Download RUNNING HEAD: Biopsychosocial Assessment and Care

Biopsychosocial 1
RUNNING HEAD: Biopsychosocial Assessment and Care Plan
Biopsychosocial Assessment and Care Plan
Tiffany Reed
Kent State University
Biopsychosocial 2
Introduction
S.F. is a Fifty-one-year-old Hispanic decent male, who was born on July 5, 1958 in
Medina, Ohio. Patient came to Heartland Behavioral Healthcare(HBH) voluntarily on November
21st, 2002 after being released from prison for further rehabilitation and treatment. S.F. was
convicted of killing father and went to prison on April 10th, 1986 to serve sixteen years. S.F. was
close to father until being sexually and physically abused by father. The father was stabbed and
beaten to death on November 22nd, 1977 by patient who was nineteen years old at the time.
Patient came to HBH before going to prison because S.F. was considered incompetent to stand
trial. Patient grew up in a low socially economic status home and was expelled in the ninth
grade. S.F. had a history of violence before murdering father. Client was arrested five times prior
to the murder for theft, possessions of hallucinogens, indecent exposure, disorderly conduct,
resisting arrest and assault. According to the most recent assessment, S.F. demonstrated
Schizoaffective disorder bipolar type at Axis I, Mild mental retardation at Axis II, Water
intoxication at Axis III, Long term incarceration at Axis IV, and Global assessment of function
of a 35 at Axis V. This writer has had only three encounters with the patient. The first encounter
was very brief, just exchanging of names. During the second encounter the patient refused to
talk. Patient claimed, “I do not like girls.” Finally on the third interaction patient communicated
but, very minimally and refused to reveal much information. All information was retrieved from
patient’s medical records.
History of illness/ Psychiatric treatment
S.F. was reportedly victimized by physical and sexual abuse as a child. Patient, although,
denies history of physical, sexual or emotional abuse and neglect. S.F. was admitted to first
psychiatric hospital in 1975 at the age of sixteen. Client was admitted for destructive and violent
Biopsychosocial 3
behavior, later diagnosed with schizoaffective disorder bipolar type. S.F. has been to numerous
psychiatric hospitals around the state of Ohio. These hospitals include: Fallsview, Oakwood
Forensic Center, and Northfield. As mentioned above patient was in prison from April 10th, 1986
till November 21st, 2002 for murdering father. S.F. does have a history of non-compliance with
medications but according to staff not since patient has been at HBH. Patient also has a history
of abusing a lot of psychoactive substances. Client started at a very young age, at the age of ten.
S.F. abused alcohol, marijuana, PCP, Hallucinogens, LSD and angel dust. Information was
obtained from S.F. chart.
Medical History/Relevant diagnostic testing
Client is considered to have mild mental retardation and is hearing impaired. Patient must
wear hearing aide daily. At the age of three, S.F. fell down the steps. Even though patient was
not unconscious there was suspicion of a possible brain injury. Patient also has had a fractured
nose and right index finger. S.F. has had a CT scan of the brain due to Encephalopathy related to
acute viral illness, although, no results were obtained by this writer. Patient has history of water
intoxication. Labs are drawn on the client randomly, these labs include: Sodium, potassium,
Chloride, CO2 and Electrolyte Balance. Patient is also weighed four times a day to determine if
there is any weight gain due to water consumption. S.F. has no history of any surgeries. Pain was
not observed or assessed due to patient dismissive behavior. Little information was found in the
chart regarding pain. Chart states the patient does experience chronic pain in head, shoulders,
back, hips and other areas. No information was given on the cause or reassessment. All
information was retrieved from patient’s medical records.
General Description
Biopsychosocial 4
S.F. is a short, slightly over weight male, who appears the appropriate age of fifty-one.
Patient was properly dressed with the blue work shirt, blue jeans and tennis shoes. The only
problem with the patient’s dress was the shirt was dirty; the shoes were untied and wore two
watches, one on each wrist. S.F. had been shaved and had a haircut by one of the nurses on duty
the day of the third encounter. Patient refused to get a shower and wash face until after work
because client did not want to take two showers in one day. The shower was needed due to the
body odor of the patient. S.F posture is slumped and walks with an abnormal gait at times. Facial
expression was congruent with eye contact that was both direct and fleeting. Patient’s motor
activity was normal but included childish actions at times. Client would face and hold on to the
rail on the wall and rock back and forth. Patient wasn’t very responsive to the interviewer. S.F.
was withdrawn, dismissive, suspicious, guarded, uncooperative, and defensive towards this
writer. A mini mental status exam could not be completed due to short attention span and
dismissive actions. Client intellectual functioning is mild mental retardation range.
