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PSYCHIATRIC NURSINGCRITICAL THINKING/CAREPLAN BASICS FOR FINAL NURSING DIAGNOSISto be used in Critical Thinking/ Care Plan exercises:
•
Risk For Self-Directed Violence (=Risk for Suicide)
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Risk For Violence directed toward self and others
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Risk for Injury towards self and others
•
Disturbed thought ProcessGUIDELINES FOR CRITICAL THINKING EXERCISESUse this table to help you identify the problems from the scenario:1.
IdentifyEGO FUNCTIONS
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Reality Testing
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Judgment
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Sense of Reality of the world and Self (=Self Esteem)
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Impulse Control
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Thought Processes
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Object Relations
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A.R.I.S.E (Creativity)
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Defensive Functioning
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Stimulus Barrier 
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Autonomous Functioning
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Mastery-Competence
2.
IdentifyDEFENSE MECHANISMS
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Sublimation
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Rationalization
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Intellectualization
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Suppression
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Repression
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Displacement
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Reaction Formation
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Somatization (=Conversion)
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Undoing
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Passive-Aggression
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Acting-Out Behavior 
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Idealization
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Splitting
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Devaluation
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Projection
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Denial
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Introjection
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Compensation
3.
IdentifySTAGE OF DEVELOPMENT
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Trust vs. Mistrust
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Autonomy vs. Shame and Doubt
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Initiative vs. Guilt
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Industry vs. Inferiority
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Identity vs. Role Confusion
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Intimacy vs. Isolation
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Generativity vs. Stagnation
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Integrity vs. Despair 
4.
IdentifyANXIETY LEVELS
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Mild
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Moderate
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Severe
5.
IdentifyPSYCHOPATHOLOGY(S&S OFDISEASE)
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Refers to signs and symptoms of specific mentalillnesses (e.g. Schizophrenia, Depression, AnxietyDisorders, Personality Disorders, etc) (See the listthat follows next page)
 
PSYCHOPATHOLOGY OF THE DISEASE: (These terms must be used –in addition to the previous table terms)when referring to identified signs and symptoms. For example, instead of writing “Risk for violence towards self or others AEB pt throwing objects at staff, and verbalizes “I think you want to kill me” it should say “AEB Poor Impulse control, Poor judgment, and aggressive behavior toward staff”)
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Type of Crisis (Maturational/Developmental,Situational, Adventitious)
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Phobia (specify type)
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Obsessions
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Compulsions
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Persistent intrusive thoughts
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Restlessness
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Sleep Disturbances
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Fatigue
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Amnesia
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Dissociative Amnesia
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Depersonalization
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Derealization
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Suicidal Ideations/Thoughts
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Hopelessness
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Helplessness
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Inability to perform ADLs
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Poor Self-Care (=Poor grooming and Hygiene)
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Increased/Decreased/Inadequate Appetite
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Increased/Decrease/Inadequate Fluid Intake
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Inappropriate Affect Blunted/Flat)
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Hallucinations (specify: auditory, visual…)
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Delusions (specify: of persecution, of reference…)
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Bizarre behavior (=Inappropriate behavior)(extreme motor agitation, stereotypedmovements, automatic obedience, waxyflexibility, stupor)
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Aggressive behavior 
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Impulsive behavior 
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Disorganized speech –specify the presenceof: (associative looseness, neologisms,echolalia, clang association, word salad)
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Hypervigilance (instead of saying“paranoia”)
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Alterations in perception
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Disorganized thinking
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Labile mood
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Anergia
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Avolition
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Alogia
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Apathy
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Anhedonia
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 Non adherence to medication regimen(=Non-compliance)
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Withdrawal symptoms
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Substance abuse (if obvious, specify)
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Altered level of conscience (LOC)
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Altered mental status
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Decreased LOC (=Acute confusion)
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Dysphasia
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Aphasia
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Apraxia
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Agnosia
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Comorbidities (Identify any current medical problems: Hyper/Hypoglycemia, High BPetc)
 
 NURSING DIAGNOSIS: Lets assume pt is depressed or schizophrenic, and expresses will to kill himself (or makes overt statement)
1.Risk for Suicide (Self-directed violence)
R/T Biochemical/ Neurological imbalance in the brain AEB(use available data from problem list)
2.Disturbed Thought Process
R/T
 
Biochemical/Neurological Imbalance in the brain AEBPOSSIBLE EXPECTED OUTCOMES
•
Patient will not harm his/herself during hospitalization and will demonstrate absence of suicidalideations/plans AEB no suicidal intent, pt signs “no suicide” contract every shift, makes no overt/covertstatements and verbalizes will to live
•
Pt will state that “I will not harm myself now and throughout hospitalization” and will verbalize a will toliveASSESS: Rationale:1.Vital Signs2.Safety of patient and in theenvironment3.Suicidal Risk (SAD PERSONS scale,overt/covert statements)4.Previous history of Suicide attempts(patient) or Suicide (family)5.Psychiatric assessment6.Past and present psychiatric history7.Past and present medical history8.Past and current medication regimenand compliance9.Past and present history of substanceabuse10.Mental status11.Level of anxiety12.Pt’s perception of the event and Copingmechanisms13.Support system14.Ego functions (Reality testing, thought process, Impulse control, sense of reality of the world and self, Judgment)15.Stage of development16.Psychopathology of specific currentdisease process17.Assess any comorbid (medical)condition if present1.To establish a baseline for future treatment and evaluation of  pt’s progress2.To prevent pt from harming self 3.To determine potential for suicide, presence of a plan, andits lethality, and adjust interventions accordingly4.B/C a history of previous suicide attempts and/or successfulfamily Hx of suicide is an important risk factor 5.To obtain significant data on which to base plan of care6.To determine risk factors7.To determine comorbid conditions that may impact outcomeand mental health8.B/C medications play a role at adjusting (or failing to adjust)any present chemical imbalance that may be causing the problems9.To rule out abuse as the cause of the mental disorder, andadjust treatment accordingly10.To monitor thought process, cognition, and changes towardexpected outcome11.B/C anxiety level strongly influences behavior 12.B/C pt’s perception may influence pt’s decisions13.B/C a structured environment and support system isimportant to mental balance, especially after discharge14.B/C Ego integrity constitutes the pillar of mental health15.B/C successful achievement of each developmental stage isessential to mental health16.B/C identifying specific disease traits may aid in theformulation of a treatment plan17.To identify current conditions that may need interventions
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