NURSING CARE PLAN

1. Bio data of patient

 Name: Reeta rani w/o Shri Mukund lal
 Age: 46 years
 Gender: Female
 Religion: Hindu
 Address: Ladoka mandi, Fazilka
 Education: 10th
 Occupation: Housewife
 Marital status: Unmarried
 Languages known: Hindi, English, Punjabi
 Monthly income: 15000/-
 Date of Admission: 3/12/18
 CRF: PFDGG1001060816
 Mobile no. : 09780216560
 Diagnosis: Obsessive compulsive disorder
 Reason for admission : Treatment and evaluation purpose
 Informant:
 Patient
 Reliability of Informant: reliable

1. CHIEF COMPLAINTS:
According to records:
 Obsessions of symmetry
 Sadness
 Obsession for frequent hand washing X 20 years
 Hopelessness
 Loss of concentration
 Disturbed sleep pattern
 Decreased sleep
 Irritability
 Generalized body ache
 Constipation

2. HISTORY OF PRESENT ILLNESS:

 Duration : 20 years
 Mode of onset: Chronic
 Course of illness: Continuous
 Predisposing factors : conflicts with family and husband
 Aggravating factors : Loneliness in the home

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 3. PAST HEALTH HISTORY
 Medical history:
 No H/O hypertension, Diabetes mellitus , Asthma, or any other medical illness.
 No h/o neurological disorders
 No h/o convulsions
 No h/o unconsciousness
 No h/o HIV, visceral disorders
 H/o hypertension from last 10 years
 Surgical history: Not available
 Psychiatric history :
H/o OCD * 20 years
h/o decreased interest in work
h/o crying spells
h/o suicidal thoughts
o Hospitalization : In AIIMS , New Delhi , PGI , Chandigarh and from Rajasthan
also
o Nature of treatment : Drug therapy and ECT
o Improvement : Not significantly

4. FAMILY HISTORY
Sr Members Relation with Education occupation Health status
.no Patient
1 Mukund lal Husband Graduate Businessman Good

2 Reeta rani Patient Matric Housewife Ill

3 Aditya Son Graduate Private job Good

4 Kusum Daughter Undergraduate Student Good

Type of family : Nuclear

Birth order : 2nd in order

Psychiatry history: H/o OCD in elder sister , H/o OCD in aunt

No h/o substance abuse in family

Medical history: No significant history

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Surgical history: No significant history

Current housing conditions :

i. Home circumstances: conflicts with family

ii. Per capita income : 3750 rs. per month
iii. Socioeconomic status : Middle class family
iv. Head of the family : Husband
v. Current attitude of family members towards illness : Cooperative from son and
daughter but not satisfactory from husband
vi. Communication pattern in family : not satisfactory
vii. Cultural and religious view : Hindu religion
viii. Ethnicity : Punjabi
ix. Social support systems available : From relatives

FAMILY TREE

Father mother

Sister husband patient brother brother brother brother

Son daughter

5. PERSONAL HISTORY

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 a) BIRTH & DEVELOPMENT
 Antenatal period:
o Any febrile illness : no history
o Physical illness : no history
o Medications / drugs use : no
o Trauma to abdomen : no
o Immunization : no history available
 Natal period:
o Birth : full term
o Wanted : yes
o Type of delivery : normal vaginal delivery
o Birth cry : immediate
o Birth defects : no
o Postnatal complications : no
b) CHILDHOOD HISTORY :
o Primary caregiver : mother
o Feeding : breast feed
o Age at weaning : 1 year
o Developmental milestones : normal
o Age and ease of toilet training : 2 and half years
o Behavioural and emotional problems :
i. Thumb sucking : YES
ii. Temper tantrums : NO
iii. Tics and head banging : NO
iv. Night terror : YES
v. Fears : YES
vi. Bed wetting : YES
vii. Nail biting : YES
viii. Stuttering : NO
ix. Enuresis: NO
x. Encopresis: NO
xi. Somnambulism : NO
c) EDUCATIONAL HISTORY :
o Age at beginning of formal education : 5 years
o Age of finishing formal education : 17 years
o Relationship with peers and teachers : fear from teachers
o School phobia : yes
o Truancy , non attendance : no
o Learning disabilities : present in mathematics
o Reason for termination of studies : Family issues

