Midterms - Latada, Christiane Kyla G

Calamba Doctors’ College
Virborough Subd. Parian, Calamba City Laguna 4027

Tel.Nos: (049) 545-9921/ 545-9922
Bachelor of Science in Nursing
Latada, Christiane Kyla G.

BSN 3-B
1. Lisa is a 40-year-old woman who has been experiencing intense anxiety and fear of open or public places. She
avoids leaving her house for fear of experiencing panic attacks, and she feels unsafe and vulnerable in crowded
or unfamiliar environments. Lisa's agoraphobia has caused her to become socially isolated, and she relies on her
family to provide for her basic needs.
NURSING DIAGNOSIS: Fear related to closed places or situations where she feels trap and where escape would be
difficult
Assessment Planning Intervention Evaluation
Subjective: 1. Encourage discussion of

The patient verbalized that After 2 weeks the patient the phobia. Investigate After 2 weeks the patient
she avoids closed places will be able to recognize sexual concerns, noting recognized symptoms of
and situations where she symptoms of onset anxiety problems expressed (e.g sex onset anxiety and
feels trapped or difficult to and intervene before is a duty/obligation that is intervene before reaching
escape. reaching the panic stage by not enjoyed by the client). the panic stage by the
the time of discharge from Only when a difficulty is time of discharge from
Objective: treatment acknowledged can it be dealt treatment
Appeared anxious and with. Note: Phobic reaction to
agitated. After 2 weeks the patient sex may indicate a problem of After 2 weeks the patient
will be able to lists stimuli incest/sexual abuse. was able to cope with the
Dyspnea that causes her fear. closed places and
Diaphoresis 2. Provide for the client’s situations.
After 2 weeks the patient safety (e.g. a secure
HR - more than 100 bpm will be able to cope with environment, staying with After 2 weeks the patient
the closed places and the client, letting the client was able to use
situations. know the nurse will provide therapeutic techniques
for safety). such as relaxation.
After 2 weeks the patient In severe anxiety, the client
will be able to express her fears total disintegration and After 2 weeks the patient
fear without feeling judged loss of control. will be able to lists stimuli
with family or therapists. that causes her fear.
3. Suggest that the client
After 2 weeks the patient substitute positive thoughts After 2 weeks the patient
will be able to use for negative ones. will be able to express
therapeutic techniques Emotion connected to her fear without feeling
such as relaxation. thought, and changing to a judged with family or
more positive thought can therapists.
Tel.Nos: (049) 545-9921/ 545-9922
decrease the level of anxiety

experienced. This also gives
the client an alternative way
of looking at the problem.
4. Discuss the process of

thinking about the feared
object/situation before it
occurs.
The anticipation of a future
phobic reaction allows the
client to deal with the physical
manifestations of fear.
5. Encourage the client to

share the seemingly
unnatural fears and feelings
with others, especially the
nurse therapist.
Clients are often reluctant to
share feelings for fear of
ridicule and may have
repeatedly been told to ignore
feelings. Once the client
begins to acknowledge and
talk about these fears, it
becomes apparent that the
feelings are manageable.
6. Encourage to stop, wait,

and not rush out of feared
situation as soon as
experienced. Support the use
of relaxation exercises (e.g
breath control, muscle
relaxation, self-hypnosis).
The client fears
disorganization and loss of
control of body and mind
Tel.Nos: (049) 545-9921/ 545-9922
when exposed to the

fear-producing stimulus. This
fear leads to an avoidance
response, and reality is never
tested. If the client waits out
the beginnings of anxiety and
decreases it with relaxation
exercises, then she or he may
be ready to continue
confronting the fear.
7. Explore things that may

lower fear level and keep it
manageable (e.g. use of
singing while dressing,
practicing positive self-talk
while in a fearful situation).
Provides the client with a
sense of control over the fear.
Distracts the client so that
fear is not totally focused on
and allowed to escalate.
NURSING DIAGNOSIS: Ineffective coping related to lack of effective coping skills

Subjective: After 2 weeks: 1. Initially meet the client’s After 2 weeks:

