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NCP Delusional Disorder | Nursing Care Plan

SPECIFIC TYPE:
Erotomanic (delusions that another person of higher status is in love with the individual)
Grandiose (delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person)
Jealous (delusions that one’s sexual partner is unfaithful)
Persecutory (delusions that one, or someone to whom one is close, is being malevolently treated in some way)
Somatic (delusions that one has some physical defect or general medical condition)
Mixed (delusions characteristic of more than one of the above types, but no one theme predominates)

DSM-IV
297.1 Delusional disorder

ETIOLOGICAL THEORIES
Psychodynamics
Emotional development is delayed because of a lack of maternal stimulation/attention. The infant is deprived of a sense of security and fails to establish basic trust. A fragile ego results in severely impaired self-esteem, a sense of loss of control, fear, and severe anxiety. A suspicious attitude toward others is manifested and may continue throughout life. Projection is the most common mechanism used as a defense against feelings.

Biological
A relatively strong familial pattern of involvement appears to be associated with these disorders. Individuals whose family members manifest symptoms of these disorders are at greater risk for development than the general population. Twin studies have also suggested genetic involvement.

Family Dynamics
Some theorists believe that paranoid persons had parents who were distant, rigid, demanding, and perfectionistic, engendering rage, a sense of exaggerated self-importance, and mistrust in the individual. The clients become vulnerable as adults because of this early experience.

NURSING PRIORITIES
1. Promote safe environment, safety of client/others.
2. Provide open, honest atmosphere in which client can begin to trust self/others.
3. Encourage client/family to focus on defining methods for coping with anxieties and life stressors.
4. Promote a sense of self-worth and increased self-esteem.

DISCHARGE GOALS
1. Copes with anxiety without the use of threats or assaultive behavior.
2. Recognizes reality; agrees to give up or live with the delusional system.
3. Client/family/SOs participate in therapy (e.g., behavioral, group).
4. Family/SO(s) provide emotional support for the client.
5. Plan in place to meet needs after discharge.

Nursing diagnosis for delusional disorder: Risk for Violence, directed to self and others may be related to perceived threats of danger and increased feelings of anxiety possibly evidenced by Acting out in an irrational manner and Becoming threatening or assaultive in the face of perceived threat.

Desired Outcomes:
1. Verbalize awareness of delusional system.
2. Resolve conflicts, coping with anxiety without the use of threats or assaultive behavior.

Nursing intervention and rationale:
1. Note prior history of violent behavior when under stress.
Rationale: Indicator of increased risk for recurrence of aggression/violent behavior.

2. Assist client to identify situations that trigger anxiety and aggressive behaviors.
Rationale: Understanding relationship between severe anxiety and aggressive feelings can help client identify options to avoid violent behavior.

3. Explore implications and consequences of handling these situations with aggression.
Rationale: Emphasizes importance of thinking through situations before acting.

4. Encourage to engage in solitary activity instead of group activities to being with.
Rationale: Anxiety, fear, and suspiciousness may escalate if client is involved in competitive/group activities.

5. Assist client to define alternatives to aggressive behaviors. Engage in physical activities such as Ping-Pong, foosball. (Monitor competitive activities; use with caution.)
Rationale: Enables client to learn to handle situations in a socially acceptable manner. Appropriate outlets will allow for release of hostility. Note: Competition can trigger violent behavior.

6. Encourage verbalizations of feelings and promote outlet for expression.
Rationale: Ventilation of feelings reduces need for physical action.

7. Be alert to signs of impending violent behavior (e.g., increase in psychomotor activity, intensity of affect, verbalization of delusional thinking, especially threatening expressions).
Rationale: Therapeutic interventions are more effective before behavior becomes violent.

8. Accept verbal hostility without retaliation or defense. Nurse (caregiver) needs to be aware of own response to client behavior (e.g., anger/fear).
Rationale: Behavior is not usually directed at nurse personally, and responding defensively may exacerbate situation. Concentrating on meaning behind the words is more productive. Awareness of own response allows nurse to confront/deal with those feelings.

9. Isolate promptly in nonpunitive manner, using adequate help if violent behavior occurs. Hold client if necessary. Tell client to STOP behavior.
Rationale: Removal to a quiet environment can help calm client. Sufficient help will prevent injury to client/staff. Usually the individual is being selfcritical and afraid of hostility and does not need external criticisms. Saying “Stop” may be enough to allow client to regain control.

10. Administer medications, as indicated.
Rationale: Antipsychotic/antianxiety drugs may decrease anxiety and delusional thinking, decreasing suspicious thoughts/aggressive behaviors and aiding client in maintaining control.
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