Nursing Care Plan (NCP) for Paranoid Disorders

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Outline

Pathophysiology

Some paranoid disorders such as paranoid personality disorder and paranoid schizophrenia may have more bizarre behavior and have intense feelings of distrust or fear. These clients will not confide in others and may be difficult to talk to as they often misinterpret harmless conversation or behavior.

Etiology

The exact cause of PPD is not known, but it likely involves a combination of biological and psychological factors. The fact that PPD is more common in people who have close relatives with schizophrenia and delusional disorder suggests a genetic link between the two disorders. It is also believed that early childhood experiences, including physical or emotional trauma, play a role in the development of PPD.

Desired Outcome

The client will be able to identify appropriate coping techniques. The client remains safe and free from harm.

Paranoid Disorders Nursing Care Plan

Subjective Data:

  • Suspicion
  • Fear of being deceived 
  • Feelings of being persecuted 
  • Poor self-image

Objective Data:

  • Perfectionism 
  • Rigid behaviors and beliefs 
  • Self-righteous attitude 
  • Easily offended 
  • Social isolation
  • Detachment 
  • Hostility
  • Argumentative

Nursing Interventions and Rationales

Nursing Intervention (ADPIE) Rationale
Assess the client’s neurological status To determine if other issues may be causing symptoms or if the disorder has progressed to another serious condition such as schizophrenia 
Monitor behaviors and interactions with staff and other clients Determine how the client interacts with others. Paranoid clients may exhibit aggressive behaviors for no apparent reason. 
Talk openly with the client about their beliefs and thoughts, showing empathy and support Help build trust and rapport with clients. Paranoid clients may be more reluctant to trust anyone, but open communication generally offers more cooperation 
Explain all procedures clearly and carefully, and their purpose, before starting them Prevents aggressive behavior and suspicion. Promotes cooperation and compliance. Helps develop trust. 
Remain aware of the client’s personal space. Avoid startling the client, sudden movements or touching the client unnecessarily Even the best of intentions, such as a handshake, tidying the room, or body language may be misinterpreted as threatening and may lead to aggressive behavior. Showing respect for the client’s space and possessions helps build trust. 
Discuss feelings and help the client identify behaviors that cause conflict or alienate others Helping clients see the reality of their behaviors can help treatment progress and lead to more appropriate behaviors and interactions. 
Discuss and have client demonstrate (through role-play if appropriate) more acceptable responses and reactions to behaviors and stressors Helps the client develop more positive coping skills for dealing with delusions, suspicions, and fears 
Minimize environmental stimuli Overstimulation from loud noises, excessive talking, television, or radio may increase paranoia and prompt erratic or aggressive behaviors. 
Encourage socialization with others, but do not force participation in activities Help clients develop relationships and more positive interactions with others. Helps reorient the client to reality. Forcing them to participate may trigger paranoia that you are trying to trick or trap them. 
Set behavior boundaries and enforce per facility protocols with medications or restraints as necessary Promote the safety of clients during agitated moments and the safety of others from aggressive behaviors. Follow your facility’s specific protocol regarding supervision, restraint, and documentation. 
Administer medications appropriately and monitor for reactions to medications Antipsychotic medications may be given to manage delusions and behaviors. Monitor for adverse reactions. 
Offer praise and encouragement for accomplishments of tasks Promote a sense of self-worth and improves self-esteem 
Consider any cultural concerns or impacts of treatment Depending on their culture, some behaviors and beliefs may be considered acceptable to the client. Take these into consideration when implementing interventions. 
Provide reorientation as appropriate, but avoid confrontation of the delusions The client may need to be refocused to reality at times but avoid confrontation that may be interpreted as argumentative to avoid non-compliance and uncooperative behaviors.
Provide education, resources, and support for client’s family and loved ones Help family members understand the nature of the client’s illness and avoid conflict that could exacerbate the client’s symptoms. Encourages the coping skills of family members through each other and support groups. 
Involve patients’ family or loved ones in care as appropriate in treatment plan  Help develop trust between client and loved ones and promote positive management of illness going forward. Help clients and family members stay on track with treatment. 

