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Additional Nursing Care Plans - Schizophrenia

Additional Nursing Care Plans - Schizophrenia

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Published by jaz

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Categories:Types, Research
Published by: jaz on Apr 14, 2009
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06/29/2013

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ADDITIONAL NURSING CARE PLANS
(Following are care plans supplemental to those found in the 4
th
edition of Townsend, M.C. (2003).
 Psychiatric/Mental Health Nursing: Concepts of Care
)
 DELIRIUM, DEMENTIA, AND AMNESTIC DISORDERS
DISTURBED SENSORY PERCEPTION (Specify)
 Definition:
Change in the amount or patterning of incoming stimuli accompanied by adiminished, exaggerated, distorted, or impaired response to such stimuli.
 
Possible Etiologies ("related to")
[Alteration in structure/function of brain tissue, secondary to the following conditions:Advanced ageVascular diseaseHypertensionCerebral hypoxiaAbuse of mood- or behavior-altering substancesExposure to environmental toxinsVarious other physical disorders that predispose to cerebral abnormalities (see PredisposingFactors)]
Defining Characteristics ("evidenced by")
[Disorientation to time, place, person, or circumstances][Inability to concentrate][Visual and auditory distortions]Inappropriate responses[Talking and laughing to self][Suspiciousness]Hallucinations
Goals/Objectives
 Short-Term Goal 
With assistance from caregiver, client will maintain orientation to time, place, person, andcircumstances for specified period of time.
 Long-Term Goal 
Client will demonstrate accurate perception of the environment by responding appropriatelyto stimuli indigenous to the surroundings.
Interventions with
 Selected 
 
 Rationales
1.
Decrease the amount of stimuli in the client's environment (e.g., low noise level,few people, simple decor).
This decreases the possibility of forming inaccurate sensory perceptions.
2.
Do not reinforce the hallucination. Let client know that you do not share the
 
 perception. Maintain reality through reorientation and focus on real situations and people.
 Reality orientation decreases false sensory perceptions and enhancesclient's sense of self-worth and personal dignity.
3.
Provide reassurance of safety if client responds with fear to inaccurate sensory perception.
Client safety and security is a nursing priority.
4.
Correct client's description of inaccurate perception, and describe the situation as itexists in reality.
 Explanation of, and participation in, real situations and real activities interferes with the ability to respond to hallucinations.
5.
 Provide a feeling of security and stability
in the client's environment by allowingfor care to be given by same personnel on a regular basis, if possible.6.Teach prospective caregivers how to recognize signs and symptoms of client'sinaccurate sensory perceptions. Explain techniques they may use to restore reality tothe situation.
Outcome Criteria
1.With assistance from caregiver, client is able to recognize when perceptions withinthe environment are inaccurate.2.Prospective caregivers are able to verbalize ways to correct inaccurate perceptionsand restore reality to the situation. 
SITUATIONAL LOW SELF-ESTEEM
 
 Definition:
Development of a negative perception of self-worth in response to a current  situation (specify).
Possible Etiologies ("related to")
[Loss of independent functioning][Loss of capacity for remembering][Loss of capability for effective verbal communication]
Defining Characteristics ("evidenced by")
[Withdraws into social isolation][Lack of eye contact][Excessive crying alternating with expressions of anger][Refusal to participate in therapies][Refusal to participate in own self-care activities][Becomes increasingly dependent on others to perform ADLs]Expressions of shame or guilt
Goals/Objectives
 Short-Term Goal 
Client will voluntarily spend time with staff and peers in dayroom activities within 1 week.
 Long-Term Goal 
 
By discharge, client will exhibit increased feelings of self-worth, as evidenced by voluntary participation in own self-care and interaction with others.
Interventions with
 Selected 
 
 Rationales
1.
Encourage client to express honest feelings in relation to loss of prior level of functioning. Acknowledge pain of loss. Support client through process of grieving.
Client may be fixed in anger stage of grieving process, which is turned inward onthe self, resulting in diminished self-esteem.
2.Devise methods for assisting client with memory deficit. Examples follow:a.Name sign on door identifying client's room. b.Identifying sign on outside of dining room door.c.Identifying sign on outside of restroom door.d.Large clock, with oversized numbers and hands, appropriately placed.e.Large calendar, indicating 1 day at a time, with month, day, and year identified in bold print.f.Printed, structured daily schedule, with one copy for client and one postedon unit wall.g."News board" on unit wall where current national and local events may be posted.
These aids may assist client to function more independently, thereby increasing  self-esteem.
3.
Encourage client's attempts to communicate. If verbalizations are notunderstandable, express to client what you think he or she intended to say. It may benecessary to reorient client frequently.
The ability to communicate effectively withothers may enhance self-esteem.
4.
Encourage reminiscence and discussion of life review. Also discuss present-dayevents. Sharing picture albums, if possible, is especially good.
Reminiscence and life review help the client resume progression through the grief process associated with disappointing life events and increase self-esteem as successes are reviewed.
5.
Encourage participation in group activities. Caregiver may need to accompanyclient at first, until he or she feels secure that the group members will be accepting,regardless of limitations in verbal communication.
 Positive feedback from groupmembers will increase self-esteem.
6.Offer support and empathy when client expresses embarrassment at inability toremember people, events, and places. Focus on accomplishments to lift self-esteem.
7.
Encourage client to be as independent as possible in self-care activities. Providewritten schedule of tasks to be performed. Intervene in areas where client requiresassistance.
The ability to perform independently preserves self-esteem.
Outcome Criteria
1.Client initiates own self-care according to written schedule and willingly acceptsassistance as needed.

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