ncp anxiety.pdf

ncp

1. NURSING CARE PLAN
MENTAL HEALTH NURSING
NURSING CARE PLAN
I. Identification Data of Patient
Name: Pritam Singh
Age: 33
Sex:Male
Religion:Sikh
Marital Status:Married
Educational Status:10
TH

Occupation: Farmer
Income Per Month:10,000
Languages Known: Punjabi
Ward: Medical ward
Diagnosis: Anxiety
Address:Panchkulla
Date of Admission:16-1-2022
Informant :wife Relationship with Patient:wife
Reliability of information : Yes/No
II. Presenting Chief Complaints
III. He/she presented to the ED obtunded, and only responsive to painful stimuli, with positive drug and alcohol screening, along with
low magnesium level. CT of head was WNL. IV fluids were administered, and patient monitoring continued since admission.
Patient: The patient is now alert, oriented to name and place, becoming increasingly agitated with notable tremors, pacing,
talking to self and uncooperative with care. The patient asks every person who enters the room to sign his/her notebook.
He/she continually asks about the location of his/her belongings and his/her dog. Patient becomes restless and frustrated,
expressing a desire to leave the hospital.
Informant:Mother,Wife

IV. Present History

2. (While describing present illness consider chronological description of abnormal behavior, associated problems like suicide,
homicide, disruptive behavior, thought content, speech, mood states, abnormal perception, biological functioning, social
functioning, occupational functioning, changes in ADLs)


V. Treatment History


ECT: Not given

Psychotherapy: Primary nurse and/or Team Leader use therapeutic communication attempting to calm patient, Calls for Social
Service and Psychology to assist with patient
Family therapy:Given
Medication Dosage Route Side effects
Olanzapine
Geodon
Chlordiazepoxide
10 mg
10 mg
100 mg

Po
Po
Po
Lethargy,drawsiness
Thiamine 100 mg IV
Normal Saline 1000 ml IV
MVI 1amp IV

3. Rehabilitation: Vocational,

VI. Past Psychiatric and Medical History
He has a history of schizophrenia with paranoia, and per last hospital record, the patient was prescribed Olanzapine (Zyprexa)
10 mg daily. Alcohol abuse; Schizophrenia with paranoia; probable drug use.


Treatment outcome:He was quit alcohol for some time.

Substance use details: . Alcohol abuse from past 3 years, ; probable drug use.

Family History

Name of
family
member

Age/ Sex

Education

Occupation

Health
Status

Relationship
with patient
Age at death
and mode of
death
-Guzar singh
-Sarvan kaur
-Sarabjeet
kaur
-Arjun
60/Male

58/female

30/female

3year/male
10
th


10
TH


B.A
Farmer

Housewife

Private job
Good

Good

Good

Good
Father

Mother

Wife

Son








Genogram
(family of origin, three generations)




VII. Personal history

4. A. Perinatal history
✓ Antenatal period: NO
✓ Intranatal Period: type of delivery- normal:

✓ Birth: full term

✓ Birth Cry: immediate

✓ Birth Defects: No
✓ Postnatal complications: jaundice

B. Childhood history
✓ Primary caregiver: Mother
✓ Feeding: breastfed
✓ Age at weaning: 6 month
✓ Developmental milestones: normal
✓ Behavior and emotional problems: thumb sucking, excessive temper tantrums, nail biting, pica, enuresis,night terrors
✓ Illness during childhood: No
C. Educational History
✓ Age at beginning of formal education:4 year
✓ Academic performance:Good
✓ Extracurricular achievements, if any:No
✓ Relationship with peers and teachers:Good
✓ School phobia: yes
✓ Look for conduct disorders: No
(For e.g., truancy/ stealing)
✓ Reason for termination of studies: No

5. D. Play History
✓ Games Played:Football with friends
✓ Relationship with Playmates:Good

E. Emotional Problems during Adolescence
smoking
F. Puberty
✓ Age at appearance of secondary sexual characteristics:14 years
✓ Anxiety related to puberty changes:yes
✓ Age at menarche:No
✓ Reaction to menarche:’No
✓ Regularity of cycles, duration of flow:No
✓ Abnormalities, if any (menorrhagia, dysmenorrhea, etc.):No

G. Obstetrical History
✓ LMP:
✓ Number of children:
✓ Any abnormalities associate with pregnancy, delivery, puerperium:
✓ Termination of pregnancy, if any:
✓ Menopause (including any associated problems):

H. Occupational History
✓ Age at starting work:25
✓ Job held in chronological order:
✓ Reasons for changes:No
✓ Current job satisfaction:Satisfied,Good relationship with collegues
✓ Whether the job is appropriate to patient’s background: Yes

