Mental Health Care Plan practice and Prioritizing

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Apologies in advance for the long novel but I wanted to give a brief & concise description of my patient.

I just had my Mental Health Clinical and am practicing on writing a problems list with diagnosis and then I have to pick one diagnosis for a care-plan. I think I am making it more difficult than it should but, that's because I push myself to learn more! :) First half of this semester I was in Maternal Newborn Clinical Rotation and my instructor loved the diagnosis and care-plan that I typed up...Thanks with the help on Allnurses!!! Unfortunately it took me about 3 days to type it all up but fortunately my teacher loved it! With that being said, it should be a breeze for me to type up Mental Health...but it is/was not! I am not sure if I am satisfied with my diagnosis because I am still learning. Also, I don't know which 1 to focus on creating a care plan for.

Majority of the assignment is made-up (for practice) but the patient that I was dealing with for a brief moment is a...

39/F admitted for Benzo OD, daughter found her. Pt. has 4 kids (1 is sort of adopted), 23 F with 3 kids, 19 F in college, two 23 M (working and in school, one is adopted). Pt. takes care of the 23 year old and grand children in own home. Pt's home was foreclosed, resulting in the family having to move out and then (unknown reasons) was able to move back into the foreclosed home. Pt. c/o of having to reorganize and unpacking the items at home and is not ready to return to that and the responsibilities.

What led to the SA was after having an argument with her husband (not the father of the 3 kids), she pushed him, he pushed her back, she OD'd.

Diagnosed with anemia, MDD, and GAD.

Past history: first husband (father of children) was shot in the head 30+ times in front of their home in Puerto Rico (Pt. from there), she did not witness it, but the police showed her a picture for identification without any warnings...all she remembered was his teeth and his blood distorted face, but it was his teeth that she recognized. I'd say she was around her late teens or early twenties when it happened.

Also, her mother continues to ask her to visit her in Puerto Rico, but Pt. states "There is nothing for me to do there, everybody that I use to know is either dead or in jail. I have no one to visit. My mom was just in WI. visiting me, so i don't have to go see her."

In order by Priority (I will abbreviate some words just for here)

**1. Risk for injury R/T depression and anxiety AEB previous history of attempted suicide.

2. Imablanced nutrition less than body requirements R/T lack of interest in food AEB lost five-pounds in four days

3. Disturbed sleep pattern R/T stress AEB patient reported difficulty concentrating and functioning the following day because of interrupted sleep.

4. Grieving R/T recent home foreclosure AEB patient's statement "I just can't handle losing my home and having my children being unstable."

5. Low self-esteem R/T depression AEB patient feels like a failure

1. Knowledge deficit R/T constipation AEB patient statement (ps) "is it normal for me to not have to poop in four days?"

2. KD R/T medication compliance AEB ps "I take my medications whenever I can remember to take them. I don't even notice anything changing"

3. KD R/T stress management AEB ps "when I feel stressed, I just isolate myself, but it seems to make things worse for me."

4. KD R/T MDD AEB ps "I don't know what depression is. It's annoying because my doctor just tells me to take medications for it."

5. KD R/T GAD AEB Patient Statement (PS) "I don't know how to control my anxiety!"

I am leaning towards Risk for Injury as a care plan.

Thanks in advance in taking your time in reading this and giving your input. I want to make sure I am well prepared at comprehending and creating care plans.

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Actually, I think I am more interested in KNOWLEDGE DEF. R/T STRESS MANAGEMENT! :) My teacher told me that there was more than risk for suicide/injury, but I could not put my finger to it.

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Specializes in Psychiatric Nursing.

Risk of injury related to maladative coping: OD of benzos after being pushed by boyfriend.

Needs to learn coping skills, such as managing anger , assertiveness training

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Also, I forgot to add...my teacher does NOT want anything dealing with Ineffective coping :(

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

If this is not due tomorrow.....I'll be back but here are a quick few that I can think of.....I have a high school project for my son to work on. ;)

Caregiver role strain

Parental role Conflict

Compromised family Coping

Hopelessness

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If this is not due tomorrow.....I'll be back but here are a quick few that I can think of.....I have a high school project for my son to work on. ;)

Caregiver role strain

Parental role Conflict

Compromised family Coping

Hopelessness

It is due Friday morning! I try to be an overachiever student by doing things in advance, but it's the getting lost part that gets me finishing the assignment a little later. :banghead:

I have been erasing, rewriting, erasing, rewriting, erasing, and rewriting diagnosis...I just don't like what I have....THANK YOU FOR THE SUGGESTIONS ESME! I was thinking of you when I posted because you helped me last time.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
39/F admitted for Benzo OD(Risk for Suicide) , daughter found her. Pt. has 4 kids (1 is sort of adopted), 23 F with 3 kids, 19 F in college, two 23 M (working and in school, one is adopted). Pt. takes care of the 23 year old (Parental role Conflict) and grand children in own home(Caregiver role strain). Pt's home was foreclosed, resulting in the family having to move out and then (unknown reasons) was able to move back into the foreclosed home. Pt. c/o of having to reorganize and unpacking the items at home and is not ready to return to that and the responsibilities.(Relocation Stress Syndrome)(Impaired individual Resilience)

What led to the SA was after having an argument with her husband (not the father of the 3 kids), she pushed him, he pushed her back, she OD'd.

Diagnosed with anemia, MDD, and GAD.

Past history: first husband (father of children) was shot in the head 30+ times in front of their home in Puerto Rico (Pt. from there), she did not witness it, but the police showed her a pictuere for identification without any warnings...all she remembered was his teeth and his blood distorted face(Post-trauma syndrome) , but it was his teeth that she recognized.( Complicated Grieving) I'd say she was around her late teens or early twenties when it happened.

Also, her mother continues to ask her to visit her in Puerto Rico, but Pt. states "There is nothing for me to do there, everybody that I use to know is either dead or in jail(Hopelessness). I have no one to visit. My mom was just in WI. visiting me, so i don't have to go see her."(Compromised family Coping)

Lots of living for a 39 year old. How does she look? Is she unkempt? Does she make eye contact? What is her affect?

What does NANDA say about these individual diagnoses?

The patient is at risk for suicide (NANDA-IDefinition: At risk for self-inflicted, life-threatening injury) because she remains in the same situational place with poor insight/coping. She is a widow, has already attempted SI, legal problems, loss of "important relationship (boyfriend pushed her), hopeless and isolated.

Parental role conflict....NANDA-IDefinition: Parent's experience of role confusion and conflict in response to crisis

Defining Characteristics: Anxiety; demonstrated disruption in caretaking routines; expresses concern about perceived loss of control over decisions relating to his or her child; fear; parent(s) express(es) concern(s) about changes in parental role; parent(s) express(es) concern(s) about family (e.g., functioning, communication, health); parent(s) express(es) feeling(s) of inadequacy to provide for child's needs (e.g., physical, emotional); reluctant to participate in usual caretaking activities, verbalizes feelings of frustration, verbalizes feelings of guilt

Related Factors (r/t)Change in marital status; home care of a child with special needs; interruptions of family life due to home care regimen (e.g., treatments, caregivers, lack of respite); intimidation with invasive modalities (e.g., intubation); intimidation with restrictive modalities (e.g., isolation); separation from child because of chronic illness; specialized care center

OR....caregiver role strain......NANDA-IDefinition: Difficulty in performing family caregiver role....related to......Alienation from others; competing role commitments; insufficient recreation; isolation from others, History of family dysfunction; history of marginal family coping. Look to your NANDA reference/Nursing care plan book I use Ackley: Nursing Diagnosis Handbook, 9th Edition

Post-trauma syndrome......NANDA-IDefinition: Sustained maladaptive response to a traumatic, overwhelming event.

Defining Characteristics

Aggression; alienation; altered mood state; anger; anxiety; avoidance; compulsive behavior; denial; depression; detachment; difficulty concentrating; enuresis (in children); exaggerated startle response; fear; flashbacks; gastric irritability; grieving; guilt; headaches; hopelessness; horror; hypervigilance; intrusive dreams; intrusive thoughts; irritability; neurosensory irritability; nightmares; palpitations; panic attacks; psychogenic amnesia; rage; rape; reports feeling numb; repression; shame; substance abuse

Related Factors (r/t)

Abuse (physical and psychosocial); being held prisoner of war; criminal victimization; disasters; epidemics; events outside range of usual human experience; serious accidents (e.g., industrial, motor vehicle); serious injury/threat to self or loved ones; sudden destruction of one's home or community; torture; tragic occurrence involving multiple deaths; wars; witnessing of mutilation/violent death

Hopelessness.....NANDA-IDefinition: Subjective state in which an individual sees limited or no alternatives or personal choices available and is unable to mobilize energy on own behalf

Defining Characteristics

Closing eyes; decreased affect; decreased appetite; decreased response to stimuli; decreased verbalization; lack of initiative; lack of involvement in care; passivity; shrugging in response to speaker; sleep pattern disturbance; turning away from speaker; verbal cues (e.g., despondent content, “I can't,” sighing)

Related Factors (r/t)

Abandonment; deteriorating physiological condition; lost belief in spiritual power; lost belief in transcendent values; long-term stress; prolonged activity restriction creating isolation

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She has weakness of legs.