Emotional State
S. F.’s mood was euthymic at the beginning of the interview but became dismissive.
When a subject came up that the patient did not want to talk about, client would try to change the
subject or ignore the interviewer all together. Patient’s affect was congruent, expansive in range
and labile in duration. S.F. would laugh and joke periodically then become angry and act
childlike. Patient asked interviewer at one point “What are you looking at?” Staff noted patient’s
mood to be good but noticed patient to become irritable to very hyper. Staff also stated, S.F.’s
behavior was quiet childish, intrusive and has poor boundaries.
Cognition
Biopsychosocial 5
Patient was alert and oriented to person, place and time, but not situation. Patient was
aware of name, location, time and date. Recent and remote memory is intact. S.F. was able to
remember things asked, but unwilling to talk about situations. Client remembered names of
people, outings involved in and what was going on November 3rd, 2009. Patient’s concentration
and attention was very poor. Client has a very short attention span. S.F. would not concentrate or
pay attention to conversation if it wasn’t something client wanted to talk about. Although unable
to assess thinking due to dismissive behavior and short-term attention span it can be concluded
that the patient has concrete thinking. It’s apparent that S.F. has difficulty with multiple-step
commands resulting in miss directions. Patient needs to be told what is expected of behavior.
It is apparent as well as noted in the chart that client has trouble solving problems, lack of
insight and impaired judgment. According to chart, patient has minimal insight into own mental
health symptoms. Chart also states that client shows signs of impulsive and impaired judgment,
particularly when consumes large amounts of fluids. When client was asked by the staff if
understands illness, patient blames outside factors or others as the cause. After talking with
patient both poor judgment and insight are accurate. Patient shows poor judgment by getting
privileges taken away for inappropriate behavior and client then shows poor insight for
expressing childlike behavior after being punished. This reveals that S.F. is unwilling to accept
consequences. Patient’s speech was very pressured, rapid and loud. Speech was garbled at times
making it difficult to understand.
Due to client’s paranoia, interviewer was unable to determine patient’s thought content.
Depressive characteristics were unable to be assessed as well. During the conversation patient
became paranoid and suspicious about the interviewer. Client thought the interviewer was a
police officer. Patient Stated, “I know who you are you’re a cop. What do you want?” Also
Biopsychosocial 6
Stated in the patient’s medical record, patient conveyed some persecutory ideations. S.F. stated,
“The police put people in pain to get information out of them.” After speaking to patient, client
express thought in a disorganized manner. S.F. also expresses his thought with a flight of ideas,
tangential, loose of association and preservation.
Even though hallucinations were unable to be assessed or observed. Patient does have a
history of both auditory and visual hallucinations. The hallucinations are mostly auditory.
According to staff S.F verbalizes that father’s voice is haunting the patient. Client has also told
staff that there is a dead person hanging in the bathroom and that all people are vampires. During
a cognitive assessment found in the chart S.F. was asked about perceptions. When asked if
experienced any auditory hallucination, the patient replied, “Voice”? Patient responded “nuns at
work if you’re a religious man. Remember Sally Fields, the flying nun?” When asked if client
experienced visual hallucinations, the patient replied that another patient “did that”. “He’s the
living dead.” Overall, the cognitive ability of this patient is poor. S.F. would have difficulty
being in a process-oriented group.
Risk to self or to others
S.F. was voluntarily admitted to HBH after being released for prison. Patient was
admitted for potential danger to self due to threatening agitated behaviors and history of violence
associated with crimes. Client was also considered to be danger to other due to history of
violence, homicidal behavior, disorganized thought, and manic, rapid, pressured speech. S.F. was
admitted for the inability to care for basic needs also. Patient has an ongoing, weekly problem
with water intoxication causing loud outburst of aggression towards ward staff. In S.F.’s medical
records, patient denied any suicidal or homicidal ideation during assessment. All information
was obtained from chart because of client’s superficial behavior.