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 o Bullying at school : no
d) PLAY HISTORY :
o Games played : indoor games with sister and cousin sisters
o Relationship with mates : good

e) ADOLESCENCE:
Emotional problems during adolescence :
o Running away from home : NO
o Delinquency : NO
o Smoking : NO
o Drug abuse : NO
o Any other : NO SIGNIFICANT HISTORY AVAILABLE
f) PUBERTY:
o Age at appearance of secondary sexual characteristics : 15 YEARS
o Anxiety related to puberty changes : YES
o Age at menarche : 16 YEARS
o Reaction to menarche : ANXIOUS
o Regularities of menstrual cycle : REGULAR
o Abnormalities : NO
g) OBSTETRICAL HISTORY :
o Any abnormalities associated with delivery / puerperium/ pregnancy : No
o Number of children : 2
o Termination of pregnancy : with delivery of live baby
h) OCCUPATIONAL HISTORY :
o Age at starting work : 8 YEARS
o Jobs : HOME MAKING
o Reasons for change : NO CHANGE IN THE JOB
o Current job satisfaction : NO INTEREST IN WORK
i) SEXUAL HISTORY :
o Type of marriage : ARRANGE
o Duration of marriage : 22 YEARS
o Interpersonal relationship with in laws: UNSATISFACTORY
o Relationship with husband : CONFLICTS
o Relationship with children : CONFLICTS
j) SUBSTANCE ABUSE: No significant history
k) PRE-MORBID PERSONALITY
i. Interpersonal relationships:
o Interpersonal relationships with family : unsatisfactory
o Interpersonal relationships with friends : Good
o Type of personality : introverted

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 o Making social relationships : Not good
ii. Use of leisure time :
o Hobbies : Cooking , stitching
o Interests : listening music
o Intellectual activities : no
o Energetic : no
o Sedentary : yes
iii. Predominant mood :
o Pessimistic
o Prone to anxiety
o Despondant
o Reaction to stressful events : anxious
iv. Attitude towards self and others :
o Self confidence level : low
o Self criticism : yes
o Self consciousness : yes
o Thoughts for others : thoughtful
o Self appraisal of activities : less
o General attitude towards others : sympathetic , loving and caring
v. Attitude to work and responsibilities
o Decision making : less
o Acceptance of responsibility : no acceptance
o Flexibility : no
o Foresight : impaired
o Religious beliefs : faith in god
o Fantasy life : wants a happy life
o Day dreams : no
vi. Habits :
o Eating pattern : irregular
o Elimination : irregular
o Sleep : irregular
o Use of drugs / tobacco / alcohol: no
 VITAL SIGNS

s. no. Vital signs Normal value Patient value Remarks

1 Temperature 98.6 F 98 F Normal
2 Pulse 72-100/min 82/min Normal
3 Respiration 20-24/ min 24/min Normal
4 B.P 120/80mm hg 140/90mm hg Prehypertension

INVESTIGATION

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 Investigations Normal Values Patient’s Values Remarks
Bilirubin
 Total 0.0-0.2 mg / dl 0.25 mg /dl Normal
 Direct 0.2-1.2 mg / dl 0.10 mg/dl Normal

