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Nursing Care Plan for Paranoid Disorders

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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

 

Diagnostic Criteria:

  Criteria and symptoms must persist for one month or more, and cannot be attributed to substance use or another medical or mental condition.

  • Extreme distrust and suspiciousness of others, misinterpreting motives as malevolent, begins early in adulthood
  • Presents by at least four of the following:
    • Suspects, without reason, that others are exploiting, harming or deceiving him or her
    • Is preoccupied with unjustified doubts about the trustworthiness of friends or associates
    • Is reluctant to confide in others because of fear that information will be used against him or her
    • Misinterprets threatening meanings into harmless remarks or events
    • Bears grudges or is unforgiving of insults, injuries
    • Perceives attacks on his or her character or reputation
    • Recurrent, unjustified suspicions about partner’s fidelity
  • Does not occur only during, but may be diagnosed before,  schizophrenia

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:

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

Nursing Interventions and Rationales

  • 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.  
  • As client agrees, and per facility protocol, incorporate client’s family or loved ones in the ongoing 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.  

References

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  • Question 1 of 3

A client has been brought into the emergency department under the influence of illicit drugs. The client is experiencing paranoia and yells at the nurse, “You can’t hurt me! I am more powerful than you!” Which tactics would the nurse use that would help to orient this client to reality? Select all that apply.

  • Question 2 of 3

A nurse is working with a client who has paranoid thinking. The client believes that a secret chip has been implanted under the client’s skin by the government. Which is the most appropriate first approach from the nurse?

  • Question 3 of 3

A client with a history of aggression requires medical management to control his behavior. The nurse performs an intake assessment of this client upon admission to the hospital. Which information is the priority to include in the initial assessment?

Module 0 – Nursing Care Plans Course Introduction
Module Obstetrics (OB) & Pediatrics (Peds) Care Plans

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