UNIVERSITY OF RHODE ISLAND COLLEGE OF NURSING

NUR 334: PRACTICUM IN PSYCHIATRIC MENTAL HEALTH NURSING

PT. INITIALS: CASE STUDY
NURSING DIAGNOSIS PATIENT OUTCOME / GOALS NURSING INTERVENTIONS EVALUATION & REVISION
Risk for violence directed towards self
or others r/t intrusive memory, rage
reactions

Anxiety r/t traumatic war experience,
environment change, preoccupation
with experience AEB fear, withdrawal
from support system
Ineffective coping r/t stress AEB
disinterest in present and distancing
from supports
Distinguish etween present and
memories
Recogni!e triggers
Demonstrate relaxation techni"ues
Demonstrate control
Identify anxious feelings and report
feeling control over factors
contriuting to fear
#se appropriate coping strategies
Reduction in highest phase of anxiety
reached
Recogni!e ineffective coping
strategies and correlate to negative
outcomes
Express feelings ade"uately and
utili!e positive coping mechanisms
Evaluate s/s $I/suicidal/homicidal
ehavior
%ontract for safety
Encourage identification of triggers
Reorient pt when necessary
#tili!e deescalation techni"ues
&R' meds as prescried if necessary
Assess anxiety level, perceived threat
Develop trusting therapeutic
relationship
Determine other psychological effects,
change in mood/affect
Assess for non threatening items that
yield phoic reactions
Remain c pt, decrease stimuli, create
calming environment
Assess for distortions and help correct
Determine perception of cause,
encourage use coping skills
Encourage gradual participation in
groups, activities, c peers
Administer meds as ordered
Encourage identification ineffective
coping mechanisms and
conse"uences
&rovide ade"uate time for pt to
discuss and explore feelings
Encourage acceptance of emotions
Develop appropriate support
systems/referrals for further therapies
Administer meds as ordered
&t remains safe, effectively contracts
for safety, and remains A()x*+ Ale
to ID triggers and use positive coping
skills to deescalate self when
necessary+ %ompliant with
interventions+
&t presents with severe anxiety at
times causing feelings of depression,
fear, and guilt+ Identifies causes of
emotions and uses positive coping
skills appropriately and effectively+
%ompliant with interventions and
treatment+
&t+ ale to ID negative ways of coping
and verali!e appropriate positive
coping skills to replace+ ,erali!es
understanding of ehavior
conse"uences+ -ore readily discusses
feelings+ &lans to utili!e resources as
part of support system+
NURSING DIAGNOSIS PATIENT OUTCOME / GOALS NURSING INTERVENTIONS EVALUATION & REVISION
$leep disturance r/t psychological
stress, AEB nightmares, flashacks
insomnia
Dysfunctional .rieving r/t loss of
comrades, pre/war identity, and
psychological health AEB veral
expression guilt, hopelessness,
flashacks, anger, and changes in
ehavior patterns
Impaired social interaction r/t
preoccupation c trauma, change in
environment, survivor0s guilt, phoic
reactions to nonthreatening stimuli
AEB withdrawal from family support,
generali!ed loss of interest, guilt
Decrease fre"uency awakening during
night and flashacks
Increase feelings of eing rested,
experience limited fatigue during day
1all asleep s difficulty, acceptale
numer hours of sleep
1orm edtime routine plan
Demonstrate advancement through
stages of grief
Express emotions associated c
grieving appropriately
Express hope/make appropriate plans
for future
Return to previous 2)1
Recogni!e alterations in relationships,
determine causes
Display willingness to increase social
involvement
Increase participation in groups and
activities
)tain pt sleep hx, keep sleep diary,
and oserve
%heck anxiety level a ed,
teach/utili!e relaxation techni"ues if
necessary
Determine disturance cause/trigger
&rovide environment conducive to
sleep
3each good sleep hygiene haits
Encourage development edtime
routine plan
-eds as ordered
&rovide education to wife
Encourage expression of feelings and
use of appropriate coping skills, teach
new if necessary
Assess for 4survivor0s guilt5,
avoidance ehaviors
Determine stage of grief
&rovide pt education aout grief
stages, what feelings/thoughts to
expect
-ake appropriate referrals to support
groups, counseling, therapy
Assess level of isolation
Assess pt0s feelings associated with
isolation
Assess current support system and
identify ways to improve if necessary
Encourage interactions in groups,
activities and with peers
-ake appropriate referrals
Education and referrals for wife
&t+ IDs and displays positive sleeping
haits, develops appropriate edtime
routine+ Decrease in
nightmares/flashacks/waking, and
increased feelings of eing rested
&t ale to appropriately discuss
feelings and utili!e coping skills when
necessary+ Actively moving through
grieving process+
&t showing decreased desire to
isolate, increased interactions with
family, peers, and staff+ Increased
participation in therapies+
Resources
Varcarolis, E.M., & Halter, M.J. (2010). 1oundations of psychiatric mental health nursing. St. Louis, Missouri: Evolve Elsevier
Varcarolis, E. M. (2011). -anual of psychiatric nursing care planning6 Assessment guides, diagnoses, psychopharmacology 78th ed+9+ New Yor, NY: Sau!"ers.