Help with Mental Care plan

[smurfet]

I am having a little bit of trouble putting together a mental care plan for my patient. Any help would be appreciated. He is diagnosed with schizophrenia. History of suicidal attemps, attacks on people because of audiotory hallucinations. He hears voices all the time. He does not understand his illness. Lost job because of attacks. He is an elderly man and does not have any family support. THank you very much for any help.

[Elvish, BSN, DNP, RN, NP]

Moved into Nursing Student Assistance Forum. :)

[Bec717]

Keep safety your number 1 priority!

Risk for Injury

Risk for Self Harm

Check out your Nursing DX handbook for more info!

[Daytonite, BSN, RN]

step 1 assessment - collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology - did you assess his adls? people who are depressed often do not keep up their personal hygiene and this needs to be addressed by the nursing staff.

• schizophrenia
  • symptoms
    • delusions and preoccupation with one subject
      
    • hallucinations
      
    • disorganized thinking and speech
      
    • disorganized or catatonic behavior
      • can be flat, inappropriate and unemotional
        
      • paranoid

      [*]memory and attention deficits

  [*]history of suicidal attempts

  • there are 4 male suicides for every female suicide
    
  • elderly white men over 85 have a suicide rate 6x higher of all groups
    
  • risk factors:
    • history of a prior attempt
      
    • family history
      
    • etoh or substance abuse
      
    • does the patient fit the demographic (elderly white male, widowed, native american)?
      
    • is there chronic physical illness, chronic pain or a terminal illness?
      
    • grief, bereavement or loss of an important relationship?
      
    • legal or disciplinary problems
      
    • poor support system
      
    • loneliness
      
    • hopelessness or helplessness
      
    • depression, schizophrenia, bipolar disorder
      
    • talk of suicide, a plan for suicide, the means to commit suicide
      
    • making statements of despair hopelessness, helplessness or that they have nothing left to live for

    [*]history of attacks on people because of auditory hallucinations

    • feelings of helplessness and/or powerlessness
      
    • may be depressed, despondent, withdrawn or frightened
      
    • bruises on body in various stages of healing
      
    • bruises or injuries on body that do not match the patient's description of the "accident"

step #2 determination of the patient's problem(s)/nursing diagnosis part 1 - make a list of the abnormal assessment data - i think you need to expand on this patient's symptoms of his schizophrenia and his suicidal risks. i listed the assessment information above for you. the suicide info will help you clarify the risk factors for suicide. you also need to address his coping skills. it is not normal to physically attack others when you are upset with them. he lost his job because of it. schizophrenia doesn't need to be the reason for this. he's passing the buck and not taking responsibility for the care of his disease. that's the depression at work crying out, "poor little me, have pity for me." we can have pity and compassion, but we also have a job to do. we have to recognize what is going on and what his disease is causing him to do. if he does not understand his illness or how to deal with hallucinations then he needs education because he is dangerous to himself and others.

• hears voices all the time
  
• does not understand his illness
  
• lost job because of attacks
  
• elderly man
  
• no family support

step #2 determination of the patient's problem(s)/nursing diagnosis part 2 - match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use

• disturbed sensory perception, auditory r/t biochemical imbalances aeb hearing voices all the time
  
• disturbed thought processes r/t depressed mood and biochemical imbalances aeb [could be: impaired perception, judgment and decision making; impaired attention; impaired thought; impaired insight; impaired problem solving and coping]
  
• risk for suicide - depending on patient's symptoms, use
  • hopelessness r/t loss of significant support systems and perception of a bleak future aeb [???]
    
  • risk for self-directed violence r/t hopelessness, history of previous suicide attempts, loss of job, no family support [also add if there is any talk by the patient of suicide or a plan for suicide]

  [*]ineffective coping r/t [could be: inappropriate use of defense mechanisms, inappropriate assessment of situational threat] aeb destructive behavior against others and self (attacked others and lost his job), aggressive rather than assertive behaviors.

  [*]deficient knowledge, schizophrenia and dealing with hallucinations r/t lack of resources aeb statements that he does not understand his illness and attacks on people because of auditory hallucinations.

[Daytonite, BSN, RN]

you can get some assistance on writing psych diagnoses on this website:

http://www.fadavis.com/townsend4e/additionalnursingcareplans.asp

but it's not the references that i use.