SGOT 40 U/L 38 U/L Normal

SGPT 40 U/L 43 U/L Normal
Total protein 3.5-5.3 g/dl 6.9 g/dl Normal
Albumin 3.5-5.3 g/dl 4.0 g/dl Normal
Random sugar 80-120 mg/dl 116mg/dl Normal
Urea 15-45 mg/dl 21 mg/dl Normal
Creatinine 0.6-1.3 mg/dl 0.64 mg /dl Normal
Uric acid 3.5-7.2 mg /dl 4.9 mg/dl Normal
Sodium 135-158 mmol/dl 142 mmol/dl Normal
Potassium 3.8-5.6 mmol/dl 4.5 mmol/dl Normal
Calcium 1.1 – 1.3 mmol/dl 1.2 mmol/dl Normal

MEDICATION

Name the drugs Composition Dosage Route Frequency Action

Tab. Stalopam Escitalopram + 10 mg+0.5 Oral TDS Antidepressant
plus Clonazepam mg + anti anxiety

Tab. Amigold Amisulpride 100 mg Oral OD Antipsychotic

Tab. Sertex Sertraline hydrochloride 100mg Oral OD Analgesic

Tab. Erides ER Desvenlafaxine 50 . mg Oral BD Antidepressant

Nursing care provided to patient

Day 1 1) Rapport established with the patient.

2) Vital signs are monitored.
3) Administration of medication.
4) Patient is involved in activities like painting,
Day 2 1) Co-operation of patient gained.
2) Establishment of good IPR with Patient.
3) Assessment regarding personal hygiene done.

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 4) History collection is done including biodata, illness and other all
aspects.
5) Preparation of nursing care plan according to patient’s needs.
Day 3 1) Patient is involved in activities like carom board, painting
2) Mental status examination is conducted.
3) Play therapy is given to patient.
4) Patient is assisted in self care activities.

MENTAL STATUS EXAMINATION

I. APPEARANCE

1. GROOMING AND DRESS

Inference:
Patient is wearing appropriate dress which is according to the place and season. Hair
are also combed. She is not well groomed

2. HYGIENE

Inference:
Hygienic condition of the patient is poor. Patient takes bath after 7 days and also
changes her clothes. Nails are unclean.

3. PHYSIQUE

Inference:
Patient has normal body physique

4. POSTURE

Inference:
Patient is having an open posture.

5. FACIAL EXPRESSIONS

Inference:

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 Facial expressions of the patient are anxious . They are appropriate according to the
talk of the patient.

6. LEVEL OF EYE CONTACT

Inference:
Patient maintains eye-to-eye contact throughout the conversation.

7. RAPPORT
N: Good morning
P: Good morning Ma’am
N:Main M.Sc Psychiatric Nursing ki student hoon. Aaj main aapse kuch baatein
karunga, jo aapke ilaj aur meri sahayeta karenge. Kya aap mujhse baat karoge?
P: yes
Inference:
A good rapport is maintained with the patient. She took part in the conversation well
and responded to all the questions asked to her.

II. MOTOR ACTIVITY

Inference:
Patient is able to sit still. Her psychomotor activity is decreased . Unusual gestures or
mannerisms are not present.

III. SPEECH

Inference:
Patient spoke in Hindi language. Rate of speech is normal and in normal tone.
IV. EMOTIONS

1. MOOD
N: Kaise ho ap ?
P: bus thik hoon.
Inference:
Patient ‘s mood is good.

2. AFFECT

Inference:

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 Patient’s emotional response is appropriate.

V. THOUGHT

1. FORMATION LEVEL

N: Aap kis vajah se yahan par admit ho?

P: Mujhe baar baar haath dhone ki adat hai
Inference:
Normal formation level

2. CONTENT LEVEL

N: Kya aap ko kabhi aisa lagta hai ki log aapke bare mein baat kar rahe hain yaa na
apko marna chahte hain.
P: (Smiling) nahi. Mujhe aisa nhi lagta.
N: Kya aapko kisi cheez se dar lagta hai.
P: Nahi mujhe kisi cheez se dar nahi lagta.

Inference:
Delusions, phobias etc. are absent.

3. PROGRESSION LEVEL

N: Kya koi khayal aapke mun mein baar-baar aata hai.