The patient verbalized that The client will demonstrate dependency needs as The client demonstrated
she avoids leaving her the ability to cope necessary. the ability to cope
house for fear of effectively. The sudden and complete effectively.
experiencing panic attacks. The client will verbalize elimination of avenues for The client verbalized signs
signs and symptoms of dependency would create and symptoms of increased
The patient verbalized that increased anxiety anxiety and will burden the anxiety
she feels unsafe The client will be able to client more. The client was able to
intervene to maintain intervene to maintain
anxiety at a manageable 2. Encourage anxiety at a manageable
level. independence and give level.
Tel.Nos: (049) 545-9921/ 545-9922
The patient verbalized that The client will demonstrate positive reinforcement for The client demonstrated
she’s vulnerable in crowded the ability to interrupt independent behaviors. the ability to interrupt
or unfamiliar environments. obsessive thoughts Positive reinforcement obsessive thoughts
The client will be able to enhances self-esteem and The client was able to meet
The patient verbalized that meet her needs encourages the repetition her needs independently.
she become socially independently. of desired behaviors.
isolated
3. Support and encourage
The patient verbalized that the client’s efforts to
she relies on her family to explore the meaning and
provide for her basic needs. purpose of the behavior.
The client may be unaware
of the relationship between
emotional problems and
compulsive behaviors.
Recognition and
acceptance of problems are
important before change
can occur.
4. Gradually limit the

amount of time allotted
for ritualistic behavior as
the client becomes more
involved in unit activities.
Anxiety is minimized when
the client is able to replace
ritualistic behaviors with
more adaptive ones.
5. Encourage the
recognition of situations
that provoke obsessive
thoughts or ritualistic
behaviors.
Recognition of precipitating
factors is the first step in
teaching the client to
interrupt the escalation of
Tel.Nos: (049) 545-9921/ 545-9922
anxiety.
6. Provide positive
reinforcement for non
ritualistic behaviors.
Positive reinforcement
enhances self-esteem and
encourages the repetition
of desired behaviors.
2. John is a 25-year-old man who has been experiencing intense anxiety and fear in social situations. He avoids
social interactions, and he feels uncomfortable and self-conscious around others. John's social anxiety has
caused him to become socially isolated, and he struggles to maintain relationships and employment.
NURSING DIAGNOSIS: Anxiety related to fear being in social situations

Subjective: Short Term: 1. Stay calm and be Short Term:

The patient verbalized that After 1 week the patient nonthreatening. After 1 week the patient
he is experiencing intense will be able to verbalize Maintain a calm, verbalized ways to
anxiety and fear in social ways to intervene in nonthreatening manner while intervene in escalating
situations. escalating anxiety. working with client; anxiety is anxiety.
contagious and may be
The patient verbalized that After 1 week the patient transferred from staff to After 1 week the patient
he avoids social will be able to recognize client or vice versa. recognized symptoms of
interactions. symptoms of onset anxiety onset anxiety and
and intervene before 2. Encourage intervene before reaching
The patient verbalized that reaching the panic stage by parent/caregiver presence the panic stage by the
he feels uncomfortable and the time of discharge from and participation to enhance time of discharge from
self-conscious around treatment. ability to support patient treatment
others. Patient is more likely to
After 1 week the client will comply. After 1 week the client
respond to relaxation responded to relaxation
Objective: techniques with a 3. Assure client of safety. techniques with a
Appeared anxious and decreased anxiety level. Reassure client of his or her decreased anxiety level.
agitated. safety and security; this can
Tel.Nos: (049) 545-9921/ 545-9922
After 1 week the client will be conveyed by physical After 1 week the client
Clung to her mother and reduce own anxiety level. presence of the nurse; do not reduced own anxiety
appeared to unwilling to leave client alone at this time. level.
talk After 1 week the patient
will be free from anxiety 4. Be clear and concise with After 1 week the patient
HR - more than 120 bpm attacks. words. be freed from anxiety
RR - more than 25 bpm Use simple words and brief attacks.
messages, speak calmly and
clearly, to explain hospital
experiences to client; in an
intensely anxious situation,
client is unable to
comprehend anything but the
most elementary
communication.
5. Provide a non-stimulating
environment.
Keep immediate surroundings
low in stimuli (dim lighting,
few people, simple decor); a
stimulating environment may
increase level of anxiety.
6. Utilize existing coping

strategies and assist in
developing new strategies
(e.g., music, deep breathing,
relaxation techniques,
massage, diversional activity,
play, pet therapy).
Coping strategies help
alleviate anxiety.
7. Administer medications as
prescribed.
Administer tranquilizing
medication, as ordered by
physician; assess medication
Tel.Nos: (049) 545-9921/ 545-9922
for effectiveness and for

