Tuesday, January 10, 2012

Nursing Care Plans For Patient With Obsessive Compulsive Disorder

. Tuesday, January 10, 2012

Obsessive Compulsive Disorder
This disorder is characterized by involuntary recurring thoughts or images that the individual is unable to ignore and by recurring impulse to perform a seemingly purposeless activity. These obsessions and compulsions serve to prevent extreme anxiety on the part of the individual.
Patients with obsessive-compulsive disorder are prone to abuse alcohol, anxiolytics, or other substances in an attempt to relieve their anxiety. In addition, other anxiety disorders and major depression commonly coexist with obsessive-compulsive disorder. Obsessive-compulsive disorder is typically a chronic condition with remissions and flare-ups. Mild forms of the disorder are relatively common in the population at large.

The cause of obsessive-compulsive disorder is unknown. Some studies suggest the possibility of brain lesions, but the most useful research and clinical studies base an explanation on psychological theories. Several studies have shown brain abnormalities, such as decreased caudal size and decreased white matter, but results are inconsistent and remain under investigation. In addition, major depression, organic brain syndrome, and schizophrenia may contribute to the onset of obsessive-compulsive disorder.

Nursing Assessment
The psychiatric history of a patient with this disorder may reveal the presence of obsessive thoughts, words, or mental images that persistently and involuntarily invade the consciousness. Common obsessions include thoughts of violence (such as stabbing, shooting, maiming, or hitting), thoughts of contamination (images of dirt, germs, or stool), repetitive doubts and worries about a tragic event, and repeating or counting images, words, or objects in the environment. The patient recognizes that the obsessions are a product of his own mind and that they interfere with normal daily activities but feels powerless to stop them.
The patient's history may also reveal the presence of compulsions irrational and recurring impulses to repeat a certain behavior. Common compulsions include repetitive touching, sometimes combined with counting; doing and undoing (for instance, opening and closing doors or rearranging things); washing (especially hands); and checking (to be sure no tragedy has occurred since the last time he checked). In all cases, obsessive-compulsive behaviors and activities consume more than 1 hour of the patient's time per day. The activities are done to alleviate anxiety triggered by the patient's core fear.
During the assessment interview, determine the patient's personality type. The obsessional personality usually is rigid and conscientious and has great aspirations. He exhibits a formal, reserved manner, with precise and careful movements and posture; he takes responsibility seriously and finds decision-making difficult. He lacks creativity and the ability to find alternate solutions to his problems.Also evaluate the impact of obsessive-compulsive phenomena on the patient's normal routine. He'll typically report moderate to severe impairment of social and occupational functioning.

Nursing Diagnosis

  • Anxiety
  • Chronic low self-esteem
  • Fear
  • Ineffective coping
  • Ineffective role performance
  • Impaired social interaction
  • Risk for injury
  • Social isolation

Nursing Key outcomes Nursing Care Plans For Obsessive–Compulsive Disorder

  • The patient will express feelings of anxiety as they occur.
  • The patient will develop self-esteem.
  • The patient will express fears and concerns.
  • The patient will demonstrate effective social interaction skills.
  • The patient will cope with stress without excessive obsessive-compulsive behavior.
  • The patient will reduce the amount of time spent each day on obsessing and ritualizing.
  • Ritualistic behavior won't produce harmful effects.
  • The patient will maintain family and peer relationships
  • Client is able to maintain anxiety at level in which problemsolving can be accomplished.
  • Client is able to verbalize signs and symptoms of escalating anxiety.
  • Client is able to demonstrate techniques for interrupting the progression of anxiety to the panic level.

Nursing Interventions Nursing Care Plans For Obsessive–Compulsive Disorder

  • Approach the patient unhurriedly.
  • Provide an accepting atmosphere; don't show shock, amusement, or criticism of the ritualistic behavior.
  • Allow the patient time to carry out the ritualistic behavior (unless it's dangerous) until he can be distracted into some other activity. Blocking this behavior raises anxiety to an intolerable level.
  • Keep the patient's physical health in mind. For example, compulsive hand washing may cause skin breakdown, and rituals or preoccupations may cause inadequate food and fluid intake and exhaustion. Provide for basic needs, such as rest, nutrition, and grooming, if the patient becomes involved in ritualistic thoughts and behaviors to the point of self-neglect.
  • Let the patient know you're aware of his behavior. For example, you might say, I noticed you've made your bed three times today; that must be very tiring for you. Help the patient explore feelings associated with the behavior. For example, ask him, What do you think about while you are performing your chores?
  • Make reasonable demands, and set reasonable limits; make their purpose clear. Avoid creating situations that increase frustration and provoke anger, which may interfere with treatment.
  • Explore patterns leading to the behavior or recurring problems.
  • Listen attentively, offering feedback.
  • Encourage the use of appropriate defense mechanisms to relieve loneliness and isolation.
  • Engage the patient in activities to create positive accomplishments and raise his self-esteem and confidence.
  • Encourage active diversional resources, such as whistling or humming a tune, to divert attention from the unwanted thoughts and to promote a pleasurable experience.
  • Assist the patient with new ways to solve problems and to develop more effective coping skills by setting limits on unacceptable behavior (for example, by limiting the number of times per day he may indulge in obsessive behavior). Gradually shorten the time allowed. Help him focus on other feelings or problems for the remainder of the time.
  • Identify insight and improved behavior (reduced compulsive behavior and fewer obsessive thoughts). Evaluate behavioral changes by your own and the patient's reports.
  • Identify disturbing topics of conversation that reflect underlying anxiety or terror.
  • Observe when interventions don't work; reevaluate and recommend alternative strategies.
  • Monitor effects of pharmacologic therapy.