P: hanji baar baar maan mein ek hi khyal ate hai
Inference:
Progression level of thought is impaired.

VI. PERCEPTION

N: Kya aapko kabhi koi ajeeb aawazein sunai deti hain?

P: Nahi , aisa kuch bhi hota tha .
N: Kya kabhi aisa lagta hai ki aapko koi cheez dikhayi deti hai, jo koi aur nahi dekh
sakta.
P: Nahi aisa bhi kuch nahi tha
Inference:
Patient is not having any kind of visual and auditory kind of hallucinations.
Perception in patient is intact.

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VII. SENSORIUM AND COGNITIVE ABILITY

1. LEVEL OF ALERTNESS/CONSCIOUSNESS

Inference:
Patient is alert and conscious. She is actively listening to all the questions and is also
giving appropriate answers.

2. ORIENTATION
N: Aap yahan kab se hai?
P: 03 decemeber se hun.
N: Aap kahan ke rehne wale ho?
P: Main fazilka ki rehne wali hu
N: Aaj kaunsa din hai?
P: Friday.
N: Aap is waqt kahan pe ho?
P: GGS hospital psychiatry ward mein hu
Inference:
Patient is fully oriented with person, place and time.

3. MEMORY

a) Immediate memory

N: Main jo 5 no. bolu use dhyan se sunna aur phir batana:

4,21,5,2
P: 4, 21, 5, 2
Inference:
Immediate memory of the patient is intact.

b) Recent memory

N: What had you taken in your breakfast?

P: Bread, milk, egg.
N: How many times you are taking meal in a day?
P: 3 times
Inference:
Patient’s recent memory is also intact.

c) Remote memory

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 N: what is your date of birth?
P: 23 July 1973
N: Aap is hospital mein konsi date ko aye the?
P: 03 december ko
Inference:
Patient’s remote memory is intact.

4. CONCENTRATION AND ATTENTION

N: Ek sawal hai isse solve karo: 90 - 17 =?

P: 73
N: 1 se 20 tak counting karo.
P: 1, 2, 3, 4, 5

Inference:
Patient is having loss of concentration and attention.

5. INFORMATION AND INTELLIGENCE

N: Bharat ka Pradhan mantra kon hai?

P: pta nahi
N: India ki capital kya hai?
P: New delhi

Inference:
Patient general information level is less .

6. ABSTRACT THINKING

N: orange aur ball mein kya antar hai?

P: Ball se hum game khelte hai, aur saantr amai khati hoon (with smiling face).
Inference:
Abstract thinking of the patient is good.

7. JUDGMENT

a) Social

N: Aagar aapke aas-pados mein kabhi aag lag jaye toh aap kya karoge?

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 P: Mai aag ko bujhane ki koshish karoongi.

Inference:
Patient has logical social judgment.

b) Personal

N: Agar aapko 100 ka note sadak par girahua mile toh aap kya karoge?
P: agar kana hua to mai apne paas rakhloongi.

Inference:
Personal judgment of the patient is appropriate.

VIII. INSIGHT

N: Aapko kya lagta hai ki aapko koi mansik ya sharirik bimari hai?
P: Hanji mujhe meri problem ke bare mein pta hai , ab main isko thik karna chahti hu
Inference:
Patient is having grade V insight as she accepts her illness.

IX. GENERAL ATTITUDE

Inference:
General attitude of the patient is normal and appropriate. Patient is very co-operative.

X. SPECIAL POINTS

N: Aaj subah nashta kiya aapne?

P: Haan kiya tha.
N: Bukh theekh se lagti hai?
P: nhi
N: Neend theek se aati hai?
P: nhi .
N: Kabji kabaz vagerah ki takliph toh nahi?
P: hanji hai .

Inference:
Patient’s appetite, bowel, bladder and sleep pattern is disturbed

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XI. PSYCHOSOCIAL FACTORS

1. STRESSORS

N: Aapko kisi baat se koi pareshaani hai.

