Nursing Care Plan for Paranoid Disorders

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 the course of, but may be diagnosed prior to,  schizophrenia

Desired Outcome

Client will be able to identify appropriate coping techniques. 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

  1. Assess client’s neurological status

  2. To determine if there are other issues that may be causing symptoms or if disorder has progressed to another serious conditions such as schizophrenia

  3. Monitor behaviors and interactions with staff and other clients

  4. Determine how client interacts with others. Paranoid clients may exhibit aggressive behaviors for no apparent reason.

  5. Talk openly with client about their beliefs and thoughts, showing empathy and support

  6. Help build trust and rapport with clients. Paranoid clients may be more reluctant to trust anyone, but open communication generally offers more cooperation

  7. Explain all procedures clearly and carefully, and their purpose, before starting them

  8. Prevents aggressive behavior and suspicion. Promotes cooperation and compliance. Helps develop trust.

  9. Remain aware of client’s personal space.

    Avoid startling the client, sudden movements or touching the client unnecessarily

  10. 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 client’s space and possessions helps build trust.

  11. Discuss feelings and help client identify behaviors that cause conflict or alienate others

  12. Helping clients see the reality of their own behaviors can help treatment progress and lead to more appropriate behaviors and interactions.

  13. Discuss and have client demonstrate (through role play if appropriate) more acceptable responses and reactions to behaviors and stressors

  14. Helps client develop more positive coping skills for dealing with delusions, suspicions and fears

  15. Minimize environmental stimuli

  16. Overstimulation from loud noises, excessive talking, television or radio may increase paranoia and prompt erratic or aggressive behaviors.

  17. Encourage socialization with others, but do not force participation in activities

  18. Help client develop relationships and more positive interactions with others. Helps reorient client to reality. Forcing them to participate may trigger paranoia that you are trying to trick or trap them.

  19. Set behavior boundaries and enforce per facility protocols with medications or restraints as necessary

  20. Promote the safety of client during agitated moments and the safety of others from aggressive behaviors.

    Follow your facility’s specific protocol regarding supervision, restraint, and documentation.

  21. Administer medications appropriately and monitor for reactions to medications

  22. Antipsychotic medications may be given to manage delusions and behaviors. Monitor for adverse reactions.

  23. Offer praise and encouragement for accomplishments of tasks

  24. Promote a sense of self-worth and improves self-esteem

  25. Consider any cultural concerns or impacts of treatment

  26. Depending on their culture, some behaviors and beliefs may be considered acceptable to the client. Take these into consideration when implementing interventions.

  27. Provide reorientation as appropriate, but avoid direct confrontation of the delusions

  28. Client may need to be refocused to reality at times, but avoid confrontation that may be interpreted as argumentative to avoid noncompliance and uncooperative behaviors.

  29. Provide education, resources and support for client’s family and loved ones

  30. Help family members understand the nature of the client’s illness and avoid conflict that could exacerbate the client’s symptoms.

    Encourages coping skills of family members through each other and support groups.

  31. As client agrees, and per facility protocol, incorporate client’s family or loved ones in ongoing treatment plan

  32. Help develop trust between client and loved ones, and promotes positive management of illness going forward. Help client and family members stay on track with treatment.


References

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