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Substance use/ Abuse
S.F. abused numerous amounts of substances, starting at a young age. Patient started
using alcohol at the age of ten. The Patient has used and abused alcohol, marijuana,
hallucinogens, angel dust and LSD. Chart states that the S.F.’s drug of choice was alcohol
because of the floating feeling that it give the patient. Client did attend AA, NA, and CA meeting
but none of those meeting were attended outside of HBH. The medical record did not show
history of patient participating in any compulsive behaviors.
Social functioning
S.F. can be interactive with other, until an individual demonstrates the need to know
more about the client or asks specific questions about the client. The patient will then become
dismissive. Other times the patient will keep to self by walking around the unit while listening to
a portable CD player. Client does attend group activities and goes to outings with others
regularly. S.F. is also enrolled in the HBH readiness program where he works in the cleaning/
housekeeping department, two hours a week. According to chart, patient is a single heterosexual
male. Client has never been married. S.F. is very attached to an RN on the unit. Patient is
normally only responsive to that particular person. No other information was available regarding
relationship issues in clients chart. S.F. has no spiritual/religious cultural issues or need. Patient
feels that spirituality or religion is not important. Client feels that neither one will have an impact
on the treatment received at HBH. Patient sleeps eight hours in the night most of the time. Client
stated, “I do have a good appetite”.
Client’s developmental level using Erikson
As mentioned before this patient is a fifty-one year old male. S.F. is considered to be a
middle aged adult. The only problem is the client’s physiological and developmental levels do
Biopsychosocial 8
not match. This particular patient developmental level should be in the generativity-versusstagnation stage of Erikson’s development theory. In this stage S.F. should be making
contributions to the family or to society (Feldman, 2006). S.F. is unable to reach this
developmental level due to having mild mental retardation and inability to conquer the
adolescence development stage. Client is technically in the identity-versus-identity-confusion
stage. It can be believed that S.F. had and does have trouble identifying the appropriate roles in
life (Feldman, 2006). Patient started abusing substances at the age of ten, revealing that S.F. did
indeed have low-self esteem making it hard to determine the uniqueness of self. Client is still
unable to identify self because of having delusions and hallucinations. S.F. cannot develop longterm relationships because patient believes everyone is a vampire and a cop.
Client/family appraisal of health and illness
Due to patient’s superficial behavior and unwillinigness to talk about subjects that S.F.
was not interested in, this information was only obtained from the client’s chart and observation.
Client does not have a legal guardian. When asked by staff if understands why patient is at HBH,
S.F. replied, “I have no place to go. I done my time.” Client did have a history being noncompliant with medications, but since at HBH, patient takes psychotropic medications as
prescribed. Unfortunately, S.F. has minimal insight into his mental health symptoms. Client
blames illness on outside factors and others. When patient consumes large amounts of fluids,
client shows impaired judgment as well. S.F’s psychosocial and environmental stressors were
unable to be assessed due to client’s dismissive behavior.
Coping Resources
Client has never been married and the only support person that S.F. has is mother, who is
eighty-four. Patient is the oldest of six children. Client has four brothers and one sister. Two of
Biopsychosocial 9
S.F.’s brothers suffer from mental illness as well. Both have received successful treatment in the
Media community. Patient is unable to live with mother because mother takes care of the two
brothers with mental illnesses. Patient has no history of consistent employment before coming to
HBH. From November 12th, 1976 till December 15th, 1976 patient was enlisted in the Army at
Fort Knox, Kentucky as an infantryman. Patient was an Honorable discharge. Patient is currently
enrolled in HBH adaptive work experience in the cleaning/housekeeping department. S.F. works
two hours a week and receives fifteen dollars every two weeks.
Medications
Medication
Benztropine
Mesylate
2 mg PO @ 8pm
Use in Patient
Extrapyramidal
Disease
Side Effects
Blurred vision, dry
eyes, constipation,
dry mouth
Divalproex
Sodium
100mg PO BID
Manic Bipolar
Disoder
Hepatotoxicity,
indigestion, nausea,
vomiting, pancreatitis
Haloperidol
Decanoate
200 mg IM
Q3wk
Chronic
Schizophrenia
Seizures,
Extrapyramidal
reaction, blurrd
vision, dry eyes,
constipation, dry
mouth, Neuroleptic
malignant syndrome
Nursing Implications
Assess for parkinsonian and
extrapyramidal symptoms,
assess bowel function daily,
Monitor intake and output. If
Extapyramidal symptoms occur
withhold drug and notify
Physician
Assess mood, Ideation, and
behavior frequently. Monitor
CBC, Platelet count and
Bleeding time prior to and
during therapy. May cause
Leukopenia and
thrombocytopenia. Monitor
hepatic function and serum
ammonia.
