Download Mental Health Nursing Care Plan By: Dawn Simon Priority Nursing

Mental Health Nursing Care Plan
By: Dawn Simon
Priority Nursing
Diagnoses
Disturbed thought
process R/T
diagnosis of
schizophrenia and
delusional
disorder AEB
history of
violence, history
of paranoid
delusions, and
previous
intentions to kill
someone.
Outcomes
Interventions/Activities
Theoretical Research Support
- Short term
outcome: Client
will maintain
orientation to
reality AEB
close observation
of staff and
psychiatrists.
1. Intervention: Continue giving the client Zyprexa and
make sure the client continues being compliant. SN: Do
you feel that taking Zyprexa is important? Zyprexa is a
medication that controls your symptoms of
schizophrenia. CT: I feel it’s been beneficial for me.
SN: Good, do you understand the importance of
regularly taking this medication as prescribed by your
physician? CT: I believe so. SN: Are there any
questions you have about this medication? CT: Not at
this time.
1. Rationale: The reason why I
chose this intervention is because
“Over 100 randomized doubleblind studies consistently support
the efficacy of antipsychotic
medications relative to placebo in
the reduction of the acute positive
symptoms (hallucinations,
delusions, thought disorganization,
bizarre behavior) of
schizophrenia” (Lehman et al.,
1998, pp.2).
- Long term
outcome: Client
will be observed
regularly for
effectiveness of
Zyprexa and
remain free of
delusions and
abnormal
behavior for the
next two years
AEB close
observations of
nursing staff and
observations
from 1:1
interactions that
the staff has with
2. Intervention: “Persons with schizophrenia who have
any of the following characteristics should be offered
vocational services. The person (a) identifies
competitive employment as a personal goal, (b) has a
history of prior competitive employment, (c) has a
minimal history of psychiatric hospitalization, and (d) is
judged on the basis of a formal vocational assessment to
have good work skills (Lehman et al., 1998, pp.8). SN:
Do you feel that it’s been beneficial for you to work in
the library and garden here at Heartland? CT: Yes, I
really enjoy having something to do. SN: Good, are
there any other areas in this facility that you would like
to work in? CT: No.
3. Intervention: “Individual and group therapies
employing well-specified combinations of support,
2. Rationale: I chose this
intervention because the
“…characteristics [mentioned]
have been found to be predictive of
better vocational outcomes in
persons with schizophrenia, which
applies to the client, and therefore
people with these characteristics
should be offered such services
(Lehman et al., 1998, pp.8).
3. Rationale: The reason why I
chose this intervention is because
“…controlled studies have found
the client.
Imbalanced
nutrition: more
than body
requirements R/T
weight gain from
previous and
- Short term
outcome: Client
will lose 2 lbs
within one
month AEB
weighing the
education, and behavioral and cognitive skills training
approaches designed to address the specific deficits of
persons with schizophrenia” (Lehman et al., 1998, pp.8).
SN: How do you feel about the group therapies offered
here? CT: I enjoy them, I have had a 100% attendance
rate for the past two years. SN: I’m glad that you enjoy
participating, is there anything you would change about
these therapies? CT: No. SN: Do you feel that these
therapies are beneficial for you? CT: Yes. SN: How
so? CT: I feel that it’s helped me find ways of coping
and offers me support.
some additional benefit when a
supportive
form of psychotherapy is added to
pharmacotherapy for persons with
schizophrenia” (Lehman et al.,
pp.8, 1998). This has also shown
improvements in “… functioning
and enhance[ing] other targeted
problems, such as medication
noncompliance” (Lehman et al.,
1998, pp.8).
4. Intervention: Encourage compliance with medication.
SN: Do you willingly take all your prescribed
medications? CT: Yes. SN: Do you have any questions
about any of the medications you’re currently taking?
CT: No I’ve been on most of them for a while. SN: Do
you have any concerns about the medications your
taking? CT: No. SN: Do you understand the
importance of taking your medications? CT: Yes.
4. Rationale: This intervention was
chosen because if the client is
compliant with the medication it
will reduce the frequency of
delusions and schizophrenic
symptoms (Boyd, 2008).
5. Intervention: Monitor verbalization and signs of
delusions and schizophrenia (Boyd, 2008). SN: Have
you ever heard something or seen something that
nobody else heard? CT: No. SN: What kind of
behaviors have you experienced that seemed odd to
you? CT: I don’t think I’ve ever had any.