6. I.Sexual and Marital History
✓ Types of marriage: Arrange
✓ Duration of married life:5 years
✓ Interpersonal and sexual relations: Satisfactory
✓ Extramarital relationship, if any, specify:NO

J. Premorbid Personality
✓ Interpersonal relationship: -Introvert
✓ Family and Social relationship: -Good
✓ Use of Leisure time: - Reading books,watching t.v,Drinking alcohol
✓ Predominant mood: -Pessimistic
✓ Usual reaction to stressful events: - Stressed
✓ Attitude to self and others:
✓ Attitude to work and responsibility: Unresponsive
✓ Religious beliefs and moral attitudes: Pessimistic
✓ Habits
• Eating Pattern: -Irregular
• Elimination: - Regular
• Sleep: - Irregular
• Use of drugs/ alcohol -Alcohol Addiction
• Exercise Pattern - Irregular

7. PHYSICAL EXAMINATION
• General Examination:
• Temperature: 99.2° F. oral
• Pulse: 90beats/min
• Respiration: 22
• Blood Pressure (BP):’ 144/86
• Cardiovascular system: Regular sinus rhythm, no gallops, rubs or murmurs; apical clear S1 and S2; radial and pedal pulses
+3
• Respiratory System: Lung fields clear bilaterall
• Gastrointestinal System: WNL
• Musculoskeletal System: WNL
• Lymph Nodes: WNL
• Breasts:
• Pelvic Examination:
• Any other Signs:No

Summary:

8. MENTAL STATUS EXAMINATION- MENTAL STATUS EXAMINATION
Mental Status Exam:
• Appearance
• •There is no one-size-fits-all when it comes to appearance and behavior of patients with schizophrenia.
• •Patients may be poorly groomed, fail to bathe, and dress "inappropriately" (example: dress much too
warmly for the prevailing temperatures)
• •These patients can have a wide range of appearances. You may have a patient that is completely
disheveled, screaming and agitated. You might also see someone that is obsessively groomed,
completely silent, and immobile. Many patients will present somewhere in the middle of these
spectrums.
• Also, schizophrenia patients often present with odd or inappropriate attire, such as a coat and hat worn
dur-ing the summer or dark sunglasses worn during an interview.
• Inference:-Dressed appropriately for the season. Grooming is good. The patient appears older than
stated age.
• Behavior during the interview: Individuals with schizophrenia may be friendly and coopera-tive, or
they may be hostile, annoyed and defensive during an interview. The latter may be secondary to
paranoid symptoms, which can make patients quite cautious and guarded in their re-sponses to
questions.
• Inference: In Patient-Arrived on time. Cooperative, alert, and pleasant.
• Thinking Process: During the interview, the patient was cooperative, alert, and pleasant. The patient
also arrived on time
• Social skills: Had good eye contact. Reports reduced socialization.
• Eye contact: Patient maintained good eye contact.
• Orientation: Aware of person, place and time.
• Thinking Process: Patient is within a reasonable range of self-aware

9. • Memory: Memory was good for immediate recall of interviewer’s name. Thinking process: Able to
spell the word “twitter” in forwarding and backward directions correctly. The patient can recall last four
presidents of the country.
• Speech patterns: Speech / Language

• •This is not all-inclusive but below are described some of the ways that speech / language can be
commonly affected in psychotic disorders.

• •Incoherence: speech or thought is difficult or impossible to understand because words or phrases are
not connected in a logical way. See thought process for examples

• •Neologism: creation of new words that are meaningless except to the person coining the ter

• •Paucity of speech: there is a lack of unprompted speech. Another term for this is alogia. This is
considered a negative symptom of schizophrenia. From my clinical experience working with other
residents/students this seems to be something that is commonly missed and not commented on in their
notes.

• •Poverty of content: speaking without substance. This type of speech requires excessive speech to
convey their message.
Inference- Patient speech patterns seem normal.
Thinking Process:
Thought clarity: Clear
• Thought content: She denies auditory or visual hallucinations. She denies suicidal and homicidal
ideation.
• Thought process: No overt sign of psychosis, goal-directed.
• Mood: Mood/Affect

• •Two common affective symptoms in schizophrenia are
• Reduced emotional responsiveness and

10. • "Inappropriate" emotions such as extremes of rage, happiness, and anxiety.

• •Reduced emotional responsiveness can be described along a continuum and this applies to any patient
not just those with psychotic features. This responsiveness can be described in terms of its intensity,
range, and stability.
• Constricted/Restricted is a mild reduction in the range and intensity of expression.
• Blunted is a significant reduction (greater than constricted).
• Flat is an absence or near absence of affective expression.

