Nat71

Thank you for your comment and help

Hello Daytonite, I just realized that I didn't paste my plan, silly me...here is situation: Steve is a homeless 53 year old schizophrenic. He wanders the streets convinced that the CIA is watching him and trying to take his 'collection of evidence' (his paper bag of discarded cups, cans, etc). When he is given medication, sometimes he will take it, if he believes it is for something other than 'mind control dictated by the CIA'. I got this simple nursing plan of care...cold you please check and point me to the right direction: Problem #1 - Impaired Thought Processes. Outcome/Goal: Promote appropriate interaction (reality orientation)between client and environment. Enhance physiologic stability/health maintenance, medication compliance. Provide protection; ensure safety need. Intervention: Determine severity of client's altered thought processes. Establish a therapeutic nurse-client relationship. Approach slowly with a non-demanding manner, allow periods of silence. Use therapeutic communications (e.g., reflection, paraphrasing) to intervene effectively.Express desire to understand client's thinking by clarifying what is unclear, focusing on the feeling rather than the content, endeavoring to understand (in spite of the client's unclearness), listening carefully, and regulating the flow of the thinking as needed (Active-listening). Reinforce congruent thinking. Refuse to argue/agree with disintegrated thoughts. Present reality and demonstrate motivation to understand client (model patience). Share appropriate thinking and set limits (cognitive therapy) if client tries to respond impulsively to altered thinking. Assess rest/sleep pattern by observing capacity to fall asleep, quality of sleep. Graph sleep chart as indicated until acceptable pattern is established. Assess presence/degree of factors affecting client's capacity for diversional activities. Monitor medication regimen, observing for therapeutic effect and side effects (e.g., anticholinergic [dry mouth, etc.], sedation, orthostatic hypotension, photosensitivity, hormonal effects, reduction of seizure threshold, extrapyramidal symptoms, and fatigue/weakness with sore throat or signs of infection [agranulocytosis]). Administer medications as indicated. Evaluation: Client recognizes changes in thinking/behavior. Client identifies delusions and increases capacity to cope effectively with them by reduction of pathological thinking, establishes interpersonal relationships, maintains reality orientation. Patients maintains treatment compliance. Problem #2 Disturbed Sensory Perception- Illusions, delusions, and hallucinations. Outcome/Goal: Client will identify self in relationship to environment, recognize reality and dismiss internal voice. Demonstrate improved cognitive, perceptual, affective and psychomotor abilities. Intervention: Assess the presence/severity of alterations in client's perceptions. Note possible causative/contributing factors (e.g., anxiety, substance abuse, fever, trauma, or other organic illnesses/conditions). Spend time with client, listening with regard and providing support for changes client is making. Provide a safe environment by not arguing with or ridiculing the client. Orient to reality by communicating effectively (clear, concise); reinforcing reality of client's altered perceptions; and clarifying time, place, and person. Set limits on client's impulsive response to altered perceptions. Remain with the client and provide distraction when possible. Be honest in expressing fears, especially if potential for violence is perceived. Evaluation: Client orients to reality; verbalizes absence of hallucination, absence of paranoid statements and delusions; verbal expressions of trust. Client orients in time, place and person. Problem #3 Anxiety /Fear - Disintegration of thought processes; delusion that others want to do him harm. Increased perception of danger; focus on self. Outcome/Goal: Client will respond appropriately to feelings of anxiety by decreasing regressive or aggressive behaviors (disintegrated thinking/perception affect), will verbalize no perceived danger in interactions with others. Intervention: Note the level of the client's anxiety, considering severity, unfulfilled needs, misperceptions, present use of defense mechanisms, and coping skills. Establish trust through a patient, supportive, caring, and accepting relationship. Encourage the client to verbalize fears. Assist client to identify/communicate sources of anxiety and areas of concern. Assess for drug effectiveness/side effects. Demonstrate/encourage use of effective, constructive strategies for coping with anxiety (e.g., relaxation and thought-stopping techniques, meditation, physical exercise). Use role-modeling, positive reinforcement. Remain with the client and clarify reality. Involve client in planning treatment (participation in treatment increases client's sense of control and provides opportunity to practice problem-solving skills). Provide information about shelters, support group for patients with mental illnesses. Evaluation: Client responds appropriately to feelings of overwhelming anxiety (fears of being watched by CIA, loss of control, feelings of rejection) by decreasing regressive or aggressive behaviors (disintegrated thinking/perception affect), communicates anxious feelings openly in an acceptable manner. Orient to reality as evidenced by interpreting milieu correctly. Verbalize no perceived danger in interactions with others.

Hello Daytonite, I received another problem and this is first time I would have to write POC for patient with mental illness. If you just give me some guidance. Your help greatly appreciated. Steve is a homeless 53 year old schizophrenic. He wanders the streets convinced that the CIA is watching him and trying to take his ‘collection of evidence’ (his paper bag of discarded cups, cans, etc). When he is given medication, sometimes he will take it, if he believes it is for something other than ‘mind control dictated by the CIA’.