adverse side effects.
8. Recognize precipitating
factors.
When level of anxiety has
been reduced, explore with
client possible reasons for
occurrence; recognition of
precipitating factors is the
first step in teaching client to
interrupt escalation of
anxiety.
9. Encourage client to
verbalize feelings. Encourage
client to talk about traumatic
experience under
nonthreatening conditions;
help client work through
feelings of guilt related to the
traumatic event; help client
understand that this was an
event to which most people
would have responded in like
manner.
NURSING DIAGNOSIS: Anxiety related to social interaction

The patient verbalized that After 2 weeks: 1. Establish and maintain a After 2 weeks:
he is experiencing intense The client will be free from trusting relationship by The client is free from
anxiety and fear in social injury listening to the client; injury
situations. displaying warmth,
The client will discuss answering questions The client discussed
Tel.Nos: (049) 545-9921/ 545-9922
The patient verbalized that feelings of dread, anxiety, directly, offering feelings of dread, anxiety,
he avoids social and so forth unconditional acceptance; and so forth
interactions. being available, and
The client will respond to respecting the client’s use The client responded to
The patient verbalized that relaxation techniques with of personal space. relaxation techniques with
he feels uncomfortable and a decreased anxiety level. Therapeutic skills need to a decreased anxiety level.
self-conscious around be directed toward putting
others. The client will reduce own the client at ease, because The client reduced own
anxiety level. the nurse who is a stranger anxiety level.
The patient verbalized that may pose a threat to the
he is socially isolated. The patient will be free highly anxious client. The patient is free from
from anxiety attacks. 2. Maintain a calm, anxiety attacks.
The patient verbalized that non-threatening manner
he struggles to maintain while working with the
relationships and client.
employment. Anxiety is contagious and
may be transferred from
the healthcare provider to
the client or vice versa. The
client develops a feeling of
security in presence of a
calm staff person.
3. Remain with the client
at all times when levels of
anxiety are high (severe or
panic); reassure the client
of his or her safety and
security.
The client’s safety is an
utmost priority. A highly
anxious client should not
be left alone as his anxiety
will escalate.
4. Move the client to a
quiet area with minimal
stimuli such as a small
room or seclusion area
(dim lighting, few people,
and so on.)
Tel.Nos: (049) 545-9921/ 545-9922
Anxious behavior escalates

by external stimuli. A
smaller or secluded area
enhances a sense of
security as compared to a
large area which can make
the client feel lost and
panicked.
5. Provide reassurance and
comfort measures.
Helps relieve anxiety.
3. Maggie is a 35-year-old woman who has been experiencing excessive worry and anxiety about various aspects of
her life. She finds it difficult to control her worrying and experiences physical symptoms such as muscle tension,
fatigue, and difficulty sleeping. Maggie's generalized anxiety has caused her to struggle with work and
relationships, and she feels overwhelmed and hopeless.
NURSING DIAGNOSIS: Anxiety related to lack of knowledge regarding symptoms and progression of condition
Subjective: 1. Move the client to a quiet

The patient verbalized that After 2 weeks the patient area with minimal stimuli After 2 weeks the patient
she is experiencing will be able to discuss such as a small room or discussed feelings of
excessive worry and feelings of dread, anxiety, seclusion area (dim lighting, dread, anxiety, and so
anxiety about various and so forth. few people, and so on.) forth.
aspects of her life Anxious behavior escalates
After 2 weeks the patient by external stimuli. A smaller After 2 weeks the patient
Objective: will be able to respond to or secluded area enhances a responded to relaxation
Spasticity relaxation techniques with a sense of security as techniques with a
Fatigue decreased anxiety level. compared to a large area decreased anxiety level.
Insomnia which can make the client
After 2 weeks the patient feel lost and panicked. After 2 weeks the patient
HR - more than 120 bpm will be able to reduce their was able to reduce their
RR - more than 25 bpm own anxiety level. 2. Provide reassurance and own anxiety level.
comfort measures.
The patient will be free from Helps relieve anxiety. The patient will be free
anxiety attacks. from anxiety attacks.
3. Educate the patient
Tel.Nos: (049) 545-9921/ 545-9922
and/or SO that anxiety

