NAME OF STUDENT: __________________________ NURSING CARE PLAN NAME OF PATIENT:

________________________________
GROUP NO. ___________ MEDICAL DIAGNOSIS:
_____________________________
DATE: _______________ AGE: _____ NCP NO.: _________ RATING:
____

ASSESSMENT NURSING SCIENTIFIC OBJECTIVES NURSING RATIONALE EXPECTED

DIAGNOSIS EXPLANATION INTERVENTIONS OUTCOME
Disturbed Short Term: Assess client’s To assess causative Short Term:
personal After 5 hours of perception of the and contributing The client shall
identity related nursing extent of the threat factors have
to absence and interventions, and how client is acknowledged
rejection of the client will handling the situation threat to
parental role acknowledge personality
model threat to
personality
Have client define own To identify basis of
body image client’s personal
identity
Determine presence of To identify extent of
delusions and causation of causative
distortions of reality and contributing
factors
O> Client manifests: Long term Make time to listen to To help the client in Long term
 Uncertainties After 5 days of client, encouraging dealing with the The client shall
about long-term nursing appropriate expression situation have stated
goals or career interventions, of feelings ability to identify
choice the client will and accept self
 Vague self-image state ability to
identify and
accept self
 Excessive use of Help client recognize Touch and physical
projection separateness from presence provide
Client may manifests: nurse by clarifying reality for client and
 Self mutilation which behaviors and serve to strengthen
 Uncertainties feelings belong to weak ego boundaries.
regarding gender whom. If deemed
 NAME OF STUDENT: __________________________ NURSING CARE PLAN NAME OF PATIENT:
________________________________
GROUP NO. ___________ MEDICAL DIAGNOSIS:
_____________________________
DATE: _______________ AGE: _____ NCP NO.: _________ RATING:
____

identity appropriate, allow

client to touch your
hand or arm
Discuss client’s To reinforce client’s
commitment to an integrity
identity
Provide calm To assist the client in
environment discussing the issues
Allow the client to deal To help the client
with situation in small progress towards
steps wellness
Confront statements To avoid untoward
that project client’s incidents
feelings onto others
Always call client by his These interventions
or her name. If client help to preserve
experiences feelings of client’s feelings of
depersonalization or dignity and self-worth.
derealization,
orientation to the
environment and
correction of
misperceptions may be
helpful
Help client understand A contract gets the
that there are more subject out in the
adaptive ways of open and places some
validating his or her of the responsibility
existence than self- for his or her safety
mutilation. Contract with client. Client
with client to seek out safety is a nursing
 NAME OF STUDENT: __________________________ NURSING CARE PLAN NAME OF PATIENT:
________________________________
GROUP NO. ___________ MEDICAL DIAGNOSIS:
_____________________________
DATE: _______________ AGE: _____ NCP NO.: _________ RATING:
____

staff member when priority.

these feelings occur
Work with client to Because of
clarify values. Discuss underdeveloped ego
beliefs, attitudes, and and fixation in early
feelings underlying his developmental level,
or her behaviors. Help client may not have
client identify those established own value
values that have been system. In order to
(or are intended to be) accomplish this,
incorporated as his or ownership of beliefs
her own. Care must be and attitudes must be
taken by the nurse to identified and
avoid imposing his or clarified.
her own value system
on the client
Use of photographs of Photographs may help
client may help to increase client’s
establish or clarify ego awareness of self as
boundaries separate from others.
Alleviate anxiety by Early childhood
assuring client that he traumas may
or she will not be left predispose borderline
alone clients to extreme
fears of
abandonment.
Provide accurate Helps client to make
information about the positive decisions in
threat to and potential the future
consequences for
individual
 NAME OF STUDENT: __________________________ NURSING CARE PLAN NAME OF PATIENT:
________________________________
GROUP NO. ___________ MEDICAL DIAGNOSIS:
_____________________________
DATE: _______________ AGE: _____ NCP NO.: _________ RATING:
____

Refer to appropriate To promote wellness

support group