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NCP

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The key takeaways are that the patient is experiencing delusional disorder and disturbed thought processes related to neurochemical imbalance.

The nursing diagnosis for the patient is Disturbed thought process related to neurochemical imbalance.

Interventions provided to the patient include administering prescribed medication, reinforcing reality, maintaining distance, and recognizing the patient's accomplishments.

Cues Explanation of Goals and Intervention Rationale Evaluation Actual

the problem objectives criteria evaluation

Subjective: According to the STO:  Assess attention  Determines


DSM-IV-TR, After 8 hours of span/ distractability the ability of
 “Nung nagaral delusional nursing and ability to make the patient
ako doon sa UK disorder are intervention the decisions or to participate
madami akong characterized by patient is able to problem solve in
natapos na false beliefs verbalize logical planning/exe
course doon” with plausible and reality based cuting care
basis in reality. ideas
Objective: Formerly  Interview SO to  This is to
referred to as determine patient’s provide
 Orriented to paranoid usual thinking baseline for
Time, place, disorder, ability, changes in comparison
Person delusional behavior, length of
 Loose disorder are time problem has
association known to existed, and other
noted as involve pertinent
manifested by erotomanic, information
“ lagi mong grandiose,
tatandaan hindi jealous, or LTO:  Reorient  Inability to
babangon ang somatic themes After 2-3 weeks of time/place/person, maintain
babae kung as well as nursing as needed orientation is
walang lalaki, persecutory intervention a sign of
kaya laging delusion. Some patient is able to deterioration
andiyan si Jesus patients differentiate  Provide safety  It is always
Christ experience delusion and measure necessary to
 Delusion of several types of reality and talk consider the
grandiosity delusions; other with others about safety of the
noted as patients reality patient.
manifested by experience  Recognize and  Recognizing
“ sikat ako unspecific support the the patient’s
doon sa amin delusions that accomplishm
doo sa vigan, have no patient’s ent can
punta ka lang dominant accomplishment lessen
doon sabihin theme anxiety and
mo lang the need for
pangalan ko” delusion as a
 Hyperactive source of
 Labile mood Reference: self-esteem
American  Encourage patient  Verbalization
Psychiatric to verbalize true of feelings in
association feelings a non-
(2000). threatening
Nursing Diagnosis: Diagnostic and environment
statistical may help
Disturbed thought manual of patient come
process related to mental to terms with
neurochemical disorder(4th ed., long-
imbalance text Revision) unresolved
Washington, DC issues.
 Encourage patient  This is to
to participate in maximize
resocialization level of
activities/groups function
when available.
 Assist in identifying  This measure
ongoing treatment is important
needs/rehabilitation to maintain
program for the gains and
individual continue
progress if
able

 Reestablish the  Reality must


client what is real be
and unreal. Validate reinforced.
patient’s real Reinforced
perception, and reality and
correct the patient’s behavior will
misperception recur more
frequently.

 Maintained distance  Patient will


from the patient be violent
 Administered
prescribed  To calm the
medication patient and
mat prevent
aggressive
bahavior

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