Monday, June 28, 2010

Nursing Diagnosis Latex Allergy response

. Monday, June 28, 2010

Nursing Diagnosis Latex Allergy response an allergic response to natural latex rubber products
Related Factors:
No immune mechanism response

Nursing Outcomes
• Immune Hypersensitivity Control
• Symptom Severity
• Tissue Integrity: Skin and Mucous Membranes

Client Outcomes
• Identifies presence of latex allergy
• Lists history of risk factors
• Identifies type of reaction
• States reasons not to use or to have anyone use latex products
• Experiences a latex free environment for all health care procedures
• Avoids areas where there is powder from latex gloves
• States the importance of wearing a Medic Alert bracelet and wears one

Nursing Interventions and Rationales

Allergy Management
Latex Precautions

  • Take a careful history of clients at risk: health care workers, rubber industry workers, clients with neural tube defects, atopic individuals (asthma, atopic eczema) and food allergies.
  • Question the client about associated symptoms of itching, swelling, and redness after contact with rubber products, or swelling of the tongue and lips after dental examinations.
  • Materials and items that contain latex must be identified, and latex free alternatives must be use.
  • Five principles for management of latex-allergic clients:
1. Recognize the problem,
2. Avoid exposure to latex,
3. Inform the surgeons and operating room nurses,
4. Be prepared to treat anaphylaxis,
5. Be vigilant postoperatively and arrange follow-up care.
  • Anaphylaxis from latex allergy is a medical emergency and must be treated differently than anaphylaxis from other causes must be placed in a latex-safe environment if necessary create a latex-free environment.
Home Care Interventions patient and Family Teaching
  • Do not use latex products in care giving.
  • Assess the home environment for presence of natural latex products.
  • At onset of care, assess client history and current status of latex allergy response.
  • Assist client in identifying and obtaining alternatives to latex products.
  • Provide written information about latex allergy and sensitivity.
  • Instruct clients to inform health care professionals if they have a latex allergy, particularly if  scheduled for surgery.
  • Teach clients what products contain natural rubber latex and to avoid direct contact with all latex products and foods that trigger allergic reactions.
  • If necessary Instruct client to carry an autoinjectable epinephrine syringe if at risk for anaphylactic episode.


Tuesday, January 5, 2010

Nursing Key Outcomes, Nursing Interventions, Patient Teaching For Epilepsy

. Tuesday, January 5, 2010

Common nursing diagnosis found in nursing care plans for Epilepsy, Ineffective airway clearance, Anxiety, Deficient knowledge (diagnosis and treatment), Fear, Ineffective coping, Risk for injury, Social isolation

Nursing Key outcomes nursing care plans for Epilepsy
Patients with epilepsy will:

  • Express feelings of decreased anxiety.
  • Communicate an understanding of the condition and treatment regimen.
  • Identify any fears or concerns.
  • Use support systems and develop adequate coping.
  • Remain free from injury.
  • Resume active participation in social situations and activities.
  • Family will use support systems and develop adequate coping

Nursing interventions nursing care plans for Epilepsy
  • Provide emotional support to patients.
  • Encourage patient express their fears and concerns. Suggest counseling to help them cope.
  • Encourage family express their fears and concerns, and sugest to support counseling to help them cope.
  • Monitor the patient for signs and symptoms of toxicity, such as slurred speech, ataxia, lethargy, dizziness, drowsiness, nystagmus, irritability, nausea, and vomiting. If the patient is taking anticonvulsants
  • If needed Prepare the patient for surgery.
  • If necessary, provide preoperative and postoperative care appropriate for the type of surgery the patient is to undergo.
Patient Teaching Discharge And Home Healthcare Guidelines