P: Nhi mujhe koi pareshani nhi hai. Bas ab main thik hona chahti hu

Inference:
she is worried about her future

2. COPING SKILLS

N: Aap apni tension door karne ke liye kya karte ho?

P: kujh nhi karti

Inference:
Her coping skills are not accurate

3. RELATIONSHIPS

N: Kya aapke dost hain?

P: Ji haan.
N: Kya aapko who aache lagte hain?
P: Jihaan, woh mere kafi ache dost hain. Main sabhi ki both help krti hoon.
N: Kya aap apne gharke sabhi logon se pyar karte hain?
P: haan . par who meri baat ko nhi smjhte

Inference
Patient has good relationship with his friends and but has conflicts in the family .

4. SOCIO CULTURAL

N: Kya aap ko kabhi aisa lagta haiki is samaaj ke asool sakht hai aur aap unhe
badalna chahtehain?
P: Nahi aisa kuch bhi nahi hai
Inference
Patient follows the rules of society.
5. SPIRITUAL
N: Kya aap pooja krte ho?
P: Haan! Kabhi kabhi

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 Inference:
Patient is spiritual and believes in god.
SUMMARY : In MSE , it has been found that patient ‘s personal hygiene is not maintained .
Psychomotor activity is decreased . but thought and speech are normal . There are no
hallucinations and delusions . Patient is sad and affect is congruent. Grade V insight is present .
General attitude is good and patient is cooperative.

PROCESS RECORDING

BIO –DATA OF THE PATIENT

 NAME OF THE PATIENT: Reeta rani

 AGE : 46 years
 SEX : female
 MARITAL STATUS : married
 EDUCATION : 10th
 OCCUPATION : homemaker
 MOTHER TONGUE : Hindi, Punjabi
 ADDRESS : ladoka mandi , Fazilka
 WARD : psychiatry ward , GGS hospital , Faridkot
 TIME TAKEN : 15 min
 DIAGNOSIS : obsessive compulsive disorder

BRIEF HISTORY OF PATIENT:

Patient was admitted to psychiatry ward , GGS hospital , Faridkot with the chief complaints of

According to records:
 Obsessions of symmetry
 Sadness
 Obsession for frequent hand washing X 20 years
 Hopelessness
 Loss of concentration
 Disturbed sleep pattern
 Decreased sleep
 Irritability
 Generalized body ache
 Constipation
PROCESS RECORDING

Objectives for the patient:

1. To establish rapport and therapeutic IPR.

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 2. To socialize effectively.
3. To ventilate his feelings.
4. To identify the problems.
5. To learn healthy coping mechanisms.

Objectives for the nurse:

1. To develop adequate communication skill.

2. To develop confidence in maintaining therapeutic relationship.
3. To develop skill in acknowledging the problems of the patient.
4. To assist the patient in dealing with his personal problems.
5. To assist the patient in developing positive coping mechanisms.
6. To procure skill in evaluating the pre-set objectives in order to assess the effectiveness of
therapeutic IPR.
7. To judge self in dealing with anxiety, fear and sentiments while progressing through the
therapeutic IPR.

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S. Particip Conversation Therapeutic Inference Communica
no ants techniques tion
1. Nurse Good Morning Giving Initiation of Verbal
recognition communicatio
Patient Good Morning ! n
2. Nurse Kya mai aapse baat kar sakti hoo? Giving Initiation of Verbal
recognition communicatio
Patient Hanji n
3. Nurse Ap thik ho ? Exploring Maintain eye Verbal
to eye contact
Patient Hanji thik hu
4. Nurse Aap yahan pe kyu aye the? Questioning Responding Verbal
spontaneously
Patient Mujhe baar baar haath dhone ki adat hai
. mai tang aa chuki hu
5. Nurse Aapko kitne din ho gye yahan pe aye Linking Answer Verbal
hue? adequately
Patient Mujhe yahan aye huye 7 din hogye hai
6. Nurse Apko je problem kab se hai ? Theme Answer Verbal
identification adequately &
made
Patient Mujhe je problem pichle 20 saal se hai eye to
… maine bhut ilaaj karwaya par ab tak eye
thik nhi huyi contact.
7. Nurse Aapko yahan pe kon le kar aya? Open general Answers Verbal
lead adequately
Patient Muje yahan pe meri family leke ayi hai
8. Nurse Iske ilawa ap koi koi auar takleef toh Questioning Answers Verbal
nhi hai ? adequately