It's her 2nd husband (remarried)

Pt. pleasant, good eye contact, good recalls of timeframes and events, affect bright and mood congruent. Went to both group activities, socialable with other patients. She was in a cheerful, giggly mood when I met with her. Mood 10/10. Denies HI, feels safe, sleeps well

I appreciate you highlighting/bolding the key factors...it helps me to understand the relationship with the diagnosis :)

Now, I need to find 1 diagnosis that I can care-plan teach. Could I use?

Risk for suicide r/t depression and recent suicide attempt

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
She has weakness of legs.

It's her 2nd husband (remarried)

Pt. pleasant, good eye contact, good recalls of time frames and events, affect bright and mood congruent. Went to both group activities, sociable with other patients. She was in a cheerful, giggly mood when I met with her. Mood 10/10. Denies HI, feels safe, sleeps well

I appreciate you highlighting/bolding the key factors...it helps me to understand the relationship with the diagnosis :)

Now, I need to find 1 diagnosis that I can care-plan teach. Could I use?

Risk for suicide r/t depression and recent suicide attempt

Side note....why does she have weakness of her legs?

That is why I highlight what my clues are. I have never seen the patient but I can make a mental image...so can you...when you learn what to look for. :)

How do you teach someone not to commit suicide? I would think maybe....teaching her stress/coping mechanisms, or, community resources available to her, relaxation techniques due to her caregiver role strain. Look to your care plan book for nursing outcomes and see what seems a likely teaching subject.

What do you think? How would you teach someone how to not commit suicide? That takes therapy. Can you teach someone some quick stress relievers coping mechanisms, community programs to help relieve the strain of her care giving role? What about Spousal abuse? Teach her about spousal abuse and resources available to her.

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Love your ideas Esme! I will focus more on my care-plan teaching tomorrow after my Ob exam! Today will be study day :) The nurses report (electronic) never stated why pt. had weakness in legs. My original plan was to teach the pt. not to commit suicide, but my teacher kept saying there was more than just suicide. The teaching will be within an 8 hour shift.

Just thinking from the top of my head I would look into teaching the pt. 3 of these options

Risk for suicide r/t depression and previous attempts of suicide

Long-term goal: Patient will remain safe while in the hospital, with the help of nursing intervention and support by discharge

- Remove any objects that she could use for harming herself

- have one-on-one monitoring or suicide observation (q15 minutes visual check of mood, behavior, and verbatim statements)

- keep accurate of timely records, document clients activity q15 minutes (what they are doing, with whom, etc...)

- Construct a no suicide contract (ex: when they begin to feel overwhelmed by pain or depression - "I will speak to my nurse/family member when I first begin to feel the wish to harm myself"

- Encourage pt. to talk about her feelings and problem-solve alternatives

I feel like my mind is stuck in a little box and I am limiting my options...could I somehow relate stress management for the patient teaching?

Nursing outcome:

Pt. will identify two stress management or (relaxation techniques) to decrease suicidal ideation

Intervention (whatever rationale I end up finding)

Nurse will teach the importance of using relaxation techniques to decrease suicidal ideation

---I want to make sure if I could use the above statements because I may have misunderstood my teacher---

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

You are stuck in your head but that is ok.......It happens.

Yes......stress management to help her better cope and deal with the caregiver role strain. You can also do domestic abuse....you have Gulanick.....go to the on line care plan constructor....there will be ideas there.

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For my care-plan teaching...my teacher wants me to do

Safety risk r/t depression aeb previous suicide attempts!

Trying to find rationales for that seems difficult. I need

3 outcomes 3 interventions & rationales (with 3 subcategories?) 1a 1b 1c, 2a 2b 2c, etc and 3 evaluation of outcomes

Currently I have staff maintains a safe environment for patient (make sure pt. swallows all medication, remove any harmful objects, restricting patient visitors from bringing in any harmful objects)

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