1. Intervention: “‘A Meaningful Day’ weight control
program incorporated nutrition counseling, exercise, and
behavioral interventions designed to help patients with
schizophrenia…” (C-K. Chen et al., 2008, pp.18). SN:
I know that in previous conversations you mentioned to
me that you were unhappy with your weight. Would
5. Rationale: By monitoring the
client I can determine how
effective the current medications
are in reducing the delusions and
schizophrenic symptoms (Boyd,
2008).
1. Rationale: I chose this program
because “…those who completed
the weight control program, there
was a mean weight loss of 2.1 kg
by the end of the intervention, 3.7
kg over 6 months, and 2.7 kg over
current
medications AEB
client being 5 ft
and 9 inches tall
and weighing 220
lbs.
client and his
you be willing to try a weight control program that
weight being 218 would help you lose some weight? CT: Sure, I’m also
lbs.
currently on a fish and vegetarian diet. SN: Ok, what
this program will do is offer counseling and different
- Long term
forms of exercise that specifically aimed at helping you
outcome: Client lose weight.
will lose 10 lbs
within one year
2. Intervention: Encourage the client to write down all
AEB weighing
of the food that he eats throughout the week including
the client and his snacks and non-water beverages (Carpenito-Moyet,
weight being 210 2008). SN: How would you feel about writing down all
lbs.
of the food that you eat for a week including snacks and
non-water beverages? CT: I’d be willing to try that, but
how will that help me? SN: It can help you by allowing
you to be able to see the amount of food that you are
eating in a day along with how much you are eating in a
day. This will give you and me a better idea of whether
or not you are over eating, not eating the correct types of
food, and etc.
3. Intervention: Make sure client is taking Zyprexa
(Olanzapine) as prescribed and suggest to physician to
be switched to disintegrating tablets with clients
consent. SN: Based on your chart, I seen that you are
currently taking Zyprexa in a pill form. I wanted to let
you know that a study done in 2008 showed a weight
decrease in clients who took the dissolving tablet form
of Zyprexa compared to those who took the pill form.
Would you be willing to try a dissolving tablet instead
of the solid pill form that you are currently taking? CT:
Maybe, I would like to talk to my doctor more about it.
SN: Okay, would it be okay if I mentioned it to you
doctor? CT: Yes, thank you.
12 months” (C-K. Chen et al.,
2008, pp.17).
2. Rationale: This intervention was
chosen because the “Strategies to
assist a person to initiate a change
in eating patterns…will focus on
why, where, and what is eaten and
methods to reduce intake…”
(Carpenito-Moyet, 2008, pp. 463).
3. Rationale: This intervention is
important because it’s been proven
in a study that “…patients with
chronic schizophrenia incurred a
mean weight loss of 2.7 kg upon
switching from olanzapine SOT
(standard oral tablets) to ODT
(oral disintegrating tablets)
(Chawla & Luxton-Andre, 2008,
pp. 214).
4. Rationale: Increased activity
will promote weight loss
(Carpenito-Moyet, 2008).
5. Rationale: If there’s an
alteration in his sense of taste or
smell he may over eat in an
attempt to satisfy his taste
(Carpenito-Moyet, 2008).
4. Intervention: Plan a daily walking program with an
increase in the distance (Carpenito-Moyet, 2008). SN:
How do you feel about walking? CT: I can walk it just
can be uncomfortable for me at times because I’ve got
back pain from a herniated disc. SN: Would you be
willing to try a walking program if your back pain was
managed? CT: Sure.
Impaired comfort
R/T chronic back
pain and constant
pain level of a 7
on a pain scale of
0 to 10 and 10
being the worst
pain ever
experienced AEB
subjective data
provided by the
client.
Short term goal:
Clients pain
level will be
reduced from a 7
to a 5 within 2
months.
Long term goal:
Clients pain
level will be
reduced from a 7
to a 2 within 3
years.
5. Intervention: Continuously evaluate if the clients
experiencing a diminished sense of taste or smell. SN:
Have you noticed a significant change in the foods that
you like or don’t like? CT: Not really, I never really
thought about it. SN: Have you also noticed a change in
the smells of food? CT: I don’t think so. Next time I
eat I’ll try to think more about it.
1. Intervention: Talk to client about nonpharmacological
interventions in managing pain (Potter & Perry, 2005).
SN: Are you aware of relaxation techniques that can be
used to help with pain? CT: I know some, I’ve tried a
few in the past. My doctor has me set up to get epidural
injections. SN: Okay, are the methods that you know
helpful for you? CT: Not really. SN: I can get some
print outs for you of different stretches and relaxation
techniques that could possibly help you. Would you be
interested in this? CT: Sure.