Patient Mera mann bhut udas rehta hai .. ab

main tang aa chuki hu .. meri wajah se
sab takleef mein hai
9. Nurse Apke ghar mein kounkoun hai ? Questioning Answers Verbal
adequately.

Patient Mere ghar mein mere pati aur 2 baache

hain
10. Nurse Ap ghar mein kya karte ho ? Restating Maintains eye Verbal
to eye contact
Patient Mera gharmein koi bhi kaam karne ka
mann nhi krta ..mere ghar ka sra kaam
meri beti karti hai
11. Nurse Apko koi tension toh nhi hai Reinforcing Answered Verbal
the patient sadly
Patient Nhi ghar mein sab thik hai offering
general lead
12. Nurse Apko aur kya takleef hain ? Asking divert Answers Verbal
question adequately

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 Patient Ab toh problem itni badh chuki hain ki
paani ka glass bhi uthakr nhi pee sakti
… who bhi pados mein kisi ko bulana
padhta hai
13. Nurse Ap ghar mein ladhayi karte ho ? Giving broad Answers Verbal
opening a
Patient Nhi mai kabhi kisi se nhi ladhta . meri d
ghar aur bahr dono jagah banti hai e
q
u
a
t
e
l
y
14. Nurse Apke parivaar mein kisi aur ko yeh Encouraging Answers Verbal
takleef thi description of adequately
Patient Hanji meri badi behn ko yeh takleef thought
hain
15. Nurse Apka kya karne ka mann karta hain Encouraging Answers Verbal
ventilation of adequately
Patient Mera kujh bhi karne ka mann nhi karta. feelings.
Bas apna kamm bhi kisi aur se karwana
padhta hai…
16. Nurse Apne kabhi isko thik karne ki koshish Divert Answers sadly Verbal
ki hai ? questioning
Patient Hanji , par iska fark nhi pada kabhi….. about his
feelings
17. Nurse Apko nhi lgta ise apke ghar walon ko Encouraging Answers Verbal
preshani ho rhi hai? description of adequately
Patient Han… isliye toh mai chahti hu ki mai thought
thik ho jayu……
18. Nurse Koi baat nhi apko kisi baat ki tension Encouraging Answers Verbal
nhi leni apne ? description of adequately
Patient Hanji … thought
19. Nurse Aapko yahan a k kuch farak mehsoos Divert Answers Verbal
huya hai? questioning adequately
Patient Hanji pehle se bhut fark lag raha hai .. about his
bas thoda body mein pain hota hai .. par thinking
baki sab thik hai process
20. Nurse Theek hai. Aap ab aise hi apne aap ko Linking with Answers Verbal
sudharne k liye effort krna aur haath reality adequately
done ke bare mein bilkul nhi sochna
Patient Ji han.. ab uske ke bare mein bilkul nhi
sochungi….
21. Nurse Psychoeducation: Suggestion Linking and Verbal
 Aap samay se dwai liya kijiye ta accepting my
k aap thik ho jaye fir aap ghar ja suggestion
payenge.
 Apna dhyan apni family ki taraf
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 lagaiye
 Roj exercise kijiye
 jab bhi haath done ka mann kare
toh … baith jana hai bas
 khud uthke glass se paani peene
ki koshish karni hai
 Roj nahayea kijiye, ache se
khana khayea kijiye aur sari
counselling aur treatment
procedure mein saath dijiye

Patient Thik hai ji

Nurse Chaliye aaj k liye hum itni hi baat Informing Behave Verbal
krenge, abhi aap apne saath vale dosto k and normally and
saath baatein kijiye, aapke saath baat terminating termination of
krke mujhe bhut acha lga. Mujhse baat the interview the interview is
krne k liye thank you. Ok bye. done in normal
way and is
accepted by
Patient Thik hai beta the patient.

