Psych Care Plan Help!****

[EricaLynn<3]

HELLP! I just started my 3rd semester and today was my very first psychiatric clinical...in the past we were asked to do a concept map/care plan with only one problem/diagnosis. This semester they are asking us to do one with 2 problems/diagnosis and to connect the 2! I already have a tough time coming up with one diagnosis and now that I have to come up with 2, I dont know what to do with myself!

My patient is a 45 yo F who was admitted after being found in her home burning a bible and money on her stove. She claims that her daughter brought home a "fake" bible and my pt. felt the need to get rid of it. She said that her boyfriend had a demon inside of him and tried turning her daughter against her. The next thing she knew there were 15 cops outside her house and thats how she ended up in the hospital. After talking to her she stated that god talks to her, that her boyfriend and patients in the facility had demons inside them, that the facility set her up because her urine came up positive for cocaine and she has never touched a drug in her life and she was also scared to eat because of fear of what the facility may have put in her food ( she ended up eating anyways).

for one of the diagnosis i have done disturbed thought process related to paranoid schizophrenia

can anyone think of another problem/diagnosis that i could do and how they connect????

thanks for your help!!!!!!

erica

[fiveofpeep]

better r/t's that arent so medical diagnosy for disturbed thought process include:

impaired ability to process external/internal stimuli or sensory perceptual alterations...some profs dont want it medical dx-y thats all :)

impaired verbal communication is another for schizophrenia. r/t altered thought processes (delusions), sensory-perceptual alterations, inability to distinguish internally stimulated thoughts from actual environmental events or common knowledge, impaired insight/judgement....

defensive coping is another biggy especially with delusions. these are kinda accusatory-ish. it's hard because paranoia isnt as defensive as grandiose delusions r/t feelings of powerlessness associated with involuntary institutionalization.

good luck and explore these dx. risk for injury or others is often a good one to look at too.

PS we have had to had 2 nursing dx every semester and have 30-40 pg careplans (lame) and are surviving...you will too. it's hard cuz general nursing dx books dont have in depth mental health ones. check the internet or library. Im using handouts an instructor photocopied.

As an aside, how scared this lady must be

[Daytonite, BSN, RN]

i'm not that good with psych, but i do know how to put together a care plan. diagnoses are determined by the signs and symptoms the patient has. every nursing diagnosis has a set of signs and symptoms that your patient must match.

someone who burns a bible and money to get rid of it is not coping effectively. how many things do you light up and burn when you want to get rid of them? none, i hope! this is ineffective coping r/t unrealistic perceptions and disturbed thought processes. i think it also makes her a danger to herself and others. the diagnosis for that would be risk for injury or risk for trauma r/t hallucinations and effects of cocaine.

hearing voices (god talks to her) is hallucinatory and is disturbed sensory perception r/t chemical imbalance and substance intoxication (due to the schizophrenia and presence of cocaine in her system).

i think you should also consider the nursing diagnosis of anxiety. look at the symptoms (defining characteristics) of anxiety listed on this webpage and see if this patient doesn't have some of them: anxiety. the anxiety will be r/t her conflict with reality.

so, there are several good ideas for diagnoses for this patient. this website also has information of psych diagnoses that may help you in wording you might need for the diagnoses you do end up using:

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

[EricaLynn<3]

thank you so much guys!!! you helped out alot!

=)