disorders are treatable.
Pharmacological therapy is
an effective treatment for
anxiety disorders, these may
include antidepressants and
anxiolytics.
3. Support the client’s

defenses initially.
The client uses defenses in
an attempt to deal with an
unconscious conflict, and
giving up these defenses
prematurely may cause
increased anxiety.
4. Maintain awareness of
your own feelings and level
of discomfort.
Anxiety is communicated
interpersonally. Being with
an anxious client can raise
your own anxiety level.
Discussion of these feelings
can provide a role model for
the client and show a
different way of dealing with
them.
5. Stay with the client

during panic attacks. Use
short, simple directions.
During a panic attack, the
patient needs reassurance
that he is not dying and the
symptoms will resolve
spontaneously. In anxiety,
the client’s ability to deal
Tel.Nos: (049) 545-9921/ 545-9922
with abstractions or
complexity is impaired.
NURSING DIAGNOSIS: Anxiety related to worrying of the unknown future

The patient verbalized that After 2 weeks: 1. Educate the patient After 2 weeks:
she is experiencing The client will discuss and/or SO that anxiety The client discussed
excessive worry and anxiety feelings of dread, anxiety, disorders are treatable. feelings of dread, anxiety,
about various aspects of and so forth Pharmacological therapy is and so forth
her life an effective treatment for
The client will respond to anxiety disorders, these The client responded to
Objective: relaxation techniques with may include relaxation techniques with
Spasticity a decreased anxiety level. antidepressants and a decreased anxiety level.
Fatigue anxiolytics.
Insomnia The client will be free from 2. Support the client’s The client is free from
injury defenses initially. injury
The client uses defenses in
The client will reduce own an attempt to deal with an The client reduced own
anxiety level. unconscious conflict, and anxiety level.
giving up these defenses
The patient will be free prematurely may cause The patient is free from
from anxiety attacks. increased anxiety. anxiety attacks.
3. Maintain awareness of
your own feelings and
level of discomfort.
Anxiety is communicated
interpersonally. Being with
an anxious client can raise
your own anxiety level.
Discussion of these feelings
can provide a role model
for the client and show a
different way of dealing
with them.
4. Stay with the client
during panic attacks. Use
short, simple directions.
Tel.Nos: (049) 545-9921/ 545-9922
During a panic attack, the

patient needs reassurance
that he is not dying and the
symptoms will resolve
spontaneously. In anxiety,
the client’s ability to deal
with abstractions or
complexity is impaired.
5. Avoid asking or forcing
the client to make choices.
The client may not make
sound and appropriate
decisions or may be unable
to make decisions at all.
4. Mrs. Xen is a 25-year-old female who presents with complaints of feeling "ugly" and "deformed". She reports
that she is constantly checking her appearance in mirrors and is unable to go out in public due to her concerns
about her appearance. Mrs. Xen reports that she has lost her job and has been unable to maintain relationships
due to her BDD symptoms. She has a history of depression and anxiety, but denies any suicidal ideation.
NURSING DIAGNOSIS: Disturbed Body Image related to Low Self-Esteem

The patient verbalized After 2 weeks: 1. Acknowledge and accept After 2 weeks:
feeling ugly and deformed The client will verbalize an the expression of feelings The client was able to
without objective basis. understanding of body of frustration, dependency, verbalize an understanding
changes. anger, grief, and hostility. of body changes.
The patient constantly Note withdrawn behavior
checking her appearance in The client will recognize and use of denial. The client was able to
mirrors and incorporate body Acceptance of these recognize and incorporate
image change into feelings as a normal body image change into
The patient verbalized that self-concept in an accurate response to what has self-concept in an accurate
she is unable to go out in manner without negating occurred facilitates manner without negating
public due to her concerns self-esteem. resolution. It is not helpful self-esteem.
about her appearance. or possible to push the
The client will be able to client before ready to deal The client was able to look
The patient reports that look at, touch, talk about, with the situation. Denial at, touch, talk about, and
she has lost her job and has and care for actual or may be prolonged and be care for actual or perceived
Tel.Nos: (049) 545-9921/ 545-9922
been unable to maintain perceived altered body an adaptive mechanism altered body parts or
relationships due to her parts or functions. because the client is not functions.
BDD symptoms. ready to cope with personal
The client will verbalize problems. On the other The client was able to
She has a history of acceptance of self in a hand, denial of the client’s verbalized acceptance of
depression and anxiety, but situation. feelings impedes the self in a situation.
denies any suicidal development of a trusting,
ideation. The client will verbalize therapeutic relationship. The client was able to
relief of anxiety and 2. Recognize the normalcy verbalized relief of anxiety
adaptation to of response to the actual and adaptation to
actual/altered body image. or perceived change in actual/altered body image.
body structure or function
and discuss it with the
client.
Experiencing stages of grief
over the loss of a body part
or function is normal and
typically involves a period
of denial, the length of
which varies among
individuals. Women who
had mastectomies felt the
greatest loss among
women diagnosed with
breast cancer; they found it
challenging to adapt to a
missing breast and
consequent asymmetry,
feeling incomplete and
seeing a “different person”
when looking in the mirror
(Buki et al., 2016).
3. Set limits on
maladaptive behavior.
The client’s self-esteem will
be damaged if the client is
allowed to continue
behaviors that are
destructive or not helpful,
Tel.Nos: (049) 545-9921/ 545-9922
and adaptation to the new