Assess mental status, Monitor
BP(sitting, standing & laying)
and pulse prior to and
frequently during dose
adjustment, Monitor intake and
output, monitor for onset of
akathesia, monitor for tardive
dyskinesia, monitor for
Neuropletic malignant
syndrome (Fever, respiratory
distress, tachycardia), Monitor
CBC and liver function tests.
Biopsychosocial 10
Haldol
20 mg PO TID
Schizoaffective
Bipolar
Lorazepam
0.5mg PO BID
Manic Bipolar
disorder
adjunction tx
Zyprexa
15mg PO HS
Schizophrenia
Ambien
5mg PO HS
Insomina
Seizures,
extrapyramidal
reaction, blurred
vision, dry eyes,
constipation, dry
mouth,
Neuromalignant
syndrome
Assess mental status, Monitor
BP(sitting, standing & laying)
and pulse prior to and
frequently during dose
adjustment, Monitor intake and
output, monitor for onset of
akathesia, monitor for tardive
dyskinesia, monitor for
Neuropletic malignant
syndrome (Fever, respiratory
distress, tachycardia), Monitor
CBC and liver function tests
Dizziness,
Assess degree and manifestation
drowsiness, lethargy,
of anxiety prior to and
apnea, cardiac arrest periodically throughout therapy.
Restrict amount of drug
available due to dependence
Neuropletic
Assess mental status, Monitor
malignant syndrome,
BP(sitting, standing & laying)
seizures, agitation,
and pulse prior to and
dizziness, headache,
frequently during dose
restlessness, sedation, adjustment, Monitor intake and
weakness, amblyopia,
output, monitor for onset of
rhinitis, orthostatic
akathesia, monitor for tardive
hypotension,
dyskinesia, monitor for
tachycardia,
Neuropletic malignant
constipation, dry
syndrome (Fever, respiratory
mouth, weight gain,
distress, tachycardia), Monitor
tremor.
CBC, liver function tests, and
ocular examinations, Monitor
blood glucose in patients with
diabetes, and prior to and
periodically during therapy in
patients with risk factors of
diabetes.
Daytime drowsiness,
Assess mental status, sleep
dizziness
patterns, limit amount available
to patient due to dependence,
assess alertness at time of peak
effect, assess patient for pain
Biopsychosocial 11
Client’s Strengths
A strength that the patient possesses is motivation for treatment. Patient did have a
history of noncompliance with medications in the past before coming to HBH. Ever since patient
resides in HBH, patient has been compliant with treatment especially medications. Being
motivated for treatment and compliant with medications will lessen the psychotic episodes
making it easier to teach the client preventive measures and coping skills. Another strength that
the patient possesses is the ability to tell the staff needs and wants. Being able to tell the staff
needs and wants helps improve the quality of care that the staff gives to the patient. Expressing
needs and wants can also give the patient a sense of control pertaining to self. Feeling a sense of
control over self will lead the patient to be more open to other wanting to help. A final strength
S.F. holds is responsibility. Patient is part of the HBH adaptive work experience. S.F. works in
the cleaning/housekeeping department for two hours a week. By possessing responsibility client
will be able earn money, keep track of time to know when it’s time to go to work, control
behaviors, produce a work ethnic and follow commands.
Client’s needs
Staff is attempting to find client community placement when discharge is possible.
Patient needs to be placed in a group home that is supervised with structured activities because
patient requires med monitoring, assistance with daily grooming, and redirecting by staff to
cooperate with treatment and care. Patient also needs to learn coping skills to refrain from water
intoxication and decrease symptoms of mania. A final need for S.F. is going to AA, NA, and CA
meetings. Patient hasn’t really gone to these meetings since patient initially came to HBH. It will
be important for patient to get education from these meeting to prevent relapse after leaving
HBH and learning to refrain from going back to those substances after being discharged.