NURSING CARE PLAN

NURSING ASSESSMENT

 Vital signs are monitored.

 On MSE, it is found that patient shows depressive and decreased psychomotor
activity.
 Nutritional status of patient is assessed.
 Low self esteem in patient
 Collection of detailed history.
 Personal hygiene is assessed.

NURSING DIAGNOSIS

 Ineffective individual coping related to underdeveloped ego, punitive superego,

avoidance learning, possible biochemical changes, evidenced by ritualistic behavior
or obsessive thoughts.
 Altered role performance related to the need to perform rituals, evidenced by inability
to fulfill usual patterns of responsibility.
 Chronic low self esteem related to lack of positive feedback evidenced by inability to
tolerate being alone.

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Short Term Goals:-

 To improve coping mechanisms of patient .

 To enhance role performance in family .
 To promote coping skills.
 To promote the self esteem.
 To make patient self dependent.

Long Term Goals:-

 To rehabilitate the patient.

 To prevent further complications.
 To assist the patient in early recovery.

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Nursing Diagnosis Expected Planning Implementation Rationale Evaluation
Outcome
Ineffective Patient will (a) Work with (a) Patient is 1) Recognition is Client has
individual coping demonstrate patient to determine encouraged to the first step in started
related to ability to cope types of situations determine types of teaching the patient coping with
underdeveloped ego, effectively that increase anxiety situations that increase to interrupt the ritualistic
punitive superego, without and result in anxiety and result in escalating anxiety. behaviors and
avoidance learning,
resorting to ritualistic behaviors. ritualistic behaviors. Sudden and trying to
possible biochemical
changes, evidenced
obsessive (b) Initially meet the (b) Patient is complete control
by ritualistic compulsive patient's dependency encouraged for elimination of all obsessions
behavior or behaviors. needs. Encourage independence and give avenues for
obsessive thoughts. independence and positive reinforcement dependency would
give positive for independent create intense
reinforcement for behaviors. anxiety on the part
independent (c) patient is allowed of the patient.
behaviors. plenty of time for 2) Positive
(c) In the beginning rituals. reinforcement
of treatment, allow (d) Supporting enhances self-
plenty of time for patient's efforts to esteem and
rituals. Do not be explore the meaning encourages
judgmental or and purpose of the repetition of desired
verbalize behavior. behaviors.
disapproval of the (e) Providing 3) Denying patient
behavior. structured schedule of this activity may
(d) Support patient's activities for patient, precipitate panic
efforts to explore the including adequate anxiety.
meaning and time for completion of Patient may be
purpose of the rituals. unaware of the
behavior. (f) Limit is set to time relationship
(e) Provide allotted for ritualistic between emotional
structured schedule behavior as patient problems and

21
 of activities for becomes more compulsive
patient, including involved in unit behaviors.
adequate time for activities. 4) Recognition is
completion of (g) Positive important before
rituals. reinforcement for non change can occur.
(f) Gradually begin ritualistic behaviors is Structure provides a
to limit amount of given feeling of security
time allotted for (h) Patient is for the anxious
ritualistic behavior encouraged to learn patient.
as patient becomes ways of interrupting 5) Anxiety is
more involved in obsessive thoughts minimized when
unit activities. and ritualistic patient is able to
(g) Give positive behavior with replace ritualistic
reinforcement for techniques such as behaviors with
non ritualistic thought stopping, more adaptive ones.
behaviors. relaxation and 6) Positive
(h) Help patient exercise. reinforcement
learn ways of encourages
interrupting repetition of desired
obsessive thoughts behaviors. These
and ritualistic activities help in
behavior with interruption of
techniques such as obsessive thoughts.
thought stopping,
relaxation and
exercise.