image will be delayed. The
process of accepting their
new body image can be
multifaceted and may take
time a key difference
between women who did
and did not accept their
body image was their
ability to adapt and feel
good about themselves in
spite of their altered body
image (Buki et al., 2016).
4. Maintain a
nonjudgmental attitude
while giving care, and help
the client identify positive
behaviors that will aid in
recovery.
The client tends to deal
with this crisis in the same
way in which they have
dealt with problems in the
past. Staff may find it
difficult and frustrating to
handle behavior that is
disruptive and not helpful
to recuperation but should
realize that the behavior is
usually directed toward the
situation and not the
caregiver. Alert the staff to
monitor their own facial
expressions and other
nonverbal behaviors
because they need to
convey acceptance and not
revulsion when the client’s
appearance is affected.
Tel.Nos: (049) 545-9921/ 545-9922
5. Support verbalization of
positive or negative
feelings about the actual
or perceived loss.
It is worthwhile to
encourage the client to
separate feelings about
changes in body structure
or function from feelings
about self-worth.
Expression of feelings can
enhance the client’s coping
strategies. Encourage the
client to verbalize their
fears and anxieties
associated with identified
stressful life situations.
Verbalization of feelings
with a trusted individual
may help the client come to
terms with unresolved
issues.
NURSING DIAGNOSIS: Disturbed Body Image related to distorted view of appearance

The patient verbalized After 2 weeks: 1. Assist the client in After 2 weeks:
feeling ugly and deformed The client will seek incorporating actual The client was able to seek
without objective basis. information and actively changes into ADLs, social information and actively
pursue growth. life, interpersonal pursue growth.
The patient constantly relationships, and
checking her appearance in The client will use adaptive occupational activities. The client was able to use
mirrors devices/prostheses The more noticeable the adaptive
appropriately. change in body structure or devices/prostheses
The patient verbalized that function, the more anxious appropriately.
she is unable to go out in The client will be able to the client may have about
look at, touch, talk about, the response of others to The client was able to look
Tel.Nos: (049) 545-9921/ 545-9922
public due to her concerns and care for actual or the change. Opportunities at, touch, talk about, and
about her appearance. perceived altered body for positive feedback and care for actual or perceived
parts or functions. success in social situations altered body parts or
The patient reports that may hasten adaptation. functions.
she has lost her job and has The client will verbalize Involve the client in
been unable to maintain acceptance of self in a activities that reinforce a The client was able to
relationships due to her situation. positive sense of self not verbalize acceptance of self
BDD symptoms. based on appearance. in a situation.
The client will verbalize When the client is able to
She has a history of relief of anxiety and develop self-satisfaction The client was able to
depression and anxiety, but adaptation to based on accomplishments verbalize relief of anxiety
denies any suicidal actual/altered body image. and unconditional and adaptation to
ideation. acceptance, the actual/altered body image.
significance of the
imagined defect or minor
physical anomaly will
diminish.
ADVERTISEMENTS
2. Exhibit positive caring in
routine activities.
Positive remarks by the
nurse may encourage the
client to develop more
positive responses to the
changes in his or her body.
Work with the client’s
self-concept, avoiding
moral judgments regarding
the client’s efforts or
progress. Positive
reinforcement encourages
the client to continue their
efforts and strive for
improvement. How others
perceived them influences
women’s perceptions and
acceptance (Buki et al.,
2016).
3. Be realistic and positive
Tel.Nos: (049) 545-9921/ 545-9922
during treatments, in
health teaching, and in
setting goals within
limitations.
This enhances trust and
rapport between the client
and the nurse. Provide
information at the client’s
level of acceptance and in
small segments to allow
easier assimilation. Discuss
the client’s expectations
and anticipated body
changes, then assist the
client in identifying realistic
goals. Morbidly obese
clients often set unrealistic
goals for ideal body weight
and appearance following
bariatric surgery. Guidance
is necessary to help them
understand the limitations
of the surgery.
4. Provide hope within the
parameters of an
individual situation; do not
give false reassurance.
This promotes a positive
attitude and provides an
opportunity to set goals
and plan for the future
based on reality. Body
image distress represents
the negative effect
experienced due to
perceived body image in
the present. Hope,
however, is a cognitive
construct regarding how
Tel.Nos: (049) 545-9921/ 545-9922
the future is perceived.

