Nursing Care Plan


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Medical Diagnoses: Ineffective coping, antisocial behavior and narcissistic personality disorder

Nursing DX/Clinical Problem

Client Goals/Desired Outcomes/Objectives

Nursing Interventions/Actions/Orders

I

Evaluation

Goals

Interventions

Ineffective coping r/t antisocial behavior and narcissistic personality disorder AEB poor judgment r/t impulsive behavior, manipulation of others, assaultive behavior, and a distorted view of the world.

   

Long Term Goal

Client will remain free of destructive behavior to self and others by [date]

   

Short Term Goal

Client will begin to implement at least two new coping techniques whenever he has feelings of impulsive, aggressive behavior by [date].

Long Term Interventions:

1.) Role play alternative behaviors with clients that they can use in stressful and overwhelming situations (Ackley, & Ladwig, 2008).  Rationale: Role playing allows client to rehearse alternative ways of handling stressful and angry feelings in a safe environment.

2.) Teach the client to problem solve. Have the client define the problem and cause, and list the advantages and disadvantages of the options (Collins, & Cutcliffe, 2003).

Rationale: Cognitive behavioral therapy is a useful intervention when working on issues of hope. 

3.) Upon discharge, refer for psychiatric home healthcare services for client reassurance and implementation of a therapeutic regimen (Ackley, & Ladwig, 2008).

Rationale: An intervention study of a peer-based and regular case management for community-dwelling adults with mental illness demonstrated that improved positive regard at 6 months predicted and sustained treatment motivation for psychiatric problems.

Short Term Interventions:

1.) Assist clients to identify possible courses of action and their social/interpersonal consequences (Foley, 2010).

Rationale: Such identification helps clients assume a beginning level of responsibility for thoughts, feelings, behaviors, and possible outcomes.

2.) Determine usual methods of problem solving. Help identify maladaptive strategies and suggest appropriate replacements (Foley, 2010).

Rationale: These interventions help clients determine the most beneficial strategies and substitute them for maladaptive ones. 

3.) Work closely with the client to develop appropriate educational tools that address individualized needs (Ackley, & Ladwig, 2008).

Rationale: Educational level may affect the client’s level of concern and ability to process information. Caregiver and client coping patterns may vary.

   


Long Term:

The evaluation of this goal is set for [date]. The client has demonstrated progress toward this goal by remaining free of harm to self and others and demonstrating alternative ways of handling situations.

   

Short Term:

The evaluation of this goal is set for [date]. The client has demonstrated progress toward this goal by using alternate behaviors to use self-control during situations that get out of hand.

1.) The client has used other behaviors to deescalate stressful situations with peer, staff, and teachers.

He has discussed that he looks at the outcomes of his anger more rationally now which has caused him to talk about his feelings more or back away from situations that pose a threat.

2.) The client has stated that he wants to continue therapy after he is discharged to keep him on the right tract and learn more coping techniques.

3.) The client goes to his room to work out when he is feeling aggressive, impulsive, or in a bad mood. He said it has helped him release some built up stress and helps him calm down. 

Assessment

   

Subjective Data:

Client has lack of support and a history of assaultive behavior towards siblings, mother’s boyfriend, and teachers. Client has stated he has problems sleeping. Client has had a history of destructive behavior toward self and others.

   

   

   

Objective Data

Client has shown aggressive behavior towards teacher.  He has displayed impulsive behavior and poor concentration.

   

   

   

   

   

   




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References

Ackley, BJ, & Ladwig, GB. (2008). Nursing diagnosis handbook: an evidence-based guide to planning care. St. Louis, MI: Mosby & Elsevier.274-278.

Collins, S, & Cutcliffe, JR. (2003). Addressing hopelessness in      people with suicidal ideation: building upon the therapeutic relationship utilizing a cognitive behavioral approach. Journal of Psychiatric Mental Health Nursing, 10(2), 175-185.

Foley, M. (2010). Lippincott's handbook for psychiatric nursing and care planning. Philadelphia, PA: Wolters Kluwer Health and Lippincott Williams & Wilkins. 388-392, 398-402, 559.


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