Writing a Nursing Care Plan (NCP) for Paranoid Disorders

A Nursing Care Plan (NCP) for Paranoid Disorders starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

  • https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-causes/syc-20354463
  • https://my.clevelandclinic.org/health/diseases/9784-paranoid-personality-disorder#symptoms-and-causes
  • https://www.helpguide.org/articles/mental-disorders/paranoid-personality-disorder.htm?pdf=35249
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Transcript

Hi everyone. Today, we’re going to be creating a nursing care plan for paranoid disorders. So, let’s get started. So first let’s go over the pathophysiology. With paranoid disorders, such as paranoid personality disorder and paranoid schizophrenia, clients exhibit bizarre behavior and feel intense feelings of distrust or fear. These clients will not confide in others and may be difficult to talk to as they often misinterpret harmless conversation or behavior. Nursing considerations: we want to assess neurological status, monitor behavior, be aware of the client’s personal space, offer praise, and administer medications. The desired outcome: the client’s going to be able to identify appropriate coping techniques and the client’s going to be safe and free from harm. 

So, we’re going to go ahead and get into the care plan. We’re going to be going over some subjective data and we’re going to be going over some objective data. So, what are we going to see with these patients? One of the main things is they’re going to be suspicious. So, they’re going to have suspicion. They’re going to have fear. They’re going to have a poor self-image. Some objective data you’re going to see with these patients. They are going to be in social isolation. Hostility is big with these patients. Some other examples: fear of being deceived, feelings of being persecuted, perfectionism, rigid behaviors and beliefs, self-righteous attitude. They get easily offended, detached and argumentative. 

So, some interventions we’re going to be doing. We first want to assess the client’s neurological status. So, we’re going to be doing a new assessment. So, we want to determine if any other issues may be causing the symptoms, or if the disorder has any progress to any other serious condition, such as schizophrenia. Another intervention that we want to be doing, we want to talk openly with the client about their beliefs and thoughts, showing empathy and support. We want to make sure we’re helping build trust and rapport with patients. Paranoid clients may be more reluctant to trust anyone, but an open communication generally offers more cooperation. Another intervention we want to do is we want to remain aware of the client’s personal space. We want to avoid startling the client, any sudden movements, or touching the client unnecessarily. Even the best of intentions, such as a handshake, maybe tidying a room, or any body language can be misinterpreted as being threatening and may lead to aggressive behavior by the client. We want to make sure that we’re showing the client space and possessions, and we want to make sure we’re building that trust with them. Another intervention we want to minimize environmental stimuli. So, you want to decrease environmental stimuli. Over stimulation from loud noises, excessive talking, television or radio may increase paranoia and prompt, erratic, or aggressive behaviors. Another intervention is we want to set behavioral boundaries. And we want to enforce per facility protocol with medications or restraints as necessary. You want to promote the safety of the clients during an agitated moment and the safety of others around them because of the aggressive behavior. You want to make sure you’re following the facility specific protocol regarding supervision, restraint use, and documentation. Another intervention we want to do is administer any sort of medications appropriately and make sure we’re monitoring for any sort of reactions. This can be antipsychotics, which may be given to manage delusions and behaviors. We also, with these patients, want to offer praise and encouragement for accomplishments of tasks. This is going to promote a sense of self-worth and improve self-esteem for these patients. 

Alright, let’s go over some key points. So, it is a bizarre behavior and feelings of distrust and fear. The exact cause is not known but is said to be a combination of biological and psychological factors. Some subjective objective data for these patients: they’ll have suspicion, feelings of being prosecuted, poor self-image, perfectionism, rigid behaviors, beliefs, easily offended, social detachment, and hostility. We want to make sure we’re assessing neurological status, behaviors, talk openly about their beliefs, and be aware of their personal space. Very big with these patients, their personal space. You want to make sure to set boundaries with them and enforce them, and administer medications as needed. And that’s the care plan. 

You guys did a wonderful job. We love you. Go out, be your best self today, and as always happy nursing.

 

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