suspiciousness on the part of the patient. Close observation is necessary so that intervention can occur if required to ensure patient (and others’) safety. 3. Removal of dangerous objects pre- vents patient, in an agitated, confused state, from using them to harm self or others. 4. Validation of the patient’s feelings conveys a caring attitude and offering assistance reinforces trust.
1. Maintain low level of stimuli in patient’s environment (low lighting, few people, simple decor, low noise level).
2. Observe behavior frequently. Do this while carrying out routine activities.
3. Remove all dangerous objects from patient’s environment. Assess for risk of violence toward others or suicidal ideation. 4. Intervene at the first sign of increased anxiety, agitation, or ver- bal or behavioral aggression. Offer empa- thetic response to the patient’s feelings: “You seem anxious [or frustrated or angry] about this situation. How can I help?”
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