Be sure that the patient understands all medications, including the dosage, route, action,adverse effects, and need for routine laboratory monitoring of AEDs
  • Give adequate patient support by developing an understanding of, Answer of any patients questions.
  • Teach patients dispelling myths. For example, assure them that epilepsy is not contagious and is controllable for most patients who follow a prescribed regimen of medication. Provide assurance that most patients maintain a normal lifestyle.
  • Explain to the patient and his family the need for compliance with the prescribed drug schedule.
  • Assure the patient that anticonvulsant drugs are safe when taken as ordered..
  • Teach the patient about the medication's possible adverse effect drowsiness, lethargy, hyperactivity, confusion, visual and sleep disturbance all of which indicate the need for dosage adjustment. Tell him that phenytoin therapy may lead to hyperplasia of the gums, which may be relieved by conscientious oral hygiene. Instruct the patient to report adverse reactions immediately.
  • Explain the importance of having anticonvulsant blood levels checked at regular intervals even if the seizures are under control.
  • Instruct the patient to eat regular meals and to check with his physician before dieting. Explain that maintaining adequate glucose levels provides the necessary energy for central nervous system neurons to work normally. (See Preventing seizures.)
  • If the patient is needs  surgery, provide appropriate preoperative teaching. Explain the care that the patient can expect postoperatively.
  • Teach the patient's family to Avoid restraining the patient during a seizure
  • Know which social agencies in your community can help epileptic patients. Refer the patient to the Epilepsy Foundation for general information and to the state motor vehicle department for information about a driver's license.


Wednesday, October 28, 2009

Nursing Key outcomes, Nursing interventions, and patient teaching Nursing Care Plans for Chronic Renal Failure

. Wednesday, October 28, 2009

Nursing Key outcomes, Nursing interventions, and patient teaching Nursing Care Plans for Chronic Renal Failure
Key outcome for patients with CRF, patients will:

  • Report increased comfort.
  • Maintain hemodynamic status.
  • Remain oriented to person, place, time, and situation.
  • Maintain fluid balance.
  • Verbalize appropriate food choices according to his prescribed diet.
  • Maintain adequate ventilation and oxygenation.
  • Demonstrate skill in managing the urinary elimination problem.
  • Use support resources and exhibit adaptive coping behaviors.
  • Resume sexual activity to the fullest extent possible.
  • Maintain adequate urine output.
  • Verbalize having feelings of control over condition and own well-being.
  • Remain free from signs or symptoms of infection.
  • Avoid or minimize complications.
  • Family members will demonstrate adaptive coping behaviors.
  • The patient's oral mucous membrane will remain intact.
  • Family members will verbalize the effects of the patient's condition on the family unit.

Nursing interventions Nursing Care Plans for Chronic Renal Failure (CRF)
The widespread clinical effects of chronic renal failure require meticulous and carefully coordinated supportive care.
  • Provide good skin care.
  • Provide good oral hygiene
  • Offer small, palatable, nutritious meals
  • Monitor the patient for hyperkalemia. Watch for cramping of the legs and abdomen and for diarrhea.
  • Carefully assess the patient's hydration status.
  • Carefully measure daily intake and output.
  • Monitor for complications.
  • Encourage the patient to perform deep-breathing and coughing exercises to prevent pulmonary congestion
  • Maintain aseptic technique.
  • Carefully observe and document seizure activity. Periodically assess neurologic status.
  • Observe for signs of bleeding.
  • Report signs of pericarditis, such as a pericardial friction rub and chest pain.
  • Schedule medication administration carefully.
  • If the patient requires dialysis, check the vascular access site for patency and the arm used for adequate blood supply and intact nerve function.
  • After dialysis, check for disequilibrium syndrome, a result of sudden correction of blood chemistry abnormalities.

Patient teaching Nursing Care Plans for Chronic Renal Failure (CRF)
CRF and ESRD are disorders that affect the patient’s total lifestyle and the whole family. Patient teaching is essential and should be understood by the patient. All teaching should be reinforced at intervals during the patient’s lifetime. Include: Care of peritoneal catheter for dialysis, care of external arteriovenous dialysis access (shunt), care of the arteriovenous fistula, post-transplantation teaching.


Monday, October 26, 2009

Nursing Outcomes Nursing interventions and Patient teaching Nursing care plans for Conduct Disorder

. Monday, October 26, 2009

Nursing outcomes Nursing care plans for Conduct Disorder

  • Patients Anxiety is maintained at a level at which client feels no need for aggression and will not harm self or others physically or emotionally.
  • Client will seeks out staff to discuss true feelings.
  • Client recognizes, verbalizes, and accepts possible consequences of own maladaptive behaviors.
  • The patient and parents will attend counseling to discuss the patient's illness and learn how to handle his behavior.
  • Patient will develop effective coping skills to help him process stressors.
  • Patient will develop effective social interaction and problem solving skills.
  • Patient will utilize constructive channels to release anger.
  • Patient will express awareness of how his actions affect others.

Nursing interventions Nursing care plans for Conduct Disorder
Work to establish a trusting relationship with the child. Provide clear behavioral guidelines, including consequences for disruptive and manipulative behavior. Help the child accept responsibility for behavior rather than blaming others, becoming defensive, and wanting revenge.

Nursing Diagnosis and Interventions for Conduct Disorder

Patient teaching Nursing care plans for Conduct Disorder
  • Teach the child effective coping skills, social skills, and problem-solving skills, and have him demonstrate them in return.
  • Teach the child to express anger appropriately through constructive methods to release negative feelings and frustrations.
  • Use role playing to help the child practice handling stress and gain skill and confidence in managing difficult situations.

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