• •Reduced emotional responsiveness in these patients can actually occur from a number of mechanisms.
Differentiating these can be a challenge.
• Symptom of the underlying disease process in the brain
• Adverse effects of antipsychotic medications (parkinsonism)
• Depression


• •"Innappropriate" emotions are those emotions displayed by the patient that don't "match" the content
of speech or what would normally be felt in the circumstances. Example: They may describe how sad
they were when their mother died but they are grinning and laughing uncontrollably. These discordant
emotions can also be far ranging and may include religious ecstasy, inappropriate terror or anxiety over
common things, overwhelming ambivalence, etc...
• Depressed, anxiety level is moderate.
• Affect: Consistent with mood
• Thinking process: Patient has clarity. Patient denies suicidal and homicidal ideation.
• Insight and Judgment: Appropriate. Able to explain what He will do if when she gets to a stop sign
while driving, she responded: “I will stop”. Hhe states that she needs help with her mental health.
• Intellectual functioning: Intelligence is average. The patient was able to complete initial interview and
consent forms.
• Abstract thinking: He can interpret the proverb “make hay while the sun shines” means to work hard
while you can and save up for the future

11. NURSING MANAGEMENT
Nursing Assessment
• Objective Data: Patient will eat at least two out of three meals a day
· Patient will identify two of her medications and state why she needs to take them

1. Subjective Data: A patient says he has a fever.
2. A patient complains of nausea and loss of appetite.
• A patient complains of shakiness
List of Nursing diagnosis according to the needs of the patients
• Disturbed Thought Processes related to)Inability to trust,Panic level of anxiety,Low self-esteem.
• Altered nutritional pattern related to disease process as evidenced by lack of appetite.
• Altered sleep pattern related to hospitalization as evidenced by restlessness.
• Anxiety related to hospitalization
• Knowledge deficit related to disease and its management

12. S
.
N
O
NURSING
DIAGNOSI
S
GOAL PLANNING IMPLEMENTATION RATIONALE EXPECTED
OUTCOME
1.
























Disturbed
Thought
Processes
related
to)Inability to
trust,Panic
level of
anxiety,Low
self-esteem
.













To improve
thought
process.
















- A rapport should be
established with the
patient.
- Family should be
encouraged to provide
emotional support to the
patient
- Patient should be
encouraged to ventilate
his feelings
- Psychotherapy and
group therapy should be
planned.
- Alternate rest and
activity periods should
be planned.

- Passive exercises
should be done with the
patient.

- Patient should be
taught regarding the
withdrawal symptoms
- Rapport established with the
patient by taking history.

- Family members asked to
help the patient in daily
activities and support the
patient during the treatment.

- Patient is encouraged to
ventilate feelings and
experiences.

- Psychotherapy was given to
the patient.

- Alternate rest and activity
period is planned.

- Exercise is done and deep
breathing exercises are taught
to the patient.

- Patient is encouraged and
taught regarding withdrawal
symptoms.
- This will maintain therapeutic
relationship.


- It will decrease the feelings of
social rejection and isolation.


- Self expression will increase
the confidence.


-Group therapy will decrease
social rejection

- Alternate rest and activity
periods will save energy.

- Exercises will promote
muscle strength.

- Teaching regarding the
withdrawal symptoms will help
the patient to cope.

Thought
process is
improved.

13. 2.






























Altered
nutritional
pattern
related to
disease
process as
evidenced by
lack of
appetite.























To improve
nutritional
pattern of
the patient.


















and encouraged.

- Intake and output of
the patient should be
monitored.


- Small and frequent
meals should be
encouraged.
- Patient should be
helped in developing
interest in eating.
- Choices should be
asked from the patient.

- Food should be served
in attractive manner

-Record weight of the
patient

- Food should be served
in conducive
environment.

- Reassure the patient




- Intake and output of the
patient was monitored and
total intake was 1200ml/ day
and output was 1550 ml/day


- Small and frequent meals are
given to the patient.

- patient is encouraged to eat
and interest is developed in
eating

- Choices of the patient
included in diet.


- Food is served in attractive
manner

-weight of the patient recorded
and it was 66 kg


- Food is served in favorable
environment and all the
distractions are removed.

- Patient reassured.




- Intake and output of the
patient will help in detecting
total loss or gain per day.




- Small meals will improve the
nutritional status of the patient.



- Food served in attractive
manner will increase the
appetite of the patient.





- Weight gain and loss will
help in assessing the nutritional
status of the patient

- This will increase the appetite
of the patient.


- Reassurance will help in
relieving anxiety of the patient.



Patient will
enjoy eating
food and
patient will
show increase
in weight.

14. 3.