Biopsychosocial 12
Care plan Follows:
Priority
Nursing
Diagnosis
Outcomes
Interventions/Activities
Theoretical
Research Support
Risk for
violence r/t
water
intoxication
AEB: History
of violence,
history of water
intoxication,
when told to
monitor water
intake patient
becomes
agitated, loud
outburst of
aggression
toward ward
staff, history of
threatening
ward staff,
when patient
consumes a
large amount of
water patient
reveals signs of
impulsive and
impaired
judgment,
random lab
draws which
include:
Sodium,
Potassium,
Chloride, CO2,
and electrolyte
balance, Patient
must be
weighed four
times a day to
measure weight
gain.
STG: Patient
will
demonstrate
increase selfcontrol by
monitoring
water intake
and
decreasing
verbal
aggressive
behavior
toward staff
within seven
days.
S.1) The student nurse will
demonstrate how to use a
measuring glass to measure
3000cc of water. The patient will
also be supplied with a water
bottle that includes the
measurements on the side in case
a measuring glass is not
available. The student nurse will
then explain briefly how
measuring water intake can
prevent water intoxication. After
demonstrating how to measure
the water the patient must do a
return demonstration. E.g. “
Student Nurse: water
intoxication occurs when you
consumes too much water that
depletes the electrolytes within
your body causing severe
consequences. Measuring your
water intake daily will decrease
the risk of water intoxication and
prevent severe complications.”
S. 1)“ Patient’s with
S.2) “Staff is instructed to ignore
the patient when the patient
becomes verbally abusive.
Explain to the patient why they
are being ignored so they are
able to understand that verbal
abuse is not
acceptable”(Carpenito-Moyet,
2008). E.g. “(In a calm, low
voice) Student Nurse: When you
are able to talk to the staff in an
appropriate manner, please come
back and do so but until then
S.2) “Crisis management
techniques can help
prevent the escalation of
aggression and help the
person achieve selfcontrol. The least
restrictive safe and
affective measure should
be used” (CarpenitoMoyet, 2008). “This
intervention would be
considered limit setting- a
nonpunitive,
nonmanipulative act in
polydipsia have an
obsessive urge to drink
fluids. When not
controlled this patient may
drink up to 20 litres of
fluid in a 24-hour period.
This high intake may
cause urinary dilution and
hyposthenuria. Over time,
serum sodium may lower
and result in renal tubule
'washout'. The renal
tubule's ability to secrete
maximally dilute urine is
diminished and symptoms
of water intoxication
become
paramount”(Davidhizar &
Kriesl, 1993). Patients
who are at risk for water
intoxication should not
consume more than
3000cc of water per day
(Davidhizar & Kriesl,
1993).
Biopsychosocial 13
they will continue to ignore you
because the way you are
speaking to them is not
acceptable.”
which the patient is told
what behavior is
acceptable, what is not
acceptable, and the
consequences of behaving
unacceptably. Explaining
the rationale for the limit
and communicating to the
patient in a calm
respectful manner can
avoid potentially
aggressive behavior”
(Stuart, 2009).
S.3) Student nurse must
encourage the patient to
participate in recreational
activities as an option to
distraction from drinking excess
water or for aggressive behavior.
E.g. “ Student Nurse: Tell me
about your hobbies that you like
to engage in?” “Pt: Hobbies?
Well I really like to listen to
music and reading entertainment
magazines.” “Student Nurse: Do
you ever participate in activities
in the gym?” “Pt: Only for group
sessions.” “Student Nurse: Lets
try something, when you start to
notice yourself getting agitated
or find yourself wanting to drink
water excessively tell the staff
that you would like to go to the
gym to do a recreation activity.”
S.3) In regards to
participating in physical
activity, “Physical activity
can help reduce muscle
tension”(CarpenitoMoyet, 2008). Also as a
form of prevention,
“patients can be helped to
develop plans to gain
control of their own
behavior which include
factors such as
approaching staff to talk
when they have a desire to
drink or using a form of
activity such as weight
lifting as a distraction”
(Davidhizar & Kriesl,
1993). “These two types
of distractions will
encourage the patient to
maintain control of any
violent impulses” (Stuart,
2009).
