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    NCP - Risk For Other-Directed Violence

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    Kasandra Dawn Moquia Beriso
    This nursing care plan addresses a patient with a self-care deficit related to an inability to independently perform activities of daily living (ADLs) without assistance. The short-term goal is for the patient to establish ADLs with assistance within 3 days of nursing interventions. Interventions include establishing rapport, identifying the reasons for difficulty with self-care, determining hygiene needs and providing assistance, and inspecting the skin regularly. The goal is partially met, as evidenced by the patient being able to verbalize understanding of ADL importance and performing bathing independently but requiring stand-by assistance.

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    NCP - Risk For Other-Directed Violence

    Uploaded by

    Kasandra Dawn Moquia Beriso
    563 views2 pages
    This nursing care plan addresses a patient with a self-care deficit related to an inability to independently perform activities of daily living (ADLs) without assistance. The short-term goal is for the patient to establish ADLs with assistance within 3 days of nursing interventions. Interventions include establishing rapport, identifying the reasons for difficulty with self-care, determining hygiene needs and providing assistance, and inspecting the skin regularly. The goal is partially met, as evidenced by the patient being able to verbalize understanding of ADL importance and performing bathing independently but requiring stand-by assistance.

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    NCP- Risk for other-directed violence

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    This nursing care plan addresses a patient with a self-care deficit related to an inability to independently perform activities of daily living (ADLs) without assistance. The short-term goal is for the patient to establish ADLs with assistance within 3 days of nursing interventions. Interventions include establishing rapport, identifying the reasons for difficulty with self-care, determining hygiene needs and providing assistance, and inspecting the skin regularly. The goal is partially met, as evidenced by the patient being able to verbalize understanding of ADL importance and performing bathing independently but requiring stand-by assistance.

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    © All Rights Reserved
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    Download as docx, pdf, or txt
    563 views2 pages

    NCP - Risk For Other-Directed Violence

    Uploaded by

    Kasandra Dawn Moquia Beriso
    This nursing care plan addresses a patient with a self-care deficit related to an inability to independently perform activities of daily living (ADLs) without assistance. The short-term goal is for the patient to establish ADLs with assistance within 3 days of nursing interventions. Interventions include establishing rapport, identifying the reasons for difficulty with self-care, determining hygiene needs and providing assistance, and inspecting the skin regularly. The goal is partially met, as evidenced by the patient being able to verbalize understanding of ADL importance and performing bathing independently but requiring stand-by assistance.

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    NURSING SCIENTIFIC

    CUES OBJECTIVES NURSING INTERVENTIONS RATIONALE EVALUATION


    DIAGNOSIS RATIONALE
    SUBJECTIVE: Self – Care Deficit Self-Care Deficit is the SHORT TERM GOAL: INDEPENDENT: SHORT TERM GOAL:
    - “Danay diri ako related inability to inability of an individual After 3 days of nursing  To obtain cooperation
     Establish rapport.
    nakakagliwan hin trust evidenced by to perform self-care. The interventions, the
    Inability or patient will be GOALS PARTIALLY MET
    akon la kay gusto ko deficit may be the effect
     Underlying cause of
    hi mana teying la it unwillingness to of temporary limitations, able to  Identify reason for As evidenced by:
    establish ADL affects choice of
    mag aareglar ha carry out toileting such asthe result of difficulty in self – care; e.g.
    with assistance interventions/ strategies.
    procedures without gradual deterioration cognitive decline.
    akon.” as verbalized Problem may be
    assistance that erodes the as evidenced by:
    by the patient. minimized by e.g.,  Being able to verbalize
    individual’s ability or changes in environment or the understanding about
    willingness to perform • Verbalize adaptation of clothing, or the importance of
    OBJECTIVE: the activities required to understanding about may be more complex, performing ADL.
    care for himself or the importance of requiring consultation from
    Presents symptoms of herself. Also, patients performing ADL other specialists.  Patient reportedly
    dependence to the unit who are suffering from Important to distinguish observed to perform
    parent. any kind of psychosis • Perform self – care between partial and total bathing independently
    activities within the dependence to avoid but with stand-by
    may not have the
    level of own creating excess disability. assistance from the unit
    interest to engage in
    ability parent.
    self-care activities.
    • Patient will participate
    in feeding, dressing,  Determine hygienic  As the disease
    toileting, and bathing needs and provide progresses, basic hygienic
    activities detaching a assistance as needed with needs may be forgotten.
    little of assistance to activities, including care of Infection, gum disease,
    promote hair/nails/ skin, brushing disheveled appearance, or
    dependence. teeth, cleaning glasses. harm may occur when
    client/ caregivers become
    frustrated, irritated or
    intimidated by degree of
    care required.

     Presence of such
    lesions as ecchymoses,
     Inspect skin regularly.
    lacerations, rashes may
    require treatment, as well
    as signal the need for
    close monitoring/
    protective interventions.

     Incorporate usual  Maintaining routine may


    routine into activity prevent worsening of

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