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Help with my Psych Nursing Diagnosis!

Posted

i am working on a care plan for my psych class and i'm having a hard time coming up with nursing diagnoses on my own! i have a full history and interview on my patient, who has schizoaffective disorder and chronic renal insufficiency, and we have to go through and determine diagnoses on our own. i'm able to figure out a diagnosis, but the r/t part and aeb part are still confusing. i've alwayd had a hard time with these and my instructor is a pretty tough grader. this is an example of what i have so far..i was just wondering if i'm on the right track..?? if someone could stear me in the right direction, i would really appreicate it! thanks!! :redbeathe

i. health perception - health management pattern

a. presenting problem

1. what brought you to the hospital? (describe in detail. include documentation from the medical record.)

i was in my apartment just going nuts, sweating. just every part of my body was sweating. but, they are okay now and gone. but, i do also have massive hunger all the time now.

[color=#31849b]in the chart: patient was initially admitted to the medical floor for elevated wbc's and acute chronic renal failure, after he was found in his apartment naked and speaking in animal noises (barking and hissing). it was discovered when his sister checked his medication bottle that he had not taken his meds for a week. then, patient was transferred to the psyche unit after medical clearance.

2. when did the problem begin and how has it interfered with your usual functioning?

it happened at home. you know, my sister was calling, she asked me what date it was and i threw the calendar away and she just asked me and thought i was disoriented, but i just threw my calendar away. it happened about 2 weeks or so ago.

[color=#31849b]in the chart: the first episode occurred when the patient was 16 years old. he was admitted for inpatient care 3-4 times a year. he was started on clozapine in 1991 which was very successful and allowed him to return home. m.a. was not admitted again until the death of his mother.

nursing diagnosis:

ineffective health maintenance r/t perceptual-cognitive impairment aeb patient being found in his apartment naked and speaking in animal voices.

ineffective management of therapeutic regimen r/t exacerbation and relapse of thought disorder aeb reappearance of delusions and failure to take prescribed medications.

noncompliance r/t not taking meds for a week aeb exacerbation of symptoms.

I'm not asking for answers, I already made the effort to do the work. I'm just asking if I'm going in the right directionand if I'm not, could someone point me in the right direction. I would never ask anyone to do my work for me..why would I when I need to know this for the rest of my life? There was no point in you posting that comment on my thread.

dudette10, MSN, RN

Specializes in Med/Surg, Academics. Has 10 years experience.

I'm not asking for answers, I already made the effort to do the work. I'm just asking if I'm going in the right directionand if I'm not, could someone point me in the right direction. I would never ask anyone to do my work for me..why would I when I need to know this for the rest of my life? There was no point in you posting that comment on my thread.

Lisa, your biggest "crime" was posting in the nursing forum, which has a tendency to attract nurses who are irritated with students asking for help. There is a "nursing assistance forum" under the student tab. My I suggest that you post your HW help requests there from now on? :)

I'll hit the "report" button on your OP to request that this thread be moved.

newtress, LPN

Specializes in med surg ltc psych. Has 3 years experience.

I'd say yes you are going in the right direction with what you've presented in your care plan. I've been a nurse at a psych hospital up until July when they layed off about 40% of the nurses. Anyhooz, I've seen care/treatment plans that were not even as detailed as yours, but when you're in school and dealing with nursing instructors who want just about everything and so detailed just to get a decent grade. I understand why you would have presented what you have and just wanted some opinions or guidance on what you have, no harm in asking. I myself while in school did come to this site to ask a few questions here and there if I was unsure about some things. And it appears that as time has gone by, responses to some nursing student posters get slammed for asking and truly believe that students are trying to extract homework assignments from the experienced nurses. Perhaps some students are seeking complete answers here and others like yourself are asking for us to look over or critique your rough draft. I am saying that it bothers me to see such rude responses also. There was a time when students asked for help in understanding their course work, and we had a wonderful, exceptional Allnurses member here that gave guidance and was so instrumental in me passing my advanced pharmacology course. She shared her valuable knowledge and expertise to the benefit of all of us. I wish nurses would stop being so stingy with their knowledge and help out future nurses.

misschiatia

Specializes in geriatrics/long term care. Has 15 years experience.

I have no psych experience whatsoever and I haven't written a care plan in years, but what I read in your assignment was logical and valid. All 3 diagnoses seem relevant to this pts issues, and so far as I can tell, you are going in the right direction. Good Luck and i hope your instructor agrees!

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

Moved to Nursing Student Assistance forum :)

VickyRN, MSN, DNP, RN

Specializes in Gerontological, cardiac, med-surg, peds. Has 16 years experience.

moderator's friendly reminder: this thread has now been moved to the nursing student assistance forum. this is a place where students can safely ask for help with assignments without being dissed by the membership. please do not respond to this thread if you cannot offer helpful advice. all "unhelpful" replies to this poster have been removed from this thread. additionally, all posts containing personal attacks, rude posts, and off-topic posts have also been removed. if you do not have anything helpful to say to this poster, please do not post here at all.

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thank you.

VickyRN, MSN, DNP, RN

Specializes in Gerontological, cardiac, med-surg, peds. Has 16 years experience.

to lisamarie5, i am not a psych instructor, but it looks like you have put much thought and effort into these nursing diagnoses. i believe you are on the right track. the following are some changes i would suggest:

ineffective health maintenance r/t ineffective coping after death of mother and self-neglect aeb return of delusional symptoms (patient being found in his apartment naked and speaking in animal voices) and medical diagnosis of acute renal failure

ineffective management of therapeutic regimen r/t social supports deficit secondary to death of mother and altered thought processes aeb sister discovered that patient has not taken prescribed medications in over a week

noncompliance r/t personal and developmental factors and altered throught processes aeb not taking prescribed medications for a week

another one i would suggest:

disturbed thought processes r/t mental disorder and biochemical changes in brain secondary to not taking prescribed medications aeb disordered thoughts and abnormal behavior (speaking in animal voices)