Question

Pedro Gonzales, a 37-year-old Hispanic man, arrived by ambulance from a supermarket, where he had fallen. He remains lethargic. On his arrival to the emergency department (ED), his breath smelled “fruity.” He appears confused and anxious, saying that “they put the ‘evil eye’ on me, they want me to die, they are drying out my body … it’s draining me dry … they are yelling, they are yelling … no, no I’m not bad … oh God don’t let them get me.” When his mother arrives in the ED, she tells the staff, through the use of an interpreter, that Pedro is a severe diabetic and has a diagnosis of paranoid schizophrenia, and this happens when he does not take his medications. In a group or in collaboration with a classmate respond to the following:

A. A number of nursing diagnoses are possible in this scenario. Formulate in writing at least two nursing diagnoses (problems) given the preceding information, and include “related to” and “as evidenced by.”

B. For each of your nursing diagnoses, list one long-term outcome (e.g., the problem, what should change). Include a time frame, desired change, and three criteria that will help you evaluate if the outcome has been met, not met, or partially met.

C. For each long-term outcome, list two short-term outcomes (goals) (the steps that need to be taken in order for the goal to be accomplished), including time frame, desired outcomes, and evaluation criteria.

D. What are the four basic principles for planning nursing interventions?

E. What specific needs might you take into account when planning nursing care for Mr. Gonzales?

F. Using informatics, evaluate optimal outcomes for Mr. Gonzalez at your current health care setting, or use the charting method employed by the institution.

G. Give an example of the QSEN competencies you might stress when planning care for Mr. Gonzalez.

Answer 1

A) Paranoid schizophrenia is described by prevalently positive indications of schizophrenia, including dreams and visualizations. These incapacitating manifestations obscure the line between what is genuine and what isn't, making it hard for the individual to have a run of the mill existence.

Schizophrenia happens in about 1.1 percent of the populace, while distrustful schizophrenia is viewed as the most widely recognized subtype of this constant disorder.1 The normal period of beginning is late immaturity to early adulthood, as a rule between the ages of 18 to 30. It is profoundly surprising for schizophrenia to be analyzed after age 45 or before age 16. Beginning in guys ordinarily happens prior in life than females.

Nursing Diagnoses

1. Impaired Social Interaction related to problems in thought patterns and speech as evidenced by appears upset, agitated, or anxious when others come too close in contact or try to engage him/her in an activity.

2. Disturbed Sensory Perception related to altered sensory perception as evidenced by auditory distortions

3. Hazard for Suicide identified with lack of caution and stamped changes in conduct.

4 Hazard for Injury identified with mental trips and fancies.

5. Hazard for Imbalanced Nutrition: not as much as body prerequisites identified with self-disregard and refusal for self-care.

6. Weakened Physical Mobility identified with burdensome disposition state and hesitance to start development.

7. Diminished Cardiac Output identified with orthostatic hypotensive medication impacts.

Nursing Care Planning and Goals

• Diminish seriousness of crazy indications
• Forestall repeat of intense scenes
• Meet patient's' physical and psychosocial needs
• Assist quiet with increasing ideal degree of working
• Increment customer's consistence to treatment and nursing plan

Nursing Interventions

Build up trust and compatibility. Try not to contact customer without mentioning to him first what you will do. Utilize a tolerating, predictable methodology; short, rehashed contacts are best until trust has been set up. Language ought to be clear and unambiguous. Keep up a feeling of trust in conceivable improvement, and pass on this to the patient.

Expand level of working. Abstain from advancing reliance by doing just what the patient can't accomplish for himself. Prize constructive conduct and work with him to build his own awareness of other's expectations in improving working.

Advance social aptitudes. Offer help in helping him to learn social aptitudes.

Guarantee security. Keep up a sheltered situation with negligible incitement.

Guarantee satisfactory sustenance. Screen patient's dietary status and if the patient thinks his food is harmed, let him fix his own food if conceivable or offer him nourishments in shut holders that he can open. Establishment self destruction as well as manslaughter precautionary measures as proper.

Keep it genuine. Draw in persistent in actuality situated exercises that include human contact (e.g., workshops, inpatient social abilities preparing). Explain private language, mentally unbalanced innovations, or neologisms.

Manage fantasies by introducing reality. Investigate the substance of mental trips. Abstain from contending about the fantasies. Disclose to them you don't see, hear, smell, or feel it however clarify that you realize that these mind flights are genuine to him.

Advance consistence and screen sedate treatment. Direct recommended tranquilizes and urge the patient to go along. Guarantee that patient is truly taking the medication. Watch for indications that warrant touchiness responses and poisonousness.