S.4) “The Student nurse must
provide the client with positive
verbal feedback when positive
behavior changes are
made”(Cox, Hinz, Lubno, ScottTilley, Newfield, Slater &
Sridaromont, 2002). This will let
S.4) “Violence can have
pattern. Detecting and
changing the pattern can
eliminate the
violence”(CarpneitoMoyet, 2008). It’s good to
include positive feedback
Biopsychosocial 14
LTG: Pt will
continue with
long-term
therapy to
work on
violenceprevention
strategies and
increase
coping skills
until 1/9/10
Disturbed
thought process
r/t abuse AEB:
STG: Client
will state that
the
the patient know they are on the
right track and that their
behaviors are being
acknowledged. E.g. “Student
Nurse: Great job letting the staff
know that you felt your self
getting the urge to drink
excessive amounts of water.” Or
“ Excellent job requesting to go
to the gym. I noticed you were
becoming agitated, you handled
it really well.”
whenever possible
because “positive
feedback encourages
positive behavior to occur
again”(Cox et al., 2002).
This intervention can be
referred to as positive
reinforcement. “Positive
reinforcement is a
rewarding stimuli that will
increase the frequency of
a behavior”(Stuart, 2009).
L.1) Patient has set limits on
inappropriate behaviors. These
limits include: patient will not
threaten or show
abusive/aggressive verbal
behaviors to the staff. Also the
patient will not drink more than
3000cc of fluids per day. If
patient doesn’t follow these
behaviors then patient will get
privileges take-in away. An
example would be going to an
outside experience. The patient
must be made aware of the limits
and consequences. Also, they
must know that it is a choice for
them to follow those behaviors
or not. E.g. “ Student Nurse: The
staff and I have came up with a
set of rules that should be
followed in order to decrease
inappropriate behavior. Although
we would like you to follow
these rule you have a choice to
follow them or not, but be aware
that if they are not followed the
there will be consequences. The
loss of your privileges will occur
for example: not be able to go to
the outside experiences.”
S.1) “Student nurse will
encourage the patient to maintain
compliances with prescribe
L.1) “Setting limits
clarifies rules, guidelines,
and standards of
acceptable behavior and
establishes the
consequences of violating
the rules”(CarpneitoMoyet, 2008). “By
explaining the rationale
for the limit and
communicating to the
patient in a calm and
respectful manner,
potentially aggressive
behavior can be
avoided”(Stuart, 2009).
S.1) Medication
compliance is one of the
necessities in treating a
Biopsychosocial 15
Reports states
that patient was
close to father
until abusive
behaviors
began, this
behavior
included
spanking as a
way to control
patient’s
behavior. As a
result of the
abusive
behavior,
patient killed
father.
Although
patient denies
history of
physical,
sexual, or
mental abuse,
reports states
that patient was
both physically
and sexually
abused as a
child.
According to
staff patient has
both auditory
and visual
hallucinations.
These
hallucinations
include hearing
father’s voice
and seeing
bloody dead
people hanging
in the
bathroom.
“thoughts”
are less
intense and
less frequent
with aid of
medications
and nursing
interventions
by 11/23/09
medication, especially
antipsychotics”( CarpneitoMoyet, 2008). E.g. “Student
Nurse: It’s very important that
you remain compliant with your
medications. The reason is
because the medications your on
will help alleviate some of those
symptoms you are having. If you
don’t understand why you’re
taking a certain med or a general
question about the medication
don’t hesitate to ask questions.
psychiatric disorder. It
helps to move the patient
one step closer to recovery
and help them regain
some sort of function.
“Medication adherence is
vital for symptom
management”(CarpneitoMoyet, 2008). “ Patients
who do not their
medications as prescribed
or who do not recognize
warning signs of illness
exacerbation or drug side
effects are at risk for
unsuccessful results,
adverse reactions and poor
quality of life” (Stuart,
2009).
S.2) “The student nurse must
recognized, support and respond
to the clients feelings being
expressed in delusions and/or
hallucinations”(Cox et al., 2002).
It is very important not feed into
the delusions and hallucinations,
but pay close attention to what
the patient is telling you. E.g.
“Student Nurse: How does that
make you feel? You sound
frighten right now?” Also, Be
aware not to try and change
delusional thinking with rational
explanation.
