Need Help finding Diagnosis for Psych Nursing Care Plan

[live&love&heal]

I am writing my nursing care plan for my Psych rotation. The problem is that my pt's Axis I diagnosis is Psychosis. It's very broad. He's got hypertension and is non-compliant with his medications. He is gravely disabled. I don't know which is priority, the psychosis or his hypertension. What nursing diagnosis should I have for this pt? Thanks!

[Clovery]

Disturbed thought process or Chronic confusion?

I haven't done my psych rotation yet, but I'd guess you'd treat the psychosis by trying to build a trusting relationship, trying to get him to perform or assist with ADLs, keeping patient free from (self) harm, preventing patient agitation.

Just a guess, though, like I said we haven't covered psych issues yet.

[NCRNMDM, ASN, RN]

I haven't done psych yet, but our teacher told us that if the patient is a risk for suicide that is always your top priority. Do you think that his psychosis puts him at risk for suicide? If so, then the risk for suicide r/t psychosis is your priority diagnosis. If he has psychosis, but isn't a threat to himself or others, then I would think that the hypertension would be your priority diagnosis. If the psychosis just limits his ability to function, but doesn't pose a threat to anyone, then you need to take care of the hypertension as it could lead to bad things like stroke, MI, etc. He is probably non-compliant with his medications due to his psychosis. Once you get him on a medication that controls his psychosis, you may find that he is much more willing to take his anti-hypertensive. Trying to teach a patient who has psychosis about taking medications isn't going to work because there is pretty much no chance that you can get through to them. If the patient is also disabled, then you have a whole new set of diagnoses to use. You could use risk for impaired skin integrity, dressing/bathing self care deficit, ineffective role performance, etc. For hypertension you could use deficit knowledge. For the psychosis, you could use risk for suicide, risk for other directed violence, social isolation, disturbed sensory perception, etc. There are a ton of diagnoses out there. Start looking them up and see if you think they apply to your patient and his situation.