CUES AND CLUES

Subjective: As verbalized by the patient: Gusto ko magtayo ng mall na mas maganda pa sa mga mall ngayon. Paglabas ko magusap usap tayo para sa mall natin. Tayo na ang magpartners. Gusto ko magka-anak sa ibang babae. Gusto ko ng lalakeng anak. Objective: y Rapid, forced speech y Grandiose thoughts y Loose and poorly associated ideas y Tangentiality of ideas and speech y Easily distracted y Decreased concentration

NURSING DIAGNOSIS
Disturbed Thought Processes grandiosity related to elevated mood

SCIENTIFIC RATIONALE
Grandiose thoughts are present due disruption in cognitive operations while the person has a manic episode.

OBJECTIVES
Short-term: After the 5-hour shift, the patient will: y Demonstrate decreased push of speech y Demonstrate decreased tangentiality y Demonstrate loose associations Long-term: After the psych ward duty, the patient will: y Talk with others about reality y Demonstrate adequate cognitive functioning y Sustain concentration and attention to complete tasks and function independently

INTERVENTIONS
1.) Convey your acceptance of client's need for the false belief, while letting him or her know that you do not share the belief. 2.) Do not argue or deny the belief. Use reasonable doubt as a therapeutic technique: "I find that hard to believe." 3.) Help client try to connect the false beliefs to times of increased anxiety. Discuss techniques that could be used to control anxiety (e.g., deep

RATIONALE
1.) It is important to communicate to the client that you do not accept the delusion as reality. 2.) Arguing with the client or denying the belief serves no useful purpose, because delusional ideas are not eliminated by this approach, and the development of a trusting relationship may be impeded. 3.) If the client can learn to interrupt escalating anxiety, delusional thinking may be prevented. 4.) Discussions that focus on the false ideas are purposeless and useless, and

EVALUATION
1.) The client verbalizes thinking processes oriented in reality. 2.) Client is able to maintain activities of daily living (ADLs) to his or her maximal ability. 3.) Client is able to refrain from responding to delusional thoughts, should they occur.

breathing exercises, other relaxation exercises, thought stopping techniques). 4.) Reinforce and focus on reality. Discourage long ruminations about the irrational thinking. Talk about real events and real people. 5.) Assist and support client in his or her attempt to verbalize feelings of anxiety, fear, or insecurity.

may even aggravate the psychosis. 5.) Verbalization of feelings in a nonthreatening environment may help client come to terms with long unresolved issues.