S.2) Listening to the
patients feeling is the first
step to recognizing what’s
really going on with the
patient. It allows you to
gain insight about the
patient as well. “ The only
person who can tell the
nurse about the patient’s
feelings, thoughts and
perception of self is the
patient”(Stuart, 2009).
“Also, when trying to
change the patient’s
delusional thinking, may
encourage the client to
cling on to those
thoughts” (Cox et al.,
2002).
S.3). Student nurse will spend 20
minutes twice a day doing an
activity with the patient as well
as talking to the patient (Cox et
al., 2002). The first day will only
be 10 minutes but will gradually
S.3) It’s very important
for a care giver to
establish a trusting
relationship with a patient
especially with someone
who has disturbed
Biopsychosocial 16
LTG: Patient
increase to 20 minutes twice a
day by the fourth day. During
this time patient can participate
in enjoyable activities with the
student nurse accompanying.
Student nurse provides social
reinforcement to the client for
accomplishing the activity.
thought. If a trusting
relationship is not
established care to the
patient will be
jeopardized.
“implementing this
intervention facilitates the
development of a trusting
relationship. Also social
interaction provides
positive reinforcement. It
will also help increase
daytime wakefulness,
promoting a normal sleepwake cycle” (Cox et al.,
2002). “To build a trusting
relationship the nurse
should use active listening
and encourage patient to
discuss feelings and the
nurse should offer
unconditional
acceptence”(Stuart, 2009).
S.4) Student nurse will
encourage the client to engage in
activities in the environment
(Unit that the patient is on). This
will attempt to distract the clients
from their delusions by doing
reality-based activities. Some
examples include: card games,
arts and crafts, or even board
games (Varcarolis, 2006). It’s
important to explain to the
patient why these types of
activities will help prevent
delusions. E.g. “Student nurse:
S.F. you should go play the wii
with F.G. Participating in those
types of activities can help you
ignore those hallucination that
you have and think about
something else.”
S.4) Distractions are a
prevented route that can
be taken by patients with
hallucination and/or
delusions. Doing so
focusing on things other
than hallucinations and
delusions is key. “When
thinking is focused on
reality-based activities,
the client is free from
delusional thinking during
that time. Helps focus
attention externally
instead of
internally”(Varcarolis,
2006).
L.1) “Student nurse will assist
L.1) Patients who have
Biopsychosocial 17
Self care
deficit: hygiene
r/t Cognitive
Impairment
AEB: Pt must
be told by staff
to take a
shower, wash
face, brush
teeth, Shave
and comb hair.
Pt will go three
days without
personal
hygiene and
will not
participate on
own. Also, able
to smell the
body odor on
patient. Patient
will be able to
talk about
hallucinations
in detail with
the student
nurse by
1/9/10.
client to differentiate between
own thoughts and reality. Sit
down with the client and analyze
the hallucination that the patient
is having. E.g. “Student nurse:
How often do the hallucinations
occur? What is the intensity or
clarity of the hallucination? How
long do the episodes last? Where
and when do the hallucination
occur; what happens just before
them? What happens after the
hallucinations?”(CarpneitoMoyet, 2008). Allow time
between each question of the
patient to answer.
disturb thought process
have problems
differentiating between
own thoughts and reality.
They need help from
various treatment options
and staff to prevent these
problems.“ Helping the
person identify what
specific situations trigger
hallucinations gives
insight into possible
preventions stratergies”
(Carpneito-Moyet, 2008).
“ Inability to perceive
reality accurately makes
life difficult. Learning
about a person’s
hallucinations help avoid
the roadblocks to
communication these
symptoms can create
when unrecognized”
(Stuart, 2009).
STG: For
three
consecutive
days, patient
will perform
personal
hygiene on
own which
will included:
showering,
brushing
teeth, shaving
and combing
hair by
11/12/09
S.1) “Student nurse will discuss
expectations with the client”
(Cox et al., 2002). The
expectations must be simple so
the patient is able to understand
the criteria for the expected
behavior. E.g. “Student nurse:
S.F. it’s very important for you
to be performing personal
hygiene activities daily because
proper hygiene will promote
optimal health. In order to
perform proper hygiene you will
need to shower, brush your teeth,
shave your face and comb your
hair daily. Lets try to do those
things just mentioned for three
consecutive day.”