Altered sleep
pattern
related to
hospitalizatio
n as
evidenced by
restlessness.

























To improve
Sleep
pattern of
the patient.




















- Provide a comfortable
environment.

- Allow the relatives to
stay

- Patient should be
encouraged to sleep for
longer duration.

- Switch on the bed side
light.

- Slowly massage the
back or head

- Provide hot glass of
milk.


- Encourage the patient
to take afternoon naps

- Surrounding
environment should be
calm and free of
distractions.







- A comfortable environment
provided to the patient.

- Relatives are allowed to stay.


- Patient should be to sleep for
6 to 8 hours.


- Bed side light should be
switched on.

- Back massage is given to the
patient

- A glass of hot milk is given
to the patient.


- Patient is encouraged to take
afternoon naps.


- Environment is made calm
and free from distractions.







- Comfortable environment
will promote sleep.




- Proper sleep will decrease
physical exhaustion





- Back massage will relieve
pain and promote sleep.





- Afternoon naps will promote
adequate sleep hours.


- Environment free from
distractions can promote better
sleep pattern.






Patient will
feel fresh
after getting
up.

15. 4.
































Anxiety
related to
hospitalizatio
n




























To relieve
the anxiety
reassuring
the patient.




















- To assess the level of
anxiety & coping
mechanism


- To assess the need of
spiritual counseling.

- To allow the patient
to express anxiety &
fear.

- To use flexible
visiting hours for the
relatives.

- To encourage relatives
in active participation in
care

-To teach the patient to
do meditation.


- To provide books of
patient’s interest.



- To teach the patient
regarding the bad
effects of drugs and


- Level of anxiety & coping
mechanism assessed.



- Need of spiritual counseling
assessed.

- Patient asks questions
regarding changes in daily
living activities.

- Flexible visiting hours used
for relatives.


- Relatives are allowed to
participate in care of patient.


- Patient is encouraged to do
meditation.


- Books are provided to
patient.



- Patient is taught regarding the
bad effects of drugs and course


- This provides information
about physiological well being.



- It reduces extra strain &
fatigue.

- It helps in ventilating the
feelings.


- The presence of supportive
care reduces the anxiety of
patient as well as relatives.

- It provides feeling of homely
environment.


- Meditation reduces anxiety.


-. It diverts the mind of the
patient.




-Enhances the knowledge and
helps in better recovery.



Patient will
verbalize
anxiety and
use various
methods to
come out of
it.

16. 5.










Knowledge
deficit related
to disease
and its
management










To provide
knowededg
e regarding
disease and
its
managemen
t.
course of deaddiction
-To take medicine as
prescribed.

-To follow exercise
schedule.

-To do meditation
daily.


-To keep the record of
all medical treatment.


- To encourage follow
up


- Patient should be
taught regarding the
withdrawal symptoms.




of deaddiction

- Medicine schedule explained
to patient.

- Exercise schedule explained.

- Explained about importance
of meditation.


- Patient taught about medical
record keeping.



- Follow up encouraged




- Patient is taught regarding the
withdrawal symptoms.








-To prevent complications.


-To maintain muscle strength

- Meditation relaxes the mind.


- It is helpful in further
treatment initiation.



- Follow up will help in
maintaining the health status.


- This will help in coping with
the treatment.




Patient will
have
knowledge
regarding the
disease and
risk factors.

17. HEALTH EDUCATION
1. Stay active. Regular exercise is good for your physical and emotional health. ...
2. Don't drink alcohol. Alcohol is a natural sedative. ...
3. Stop smoking. Share on Pinterest. ...
4. Ditch caffeine. ...
5. Get some sleep. ...
6. Meditate. ...
7. Eat a healthy diet. ...
8. Practice deep breathing

18. Bibliography-1.American Psychiatric Association and American Psychiatric Association (2013) Diagnostic and statistical manual of
mental disorders: DSM-5. 5th ed. Washington, D.C.: American Psychiatric Association. Available at:
http://bangor.eblib.com/patron/FullRecord.aspx?p=1811753.
2.Murphy E. A more ambitious vision for residential long-term care. International Journal of Geriatric Psychiatry 1992, 7 (x), 851-
852.
3. Conn DK, Herrman N, Kaye A, Rewilak D, Schogt B (eds). Practical Psychiatry in the Longterm Care Home (3rd ed). Cambridge,
USA: Hogrefe, 2007.
4.Stuart, G. W. (2009). Principles and practice of psychiatric nursing (9th ed.). St. Louis, MO: Elsevier Mosby.
5.Townsend, M. C. (2012). Psychiatric/mental health nursing: Concepts of care (7th ed.). Philadelphia: F. A. Davis Company