EXAMPLE OF NURSING CARE PLAN FOR A CLIENT WITH DEPRESSION
NURSING DIAGNOSIS: Complicated Grieving
RELATED TO: Real or perceived loss, bereavement overload EVIDENCED BY: Denial of loss, inappropriate expression of anger, idealization of or obsession with lost object, inability to carry out activities of daily living OUTCOME CRITERIA NURSING INTERVENTION
Short-Term Goals 1. Determine the stage of grief in which
Client will express anger about the loss. the client is fixed. Identify behaviors Client will verbalize behaviors associated with this stage. associated with normal grieving 2. Develop a trusting relationship with the Long-Term Goal client. Show empathy, concern, and Client will be able to recognize his or unconditional positive regard. her position in the grief process, while 3. Convey an accepting attitude, and enable progressing at own pace toward the client to express feelings openly. resolution 4. Encourage the client to express anger. Do not become defensive if the initial expression of anger is displaced on the nurse or therapist. 5. Help the client to discharge pent-up anger through participation in large motor activities (e.g., brisk walks, jogging, physical exercises, volleyball, punching bag, exercise bike). 6. Teach the normal stages of grief and behaviors associated with each stage. 7. Encourage the client to review the relationship with the lost concept. With support and sensitivity, point out the reality of the situation in areas where misrepresentations are expressed
EXAMPLE OF NURSING CARE PLAN FOR A CLIENT WITH SCHIZOPHRENIA
NURSING DIAGNOSIS: DISTURBED SENSORY PERCEPTION: AUDITORY/VISUAL RELATED TO: Panic anxiety, extreme loneliness, and withdrawal into the self EVIDENCED BY: Inappropriate responses, disordered thought sequencing, rapid mood swings, poor concentration, disorientation OUTCOME CRITERIA NURSING INTERVENTION
Short-Term Goals 1. Observe client for signs of hallucinations
Client will discuss content of hallucinations (listening pose, laughing or with nurse or therapist within 1 week talking to self, stopping in midsentence). Ask, Long-Term Goal “Are you hearing the Client will verbalize understanding that voices again?” the voices are a result of his or her 2. Avoid touching the client without illness and demonstrate ways to warning him or her that you are interrupt the hallucination about to do so. Client will be able to define and test 3. An attitude of acceptance will encourage the reality, reducing or eliminating the client to share the content of the hallucination occurrence of hallucinations with you. Ask, “What do you hear the voices saying to you? “misrepresentations are expressed 4. Do not reinforce the hallucination. Use “the voices” instead of words like “they” that imply validation. Let client know that you do not share the perception. 5. Help the client understand the connection between increased anxiety and the presence of hallucinations 6. Try to distract the client from the hallucination
EXAMPLE OF NURSING CARE PLAN FOR A CLIENT WITH SCHIZOPHRENIA
NURSING DIAGNOSIS: DISTURBED THOUGHT PROCESS RELATED TO: Inability to trust, Panic level of anxiety, Repressed fears EVIDENCED BY: presence of delusional thinking, suspiciousness, and inaccurate interpretation of the environment. OUTCOME CRITERIA NURSING INTERVENTION
Short-Term Goals 1. Convey your acceptance of client’s need
By the end of 2 weeks, client will for the false belief, while letting him or her recognize and verbalize those false know that you do not share the belief. ideas occur at times of increased 2. Do not argue or deny the belief anxiety 3. Help client trye to connect the false beliefs Long-Term Goal to times of increased anxiety By time of discharge from treatment, 4. Reinforce and focus on reality client’s verbalizations will reflect 5. Assist and support client in his or her reality-based thinking with no evidence attempt to verbalize feelings of anxiety, of delusional ideation. fear, or insecurity. By time of discharge from treatment, the client will be able to differentiate between delusional thinking and reality EXAMPLE OF NURSING CARE PLAN FOR A CLIENT WITH BIPOLAR DISORDER
NURSING DIAGNOSIS: IMPAIRED SOCIAL INTERACTION
RELATED TO: Delusional thought processes (grandeur and/or persecution); underdeveloped
ego
EVIDENCED BY: Inability to develop satisfying relationships and manipulation of others for own desires
OUTCOME CRITERIA NURSING INTERVENTION
Short-Term Goals 1. Recognize the purpose manipulative
behaviors serve for the client: to reduce Client will verbalize which of his or her feelings of insecurity by increasing feelings of interaction behaviors are appropriate power and control. and which are inappropriate within 1 2. Set limits on manipulative behaviors. week Explain to the client what is expected and what Long-Term Goal the consequences are if the limits are violated. Client will demonstrate use of 3. Do not argue, bargain, or try to appropriate interaction skills as reason with the client. Merely state evidenced by lack of, or marked the limits and expectations. decrease in, manipulation of others to 4. Provide positive reinforcement fulfill own desires. for nonmanipulative behaviors
5. Help the client recognize that
he or she must accept the consequences of own behaviors and refrain from attributing them to others. EXAMPLE OF NURSING CARE PLAN FOR A CLIENT WITH ANXIETY
NURSING DIAGNOSIS: PANIC ANXIETY
RELATED TO: Real or perceived threat to biological integrity or self-concept
EVIDENCED BY: Inability to develop satisfying relationships and manipulation of others for own desires
OUTCOME CRITERIA NURSING INTERVENTION
Short-Term Goals 1. Recognize the purpose manipulative
behaviors serve for the client: to reduce Client will verbalize which of his or her feelings of insecurity by increasing feelings of interaction behaviors are appropriate power and control. and which are inappropriate within 1 2. Set limits on manipulative behaviors. week Explain to the client what is expected and what Long-Term Goal the consequences are if the limits are violated. Client will demonstrate use of 3. Do not argue, bargain, or try to appropriate interaction skills as reason with the client. Merely state evidenced by lack of, or marked the limits and expectations. decrease in, manipulation of others to 4. Provide positive reinforcement fulfill own desires. for nonmanipulative behaviors
5. Help the client recognize that
he or she must accept the consequences of own behaviors and refrain from attributing them to others. EXAMPLE OF NURSING CARE PLAN FOR A CLIENT WITH SUBSTANCE USE
NURSING DIAGNOSIS: INEFFECTIVE DENIAL
RELATED TO: Weak, underdeveloped ego
EVIDENCED BY: Statements indicating no problem with substance use
OUTCOME CRITERIA NURSING INTERVENTION
Short-Term Goals 1. Begin by working to develop a trusting
nurse-client relationship. Be honest. Keep all Client will divert attention away from promises. external issues and focus on behavioral 2. Convey an attitude of acceptance to the outcomes associated with substance client. Ensure that he or she understands “It is use. not you but your behavior that is Long-Term Goal unacceptable.” Client will verbalize acceptance of 3.Provide information to correct responsibility for own behavior and misconceptions about substance abuse. acknowledge association between 4. Identify recent maladaptive behaviors or substance use and personal problems situations that have occurred in the client’s life, and discuss how use of substances may have been a contributing factor. 5. Use confrontation with caring. Do not allow client to fantasize about his or her lifestyle
Toxic Relationship: Practical Steps to Quit an Abusive Relationship (Become Self-Aware Quit Manipulative and Narcissistic Behaviors to Boost Confidence)