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  • NCP

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    Charles Mallari Valdez
    3K views3 pages
    The document outlines a nursing care plan for a patient with delusional disorder, including assessing the patient's thought process, providing safety and reorientation, encouraging participation in activities, and establishing what is real and unreal while maintaining distance and administering prescribed medication. Goals are for the patient to differentiate between delusion and reality, recognize accomplishments, and identify ongoing treatment needs after nursing intervention. Evaluation criteria focuses on the patient's ability to maintain orientation, verbalize feelings, and determine what is real.

    Original Description:

    Disturbed Thought Process

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    The document outlines a nursing care plan for a patient with delusional disorder, including assessing the patient's thought process, providing safety and reorientation, encouraging participation in activities, and establishing what is real and unreal while maintaining distance and administering prescribed medication. Goals are for the patient to differentiate between delusion and reality, recognize accomplishments, and identify ongoing treatment needs after nursing intervention. Evaluation criteria focuses on the patient's ability to maintain orientation, verbalize feelings, and determine what is real.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    3K views3 pages

    NCP

    Uploaded by

    Charles Mallari Valdez
    The document outlines a nursing care plan for a patient with delusional disorder, including assessing the patient's thought process, providing safety and reorientation, encouraging participation in activities, and establishing what is real and unreal while maintaining distance and administering prescribed medication. Goals are for the patient to differentiate between delusion and reality, recognize accomplishments, and identify ongoing treatment needs after nursing intervention. Evaluation criteria focuses on the patient's ability to maintain orientation, verbalize feelings, and determine what is real.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 3

    Cues Explanation of Goals and Intervention Rationale Evaluation Actual

    the problem objectives criteria evaluation

    Subjective: According to the STO:  Assess attention  Determines


    DSM-IV-TR, After 8 hours of span/ distractability the ability of
     “Nung nagaral delusional nursing and ability to make the patient
    ako doon sa UK disorder are intervention the decisions or to participate
    madami akong characterized by patient is able to problem solve in
    natapos na false beliefs verbalize logical planning/exe
    course doon” with plausible and reality based cuting care
    basis in reality. ideas
    Objective: Formerly  Interview SO to  This is to
    referred to as determine patient’s provide
     Orriented to paranoid usual thinking baseline for
    Time, place, disorder, ability, changes in comparison
    Person delusional behavior, length of
     Loose disorder are time problem has
    association known to existed, and other
    noted as involve pertinent
    manifested by erotomanic, information
    “ lagi mong grandiose,
    tatandaan hindi jealous, or LTO:  Reorient  Inability to
    babangon ang somatic themes After 2-3 weeks of time/place/person, maintain
    babae kung as well as nursing as needed orientation is
    walang lalaki, persecutory intervention a sign of
    kaya laging delusion. Some patient is able to deterioration
    andiyan si Jesus patients differentiate  Provide safety  It is always
    Christ experience delusion and measure necessary to
     Delusion of several types of reality and talk consider the
    grandiosity delusions; other with others about safety of the
    noted as patients reality patient.
    manifested by experience  Recognize and  Recognizing
    “ sikat ako unspecific support the the patient’s
    doon sa amin delusions that accomplishm
    doo sa vigan, have no patient’s ent can
    punta ka lang dominant accomplishment lessen
    doon sabihin theme anxiety and
    mo lang the need for
    pangalan ko” delusion as a
     Hyperactive source of
     Labile mood Reference: self-esteem
    American  Encourage patient  Verbalization
    Psychiatric to verbalize true of feelings in
    association feelings a non-
    (2000). threatening
    Nursing Diagnosis: Diagnostic and environment
    statistical may help
    Disturbed thought manual of patient come
    process related to mental to terms with
    neurochemical disorder(4th ed., long-
    imbalance text Revision) unresolved
    Washington, DC issues.
     Encourage patient  This is to
    to participate in maximize
    resocialization level of
    activities/groups function
    when available.
     Assist in identifying  This measure
    ongoing treatment is important
    needs/rehabilitation to maintain
    program for the gains and
    individual continue
    progress if
    able

     Reestablish the  Reality must


    client what is real be
    and unreal. Validate reinforced.
    patient’s real Reinforced
    perception, and reality and
    correct the patient’s behavior will
    misperception recur more
    frequently.

     Maintained distance  Patient will


    from the patient be violent
     Administered
    prescribed  To calm the
    medication patient and
    mat prevent
    aggressive
    bahavior

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