Energize family association. Include family in understanding treatment and instruct individuals to perceive looming backslide (for example anxiety, sleep deprivation, diminished capacity to focus). Propose ways how families can oversee indications.

Evaluation

Assess viability of medication treatment (nonappearance of intense scenes and crazy manifestations).

Assess consistence to wellbeing guidelines (taking drugs on schedule, demonstrating freedom in exercises, association of family).

Level of patient's working (capacity to take part in social connections).

Patient's psychological status (arranged to the real world).

B) 1. Impaired Social Interaction related to problems in thought patterns and speech as evidenced by appears upset, agitated, or anxious when others come too close in contact or try to engage him/her in an activity.

Long term outcome - Patient will attend one structured group activity within 5-7 days.

2. Disturbed Sensory Perception related to altered sensory perception as evidenced by auditory distortions

Long term outcome - Patient will learn ways to refrain from responding to hallucinations.

C) Nursing Care Planning and Goals

• Diminish seriousness of crazy indications
• Forestall repeat of intense scenes
• Meet patient's' physical and psychosocial needs
• Assist quiet with increasing ideal degree of working
• Increment customer's consistence to treatment and nursing plan

Nursing Interventions

Build up trust and compatibility. Try not to contact customer without mentioning to him first what you will do. Utilize a tolerating, predictable methodology; short, rehashed contacts are best until trust has been set up. Language ought to be clear and unambiguous. Keep up a feeling of trust in conceivable improvement, and pass on this to the patient.

Expand level of working. Abstain from advancing reliance by doing just what the patient can't accomplish for himself. Prize constructive conduct and work with him to build his own awareness of other's expectations in improving working.

Advance social aptitudes. Offer help in helping him to learn social aptitudes.

Guarantee security. Keep up a sheltered situation with negligible incitement.

Guarantee satisfactory sustenance. Screen patient's dietary status and if the patient thinks his food is harmed, let him fix his own food if conceivable or offer him nourishments in shut holders that he can open. Establishment self destruction as well as manslaughter precautionary measures as proper.

Keep it genuine. Draw in persistent in actuality situated exercises that include human contact (e.g., workshops, inpatient social abilities preparing). Explain private language, mentally unbalanced innovations, or neologisms.

Manage fantasies by introducing reality. Investigate the substance of mental trips. Abstain from contending about the fantasies. Disclose to them you don't see, hear, smell, or feel it however clarify that you realize that these mind flights are genuine to him.

Advance consistence and screen sedate treatment. Direct recommended tranquilizes and urge the patient to go along. Guarantee that patient is truly taking the medication. Watch for indications that warrant touchiness responses and poisonousness.

Energize family association. Include family in understanding treatment and instruct individuals to perceive looming backslide (for example anxiety, sleep deprivation, diminished capacity to focus). Propose ways how families can oversee indications.

Evaluation

Assess viability of medication treatment (nonappearance of intense scenes and crazy manifestations).

Assess consistence to wellbeing guidelines (taking drugs on schedule, demonstrating freedom in exercises, association of family).

Level of patient's working (capacity to take part in social connections).

Patient's psychological status (arranged to the real world).

D) Basic principles for planning nursing interventions

Medical attendants and nursing staff treat everybody in their consideration with poise and mankind – they comprehend their individual needs, show sympathy and affectability, and give care such that regards all individuals similarly.

Medical caretakers and nursing staff assume liability for the consideration they give and answer to their own decisions and activities – they complete these activities in a manner that is concurred with their patients, and the families and carers of their patients, and such that meets the prerequisites of their expert bodies and the law.

Medical caretakers and nursing staff oversee chance, are watchful about hazard, and help to guard everybody in the spots they get medicinal services.

Attendants and nursing staff give and advance consideration that puts individuals at the middle, includes patients, administration clients, their families and their carers in choices and encourages them settle on educated decisions about their treatment and care.

Attendants and nursing staff are at the core of the correspondence procedure: they survey, record and report on treatment and care, handle data delicately and privately, manage objections viably, and are reliable in announcing the things they are worried about.

Attendants and nursing staff have exceptional information and aptitudes, and utilize these with knowledge, understanding and comprehension in accordance with the necessities of every person in their consideration.

Medical attendants and nursing staff work intimately with their own group and with different experts, ensuring patients' consideration and treatment is co-ordinated, is of an elevated expectation and has the most ideal result.

Medical attendants and nursing staff show others how its done, create themselves and other staff, and impact the manner in which care is given in a way that is open and reacts to singular needs.