2. Intervention: “Teach client to avoid negative thoughts
about ability to cope with pain” (Carpenito-Moyet,
2008, pp.131). SN: How do you currently cope with
you chronic back pain? CT: I just deal with it for the
most part. Sometimes I lay down or sit down while
trying different positions. SN: Do you feel that is an
1. Rationale: By using
nonpharmacological interventions
it will augment pharmacological
methods (Potter & Perry, 2005).
2. Rationale: This intervention will
be good for the client because
“Nonpharmacological
interventions provide a major
treatment approach for…chronic
pain. They provide clients with an
increased sense of control,
promotes active involvement,
reduce stress and anxiety, elevate
mood, and raise the pain
threshold” (Carpenito-Moyet,
2008).
effective way to cope with your pain? CT: I guess so.
SN: Do you ever feel discouraged about feeling relief
from your back pain? CT: Sometimes. SN: Let’s talk
about those feelings. CT: I just get tired of being in
pain all the time. After trying different medications and
relaxation techniques I still have pain. I’m looking
forward to starting my epidural injections because I
really think it’ll help me. SN: That’s good. Is there
anything you would like to be done differently beyond
what’s currently being done regarding your pain
management? CT: Not currently, maybe if the epidural
injections don’t work out. Right now I’m content and
the doctor has gradually been increasing my pain
medication.
3. Intervention: “Practice distraction”
(Carpenito-Moyet, 2008, pp.131). SN: Have you ever
tried listening to music or guided imagery to get your
mind off of your back pain? CT: I don’t think I’ve tried
guided imagery. SN: Well, guided imagery is a
relaxation technique that relaxes people through a story
that is supposed to allow you to imagine something very
relaxing. Numerous studies have been done that have
proved this to be effective. I can provide you with a
guided imagery story. CT: That sounds good, thank
you.
4. Intervention: Determine the effects of the chronic
pain on the client (Carpenito-Moyet, 2008). SN: How
does your back pain affect your daily life and activities?
CT: For the most part I can deal with the pain, but there
have been times where I haven’t been able to get out of
bed.
3. Rationale: I chose this
intervention because “The use of
noninvasive pain-relief measures
can enhance the therapeutic effects
of pain-relief medications”
(Carpenito-Moyet, 2008, pp.131).
4. Rationale: I chose this
intervention because it’s
“…validated that pain affects
quality of life. Assessment of
specific effects is essential”
(Carpenito-Moyet, 2008, pp.139).
In other words, chronic pain can
decrease a clients quality of life,
therefore the impact it has on a
client’s life is vital to assess.
5. Rationale: “The preventative
approach may reduce the total 24hour dose compared with a PRN
approach; it provides a constant
blood level of the drug, it reduces
craving for the drug, and it reduces
the anxiety of having to ask and
wait for PRN relief” (CarpenitoMoyet, 2008, pp.131).
5. Intervention: Discuss with physician about order the
pain medication as a 24-hour schedule basis rather than
PRN (Carpenito-Moyet, 2008). SN: Would you mind if
I talked to your doctor about possibly switching that
pain medication that is ordered as needed to a set
schedule? CT: Why? SN: I think that this might be
more beneficial for managing your pain because it can
reduce the craving of the medication and you won’t
have to wait for when the nurse is available to get the
pain medication once the pain has already begun. CT: I
might be willing to try it.
References
Boyd, M.A., (Ed.). (2008). Psychiatric nursing: Contemporary practice (4th ed.). Philadelphia,
PA: Wolters Kluwer Health/Lippincott Williams and Wilkins.
Carpenito-Moyet, L. (2008). Nursing diagnosis: application to clinical practice (12th ed.).
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Chawla, B., & Luxton-Andrew, H. (2008). Long-term weight loss observed with olanzapine
orally disintegrating tablets in overweight patients in chronic schizophrenia: a 1 year open-label, prospective trial. Human
Psychopharmacology: Clinical and Experimental, 23, 211-216.
Chen, C-K., Chen, Y-C., & Huang, Y-S. (2008). Effects of a 10-week weight control program on
obese patients with schizophrenia or schizoaffective disorder a 12-month follow up. Psychiatry and Clinical Neurosciences,
63, 17-22.
Lehman, A., Steinwachs, D., & Co-Investigators of the PORT Project, Initials. (1998). At issue:
translating research into practice: the schizophrenia patient outcomes research team
treatment recommendations. Schizophrenia Bulletin, 24(1), 1-10.
Potter, P., & Perry, A. (2005). Fundamentals of nursing (6th ed.). St, Louis, MO: Elsevier
Mosby.