Alternatively,
self-compassion is a
cognitive construct that
addresses present
emotions and thoughts.
This suggests that hope is
unlikely to be a useful
addition to existing body
image interventions
(Todorov et al., 2019).
5. Give positive
reinforcement of progress
and encourage endeavors
toward the attainment of
rehabilitation goals.
Words of encouragement
can support the
development of positive
coping behaviors.
Acceptance, which was
more prevalent among
women in the long-term
survivorship stage of breast
cancer, was achieved when
women experienced a
feeling of worth similar to
the one they had prior to
the diagnosis. A woman
needs psychological help to
find herself again, to feel
again that they are the
same person, and that they
are worth the same (Buki et
al., 2016).
5. Mr. Yan is a 45-year-old male who lives alone in a small apartment. He has a history of hoarding behavior and
reports feeling overwhelmed by the clutter in his home. Mr. Yan has limited mobility due to chronic back pain
Tel.Nos: (049) 545-9921/ 545-9922
and has difficulty accessing his living space. He also reports feeling ashamed and embarrassed about his
hoarding behavior and avoids inviting friends or family over to his home
NURSING DIAGNOSIS: Chronic Low Self-Esteem related to Shame and Guilt

Patient has history of After 2 weeks: 1. Maintain a neutral, After 2 weeks:

hoarding behavior The patient will identify calm, and respectful The patient was able to
one skill he or she will work manner, although with identify one skill he or she
The patient reported on to meet future goals. some clients this is easier will work on to meet future
feeling overwhelmed by said than done. goals.
the clutter in his home. The patient will identify Helps the client see himself
two cognitive distortions or herself as respected as a The patient was able to
The patient reports feeling that affect self-image. person even when behavior identify two cognitive
ashamed and embarrassed might not be appropriate. distortions that affect
about his hoarding The patient will identify self-image.
behavior three strengths in 2. Teach the client to
work/school life. reframe and dispute The patient was able to
The patient reported cognitive distortions. identify three strengths in
difficulty accessing his The patient will reframe Disputes need to be work/school life.
living space because of and dispute one cognitive strong, specific, and
limited mobility distortion with the nurse. nonjudgmental. The patient was able to
Practice and belief in reframe and dispute one
The patient avoids inviting The patient will set one disputes over time help cognitive distortion with
friends or family over to his realistic goal with the nurse clients gain a more realistic the nurse.
home because of his that he or she wishes to appraisal of events, the
hoarding behavior. pursue. world, and themselves. The patient was able to set
one realistic goal with the
3. Work with the client to nurse that he or she wishes
recognize cognitive to pursue.
distortions. Encourage the
client to keep a log.
Cognitive distortions are
automatic. Keeping a log
helps make automatic,
unconscious thinking clear.
4. Keep in mind clients

with personality disorders
Tel.Nos: (049) 545-9921/ 545-9922
might defend against

feelings of low self-esteem
through blaming,
projection, anger, passivity,
and demanding behaviors.
Many behaviors seen in PD
clients cover a fragile sense
of self. Often these
behaviors are the crux of
clients’ interpersonal
difficulties in all their
relationships.
5. Discourage the client

from making repetitive
self-blaming and negative
remarks.
Unacceptable behavior
does not make the client a
bad person, it means that
the client made some poor
choices in the past.
NURSING DIAGNOSIS: Ineffective Coping related to Failure to Intend to Change Behavior

