Nursing Diagnosis and Nursing Intervention


Social Isolation: withdrawal related to Low Self-esteem

Nursing Care Plan for Hallucination

Nursing Diagnosis : Social Isolation: withdrawal related to Low Self-esteem

Goal : Patients can connect with other people in stages .

Outcomes:
  • Patients can mention coping can be used .
  • Patients can mention the effectiveness of coping used .
  • Patients are able to begin to evaluate themselves .
  • patients are able to make a realistic plan in accordance with the existing capabilities at him .
  • Patients are responsible for any action taken in accordance with the plan to .
Intervention :
  1. Encourage the patient to mention the positive aspects in him physically .
  2. Discuss with the patient about his expectations .
  3. Discuss with patients who stand out for their skills at home and in the hospital .
  4. Give compliments .
  5. Identify the problems being faced by patients
  6. Discuss coping used by the patient .
  7. Discuss effective coping strategies for patients .
  8. Stressor identification with the patient and how the patient penialian to stressors .
  9. Explain that the patient confidence to stressors affect the mind and behavior .
  10. Together with the patient identification illustrate the belief that the goal is not realistic .
  11. Together with the identification of patients coping strengths and resources owned
  12. Show me the concept of success and failure with a suitable perception .
  13. Discuss adaptive and maladaptive coping .
  14. Discuss and losses due to maladaptive coping responses .
  15. Help the patient to understand that the only patients who can transform themselves not others
  16. Encourage the patient to formulate plans / objectives themselves ( not a nurse ) .
  17. Discuss the consequences and realities of planning / goal .
  18. Help the patient to clearly menetpkan changes expected .
  19. Encourage the patient to begin a new experience to develop according to the existing potential in him .

Disturbed Sensory Perception: Hallucinations related to Social Withdrawal

Nursing Care Plan for Hallucinations

Nursing Diagnosis : Disturbed Sensory Perception: Hallucinations related to Social Withdrawal

Goal : The client is able to control the hallucinations .

Outcomes :
  • Patients can and want to shake hands .
  • Patients want to mention names , would call out the name of the nurse and want to sit together .
  • Patients can mention the cause of the client withdrew .
  • Patients want to connect with other people .
  • After a home visit to a client in touch with family gradually
Intervention :
  1. Construct a trusting relationship .
  2. Make a contract with the client .
  3. Perform introductions .
  4. A name calling .
  5. Invite a conversation with a patient friendly .
  6. Assess the client's knowledge about the behavior of withdrawn and the signs
  7. and give the client a chance to express feelings cause the patient does not want to hang out / withdrawal.
  8. Explain to the client about withdrawn behavior , and signs that may be the cause .
  9. Give praise to the client's ability to express feelings .
  10. Discuss about the advantages of touch .
  11. Slowly and with the patient in the room activity through defined stages .
  12. Give credit for the success that has been achieved .
  13. Instruct the patient to independently evaluate the benefits of touch .
  14. Discuss daily schedule to do the patient to fill his time .
  15. Motivation patient in following activity room .
  16. Give credit for participation in the activity room .
  17. Perform kungjungan home , building a trusting relationship with the family .
  18. Discuss with your family withdrawn behavior , and the causes of a family facing car .
  19. Encourage family members to communicate .
  20. Instruct patient's family members routinely visit patients at least once a week .

Risk for Self or Other-directed Violence related to Hallucinations

Nursing Care Plan for Hallucinations

Nursing Diagnosis : Risk for Self or Other-directed Violence

Goal : Do not occur or other self -directed violence .

Outcomes:
  • Patients can express their feelings in its current state verbally .
  • Patients can mention the usual action when hallucinations , hallucinations and decide how to carry out an effective way for patients to use
  • Patients can use the patient's family in a way to control hallucinations often interact with the family .

Intervention :
  1. Construct a trusting relationship
  2. Give the client the opportunity to express his feelings .
  3. Listen to the client's expression of empathy
  4. Hold a brief but frequent contacts gradually ( time adjusted to the client ) .
  5. Observation of behavior : verbal and non- verbal hallucinations associated with .
  6. Explain to the client signs to describe the behavior hallucinations hallucinations .
  7. Identification with the client situation that raises and does not cause hallucinations , content , time , frequency .
  8. Give the client the opportunity to express his feelings when natural hallucination .
  9. Identification with the action taken when a client is experiencing hallucinations .
  10. Discuss ways to decide hallucinations
  11. Give the client a chance to reveal how to decide in accordance with the client's hallucinations .
  12. Encourage clients to participate in group activity therapy
  13. Instruct the client to notify the family when experiencing hallucinations .
  14. Discuss with clients about the benefits of the drug to control hallucinations .
  15. Help clients use the drug correctly .

Nursing Diagnosis

Nursing Diagnosis

NANDA NURSING DIAGNOSIS

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