Altered role Patient will be a) Determine patient's a) Determining patient's This is important Patient is able
performance related able to resume previous role within previous role within the assessment data for to resume role-

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to the need to role-related the family and the family and the extent to formulating an related
perform rituals, responsibilities. extent to which this which this role is altered appropriate plan of responsibilities
evidenced by role is altered by the by the illness. Identify care. in family .
inability to fulfill illness. Identify roles roles of other family Identifying specific
usual patterns of of other family members. stressors, as well as
responsibility. members. b) Encouraging patient adaptive and
b) Encourage patient to discuss conflicts maladaptive
to discuss conflicts evident within the responses within the
evident within the family system. Identify system, is necessary
family system. how patient and other before assistance can
Identify how patient family members have be provided in an
and other family responded to this effort to facilitate
members have conflict. change. Planning and
responded to this (c) Exploration of rehearsal of potential
conflict. available options for role transitions can
(c) Explore available changes or adjustments reduce anxiety.
options for changes or in role is done. Practice Positive
adjustments in role. through role play. reinforcement
Practice through role d) To Patient positive enhances self-esteem
play. reinforcement for ability
and promotes
d) Give patient lots of to resume role
positive reinforcement responsibilities by repetition of desired
for ability to resume decreasing need for behaviors.
role responsibilities by ritualistic behaviors is
decreasing need for given .
ritualistic behaviors.

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Chronic low Client will a) Assess the self a) Client has very a) Assessment Client’s self
self esteem demonstrate concept of low self esteem. provides the esteem is
related to lack increased client. b) Psychological baseline data. enhanced . so
of positive self esteem b) Provide support is provided b) It will enhance that she is able
feedback and psychological to client. the self esteem to do her work
evidenced by perception of support to client. c) Inaccuracies in of client. by her own and
inability to himself as a c) Discuss self perception are c) Client may not she don’t need
tolerate being worthwhile inaccuracies in discussed with see positive to depend on
alone. person self perception client. aspects of self others.
with client. d) Client is that others see.
d) Instruct the motivated to enlist d) It will help the
client to prepare the weaknesses and client develop
a list of strengths internal self
weaknesses and e) Positive feedback worth.
strengths. is provided to client, e) It will help the
e) Provide positive when she has client to learn
feedback to explored her new coping
client. feelings. behaviour.

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DISCHARGE PLAN

Patient not yet discharged and receiving treatments.

HEALTH EDUCATION
1) PERSONAL HYGIENE:
 Patient is taught about importance of personal hygiene of patient.
 She is advised to perform her self care activities independently.
 She is asked to perform hygiene practices daily.
2) DIET:
 Patient is taught about the importance of balanced diet.
 She is taught about foods that are contraindicated during taking particular medications.
3) EXERCISES:
 She is taught perform active and passive exercises.
 She is asked to assist patient to carry out activities of daily life.
4) ENVIRONMENT:-
 Environment should be calm and safe for the patient.
 Attendant is asked to remove all the hazardous objects.
5) MEDICATIONS:-
 Patient is advised to take medication regularly.
 Patient is advised to inform immediately whenever any unusual symptoms appears.
 She is advised not to discontinue medicine by their own.
Bibliography:
 Ahuja Niraj. A short Textbook of Psychiatry. 7th ed. Jaypee Brothers.
 Lalitha K. Mental Health and Psychiatric Nursing.1st ed. VMG Book House.
 Sadock BJ, sadock VA. Kaplan &Sadock’s Synopsis of psychiatry. 10th ed. Lippincott.
 Mary CT. Psychiatric Mental Health Nursing. 4th ed. F.A.Davis.

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