HELLO SOON2BAZ, I am looking for a job in Phoenix area...I live in Chicago but I need to move to AZ (I got AZ license). Currently I am taking refresher course on line and in 2-4 weeks I would need to find my preceptor. Any suggestions? I haven't practice Nursing more than 5 years that is why Board sent me to take this course.

Great to know that someone willing to help :) Thank you again very very much, I might have some more questions...still working on my refresher course online :)

hello daytonite, thank you very much for the time and effort you put in to answer my question. after i read your notes i realized that i didn't read this problem correctly. i thought that bob was diagnosed with leukemia, not his partner, but at this point i think that the partner was diagnosed. i was very confused about this problem. it would be my dream to have a mentor like you. thanks again!

Hello Daytonite, I would like to find out if you could help me with my POC? I read a lot of books but when it comes to write simple POC I don't think I get it...I haven't practice Nursing in more than 5 years. Bob is a 34 year old homosexual male, living with his partner of 14 years who is a newly diagnosed with leukemia. Client should have 3 problems. Refresher Course gave me sample POC: Problem #1 Outcome/Goal: Interventions: Evaluation: I wrote 3 problems but I am not sure if I done that correctly, Please help/guide me... Problem # 1: Knowledge Deficit regarding disease, prognosis, treatment, self-care. Outcome/Goal: Illness care. Interventions: Teaching disease process, review pathology of specific form leukemia and various treatment options. Evaluation: Knowledge of illness care, patient understanding of condition/disease process and potential complication, verbalize of understanding of therapeutic needs, participate in treatment regimen. Problem #2: Risk for Infection Outcome/Goal: Knowledge of Infection Control Interventions:Infection Protection. Screen/limit visitors as indicated, prohibit use of live plants/cut flowers. Use alcohol gels to clean hands when water not available. Restrict fresh fruits and vegetables or make sure they are washed or peeled. Inspect oral mucous membranes. Provide good oral hygiene. Use a soft toothbrush, ponge, or swabs for frequent mouth care. Avoid/limit invasive procedures. Check for Gram's stain cultures/sensitivity, HIV test for partner. Evaluation: Client will: Identify actions to prevent/reduce risk of infection. Demonstrate techniques, lifestyle changes to promote safe environment, achieve timely healing. Problem #3: Ineffective Role Performance--change in physical capacity and activity intolerance. Outcome/Goal: Endurance Interventions: Energy Management- Evaluate reports of fatigue, noting inability to participate in activities or ADLs. Encourage client to keep a diary of daily routines and energy levels, noting activities that increase fatigue. Implement energy -saving techniques; e.g., sitting, rather than standing. Provide supplemental oxygen. Evaluation: Client reports a measurable increase in activity tolerance. Participates in ADLs to level of ability. Demonstrates a decrease in physiological signs of intolerance; e.g. pulse, respiration, and BP remain within client's normal range. Client/significant other are participating in ongoing treatment/support programs.

Stopnik thank you for your reply. My situation is so complicated so I see that the only way I could precept in the hospital is actually find the job and sign a contract.

Hello everyone! Thank you for being here! I read a lot of helpful posts from many experienced Nurses! I am moving to AZ from IL, presently taking refresher course for RN online (Arizona license), any suggestions where I can find Nurse Preceptor in Phoenix area? I need 120 clinical hours. According to my refresher course Clinical assignments should be completed in 8 weeks. Clinical rotations are unpaid rotations designed to meet the goals and objectives of the course. Your employer may function as your preceptor; however, you are not functioning in a paid position. Hospital orientations, which are not clinical in nature, are not considered part of the clinical hours. Skills labs and hospital in-services, which are clinical in nature, can be used as clinical hours but may not exceed sixteen hours total. I called several hospitals and I was told that they have contract with local colleges for the Nursing students and RN preceptors are not available...I would be very glad if I can find here some tips or help/suggestion? Thank you in advance. Sincerely, Natalia

Thank you for the great info. I am moving to AZ from IL, presently taking refresher course for RN online (Arizona license), any suggestions where I can find Nurse Preceptor in Phoenix area? I need 120 clinical hours. According to my refresher course . Clinical assignments should be completed in 8 weeks. Clinical rotations are unpaid rotations designed to meet the goals and objectives of the course. Your employer may function as your preceptor; however, you are not functioning in a paid position. Hospital orientations, which are not clinical in nature, are not considered part of the clinical hours. Skills labs and hospital in-services, which are clinical in nature, can be used as clinical hours but may not exceed sixteen hours total. I called several hospitals and I was told that they have contract with local colleges for the Nursing students and RN preceptors are not available...I would be very glad if I can find here some tips or help/suggestion? Thank you in advance. Sincerely, Natalia

Thank you very m:redbeatheuch!!! I like people here- very warm and cheerful!!!

Hello everyone! I took the NCLEX on May 21, 2008. Test stopped at 85 q...On May 22 I flew to Perto Rico for a long weekend to get away from all that stress!!! While I was there I checked my result and I passssed!!! Advice to everyone- Kaplan test prep course rocks!!! I took NCLEX first time and I passed. I graduated Nursing School 15 years ago in Ukraine.