S.1) Expectations must be
presented to the individual
in order to facilitate
understanding and to
optimize success in the
future. To promote
understanding further
those expectations should
be kept simple.
“Inappropiate levels of
sensory stimuli can
contribute to the clients
sense of disorganization
and confusion”(Cox et al.,
2002). “ Client must
understand and see the
value of nursing therapies,
even though they are
oftentimes totally
dependent on the nurse.
Once a client shares the
Biopsychosocial 18
is
Schizoaffective
and is
considered to
have mild
mental
retardation.
nurse’s goals, there is a
greater likelihood of client
participation in the plan of
care”(Potter & Perry,
2005).
S.2) “Student nurse will decrease
environmental stimuli to the
degree necessary to assist the
client in focusing on the
task”(Cox et al., 2002). For
example Student nurse will turn
stereo’s down and ask other
patients and visitors to leave the
area. Student nurse will then get
the patient back on track when
disruptions occur.
S.2) Some people with
psychiatric problems
experience disruptions in
attention that leads to
unfinished tasks and
inability to focus. “
Inappropriate sensory
stimulation can contribute
to client’s sense of
disorganization and
confusion”(Cox et al.,
2002). “It will also
promote the client’s sense
of control”(Cox et al.,
2002).
S.3) “Student nurse will make
sure the patient has all the
necessary items readily available
to achieve the task”(Cox et al.,
2002). Student nurse will have
patient bring all personal
hygiene item to the nurses
station to observe. Student Nurse
will make sure the patient has a
toothpaste, toothbrush, body
wash, shampoo, razor (kept at
the nursing station), shaving
cream and comb. If any items are
missing the student nurse will
obtain those items.
S.3) Without all the
necessary personal
hygiene items the goal for
the patient will not be
attainable. As a result
promoting optimal health
by fixing hygiene will not
be possible. “So making
sure items are available
will increase the
possibility for the client to
successfully complete the
task” (Cox et al., 2002).
S.4) “Student nurse will develop
a reward schedule of the
achievement of goals. The
student nurse must first sit down
with the client to discuss
possible rewards, and list those
things the client finds rewarding
here with the goal to be achieved
S.4) By asking the client
what they would want for
a reward after obtaining
the goal before it is
attained is something that
they can look forward to
receiving and will help
them work toward the
Biopsychosocial 19
LTG: S.F.
will be able to
perform
bathing
activity at
optiminal
level by
12/29/09
to gain the reward”(Cox et al.,
2002). After obtaining the list of
thing the client finds rewarding,
the student nurse will then be
able to develop a reward
schedule. E.g. “Student Nurse:
S.F. after obtaining the goal of
performing personal hygiene
daily for three consecutive day.
What would be something you
would like to do or have that
could be used as a reward for
achieving the goal?”
goal. “Doing this
intervention it promotes
the client’s sense of
control and provides
positive feedback that will
encourage behavior”(Cox
et al., 2002). “It will also
produce involvement by
the patient that will
improve motivation,
which will then improve
the outcome” (Cox et al.,
2002).
L.1) “Student nurse must
schedule adequate time for the
patient to accomplish the
personal hygiene task”(Cox et
al., 2002). S.F. will be given two
hours in the morning, daily
beginning a 9 AM to complete
personal hygiene. E.g. “Student
nurse: S.F. let’s set aside two
hours in the morning for you to
complete your daily personal
hygiene activities. That way you
will feel refresh and ready of the
day.”
L.1) Providing a
designated time during the
day for a patient to
complete a task is
essential for the patient to
turn their focus to one
thing and will produce a
routine that they will
engage in daily. “To
encourage optimal
independence a set
bathing time and routine
should be consistent”
(Carpneito-Moyet, 2008).
“sometimes disrupted
attention may occur in
patients but it is the nurses
responsibility to get them
back on track”(Stuart,
2009).
Conclusion
In conclusion it was extremely hard to get a thorough assessment on S.F. because patient
was superficial and dismissive. Most of the information came from patient’s medical record and
staff. After doing a complete assessment on the patient, it is evident that support from others is
Biopsychosocial 20
needed to help the patient survive from day to day. Even though patient possesses some strength
it is not enough to survive in this world.
Biopsychosocial 21
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