Mental Health Care Plan

Ineffective coping

· Inadequate coping skills

· Inadequate level of confidence inability to cope

· Inadequate resources available

· Substance abuse

· Low self-esteem

1. The nurse will observe for contributing factors of ineffective coping such as poor self-concept, grief, lack of problem-solving skills, lack of support, recent change in life situation, or gender differences in coping strategies.

2. The nurse will use verbal and nonverbal therapeutic communication approaches including empathy, active listening, and confrontation to encourage the client and family to express emotions such as sadness, guilt, and anger; verbalize fears and concerns; and set goals.

3. The nurse will encourage the client to describe previous stressor and the coping mechanisms used.

2. “Clinicians communication skills contribute to well-being of clients and minimizes psychosocial problems (Duff et al, 2009).”

3. “A psychoeducational intervention that included the clients identification of symptoms, types of coping strategies used before and after the event, and ways to select alternative strategies was accompanied by mediation intervention statistically significantly improved PTSD and depression (Oflaz, Haitpoglu, & Ayan, 2008).”

4. “The supportive relationship the nurse has with the clien may be essential to individuals coping with a threatening process (Giske & Gjengedal, 2007).”

1. Patient will be not exhibit signs of behavioral problems during shift of care.

2. Patient will participate in group one group activity once per shift.

3. Patient will express feelings associated with substance abuse as a coping with stress.

4. Patient will verbalize adapt coping mechanism used.

5. Patient will verbalize concerns of harming self.

Patient will be honest with self, staff, and family members about feelings of sadness or hurt.

The patient was able to meet majority of the goal. Patient did participate in group activity with the student nurses. He tried to participate in group but left early due to fatigue. He patient understands mediation use and its side effects and is willing to take Geodon. Patient is still reluctant to take Haldol but is considering it. Patient verbalized the need for help with substance abuse of THC and would like more information regarding it. Overall the goals were met and patient seems to be improving.

Activity intolerance

Imbalance between peripheral oxygen supply and demand

Congestive heart failure

· Abnormal blood pressure response to activity

· Exertion dyspnea

· Verbal report of fatigue

· Verbal report of weakness

1. Allow for periods of rest before and after planned exertion periods such as meals, bath, treatment, and physical activity.

2. If mainly on bed rest, minimize cardiovascular deconditioning by positioning the client in an up right position several times daily if possible.

3. If the client is able to walk and has heat failure, consider use of the 6-minute heart failure test to determine physical ability

4. When the client is up observe for symptoms of intolerance such as nausea, pallor, dizziness, visual dimming, impaired consciousness, as well as changes in vital signs.

5. Assess for swaying, poor balance, weakness, and fear of falling while elders stand/walk. If present refer to physical therapy.

1. “Both physical and emotional rest help lower arterial pressure and reduce the workload of the myocardium” (Fauci et al, 2011).

2. “Deconditioning of the cardiovascular system occurs within days and involves fluid shifts, fluid loss, decreased cardiac output, decreased peak oxygen uptake and increased resting heart rate” (fauci et al, 2011).

3. The 6-minute walk test is a safe, simple exercise test that predicts functional capacity (Du et al, 2010).

4. When an adult rise to the standing position about 350- 800mL of blood pools in the lower extremities. As a results hypoperfusion may occur, including feelings of weakness, nausea, headache, lightheadedness, dizziness, blurred vision, and fatigue. (Bradley & Davis, 2012).

5. Fear of falling and repeat falling is common in the elderly. Balance rehabilitation provides individualized treatment for person with various deficits (Ebell, 2010).

1. The client will demonstrate increased tolerance to activity by end of shift 09/30/2015.

2. The client will participate in prescribed physical activity by lunch time 09/30/2015.

3. The client will complete the 6-minute walk test by end of shift 09/30/2015.

4. The client will state the symptoms and adverse effects of exercise and report onset of symptoms immediately by end of shift 09/30/2015.

The patient was able to demonstrate increased tolerance to activity by end of shift verbally. The patient participated in prescribed physical activity at 10:00 AM. The patient tolerated physical therapy well and will continue the prescribed regimen. The client was not able to complete the 6-minute walk test with physical therapy on my shift, but it completed prior to me taking care of this patient. Maybe this can be done again to see if there is any improvement. The patient was able to states the symptoms of adverse effects and reported if he had any other changes or felt different. All other goals were met by my client in the stated time frame.

Impaired mobility

Chronic limb ischemic and Post-surgical patient

· Inability to move purposefully within physical environment, including bed mobility, transfers and ambulation.

1. The nurse will perform range of motion exercises at least twice a day unless contraindicated; repeat each maneuver three times.

2. The nurse will obtain any assistive devices needed for activity, such as gait belt, walker and scooter

3. The nurse will achieve mobility by having the P.G. start walking with a walker as soon as possible.

4. The nurse will consult with physical therapy for sit to stand exercises, strength training, gait training and a development of mobility plan.

1. “Inactivity rapidly contributes to muscle shortening and changes in joint structure” (Fletcher, 2015).

2. Assistive devices can help increase mobility (Yeom, Keller & Fleury, 2011)

3. “Early ambulation improves level of independence with assistive devices” (Radawiec et al, 2010). “Early ambulation for acute limb injuries generally resulted in improved function, less plan and earlier return to work” (Ebell, 2005).

4. “Functional decline from associated deconditioning is common in elderly, and acute impatient rehabilitation can be effective in preventing immobility and activity intolerance (Yeom, Keller, &Fleury, 2011).

1. The patient will verbalize the feeling of increased strength and ability to move by discharge.

2. The patent will use assistive devices demonstrate the use of adaptive equipment when ambulating from chair to bed by the end of the shift.

3. The patient will walk around the unit one time by the end of shift.

4. The patient will increase muscle strengthening activities with physical therapy by discharge.

The patient was able to demonstrate increased tolerance to activity by end of shift verbally. The patient participated in prescribed physical activity at 10:00 AM. The patient tolerated physical therapy well and will continue the prescribed regimen. The client was not able to complete the 6-minute walk test with physical therapy on my shift, but it completed prior to me taking care of this patient. Maybe this can be done again to see if there is any improvement. The patient was able to states the symptoms of adverse effects and reported if he had any other changes or felt different. All other goals were met by my client in the stated time frame.