Patient has history of After 2 weeks: 1. Approach the client in a After 2 weeks:
hoarding behavior The patient will identify consistent manner in all The patient was able to
behaviors leading to interactions. identify behaviors leading
The patient reported hospitalization. Enhances feelings of to hospitalization.
feeling overwhelmed by security and provides
the clutter in his home. The patient will have an structure. Exceptions The patient was able to
increase in the frequency of encourage manipulative have an increase in the
The patient reports feeling expressing needs directly behavior. frequency of expressing
ashamed and embarrassed without ulterior motives. 2. Refrain from sharing needs directly without
about his hoarding personal information with ulterior motives.
behavior The patient will learn and the client.
Tel.Nos: (049) 545-9921/ 545-9922
master skills that facilitate Open up areas for The patient was able to
The patient reported functional behavior. manipulation and learn and master skills that
difficulty accessing his undermines professional facilitate functional
living space because of The patient will boundaries. behavior.
limited mobility demonstrate an increase in 3. Be aware of flattery as
impulse control. an attempt to feed into The patient was able to
The patient avoids inviting your needs to feel special. demonstrate an increase in
friends or family over to his The patient will Giving into the client’s impulse control.
home because of his demonstrate the use of a thinking that you are “the
hoarding behavior. newly learned coping skill best” or “the only one” can The patient was able to
to modify anxiety and pit you against other staff demonstrate the use of a
frustration. and undermine the client’s newly learned coping skill
need for limits. to modify anxiety and
4. Do not receive any gift frustration.
from the client.
Again, clouds the
boundaries and can give
the client the idea that he
or she is a due special
consideration.
5. If the client becomes
seductive, reiterate the
therapeutic goals and
boundaries of treatment.
The client is in the
hospital/clinic for a reason.
Being taken in by seductive
behavior undermines the
effectiveness of the
treatment.
6. Be clear with the client
as to the
unit/hospital/clinic
policies. Give brief
concrete reasons for the
rules, if asked, and then
move on.
Institutional policies
provide structure and
Tel.Nos: (049) 545-9921/ 545-9922
safety.
7. Be very clear about the
consequences if
policies/limits are not
adhered to.
The client needs to
understand the
consequences of breaking
the rules.
8. When limits or policies
are not followed, enforce
the consequences in a
matter-of-fact,
nonjudgmental manner.
Enforces that the client is
responsible for his or her
own actions.
9. Make a clear and
concrete written plan of
care so other staff can
follow.
Helps minimize
manipulations and might
help encourage
cooperation.
10. If feasible, devise a
care plan with the client.
If goals and interventions
are agreed upon,
cooperation with the plan
is optimized.

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Calamba Doctors’ College

Virborough Subd. Parian, Calamba City Laguna 4027

Latada, Christiane Kyla G.

Subjective: 1. Encourage discussion of

decrease the level of anxiety

4. Discuss the process of

5. Encourage the client to

6. Encourage to stop, wait,

when exposed to the

7. Explore things that may

NURSING DIAGNOSIS: Ineffective coping related to lack of effective coping skills

Subjective: After 2 weeks: 1. Initially meet the client’s After 2 weeks:

4. Gradually limit the

NURSING DIAGNOSIS: Anxiety related to fear being in social situations

Subjective: Short Term: 1. Stay calm and be Short Term:

6. Utilize existing coping

for effectiveness and for

NURSING DIAGNOSIS: Anxiety related to social interaction

Anxious behavior escalates

Subjective: 1. Move the client to a quiet

and/or SO that anxiety

3. Support the client’s

5. Stay with the client

NURSING DIAGNOSIS: Anxiety related to worrying of the unknown future

During a panic attack, the

NURSING DIAGNOSIS: Disturbed Body Image related to Low Self-Esteem

and adaptation to the new

NURSING DIAGNOSIS: Disturbed Body Image related to distorted view of appearance

the future is perceived.

NURSING DIAGNOSIS: Chronic Low Self-Esteem related to Shame and Guilt

Patient has history of After 2 weeks: 1. Maintain a neutral, After 2 weeks:

4. Keep in mind clients

might defend against

5. Discourage the client

NURSING DIAGNOSIS: Ineffective Coping related to Failure to Intend to Change Behavior

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