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RISK FOR OTHER - DIRECTED VIOLENCE Nursing Care Plan

        We will share to you a sample of nursing care plan(NCP) of violence, risk for other-directed. This violence is a behavior in which an individual demonstrates that he or she can be physically or even emotionally and/or sexually harmful to others. It is a state in which the client is at risk be assaultive towards others or in the environment. In making a nursing care plan for violence,  the nursing focus is to decrease the violent episodes and protecting both the client and others. Always remember that do not use this diagnosis to address other problems such as anxiety and poor self-esteem, but instead should make and refer to ANXIETY Nursing Care Plan and Effective Coping. Don't be confused between this diagnosis and domestic violence, use Disabled Family Coping instead.

ASSESSMENT:
Subjective:
"I will kill everyone!", as verbalized by the patient.

Objective:
- Clenching of fist
- Facial flaring
- Shouting
- Flaring eyes
- Grunting of teeth

Diagnosis:
        Risk for other-directed violence related to aggressive acts and manic excitement as manifested by shouting and clenching of fist.

Planning:
After 2 hours of nursing intervention, the client will refrain from threatening, loud language towards others and identifies calming strategies.

INTERVENTIONS:
- Promote trust to the client first by acknowledging the client's feelings. Tell the client: "You are having a rough time." Just be genuine and empathetic and tell the client that you will help and do not do anything destructive.

- Set limits when the client is poses a risk to others. Do not touch the client, avoid feelings of physical entrapment but do not do this intervention alone, presence of three to four staffs is necessary in order for the client not to lose control. Offer choices, sometimes it is necessary to give necessary demands to avoid a power struggle. Also encourage client to express anger by saying or verbally instead of acting out.

- Do not take the verbal abuse personally. Be calm at all times, if you become upset, leave the situation to others. After the nursing intervention, discuss your feelings about the situation to other staffs.

- Remove the client from the environment if it contributes to the aggressive behavior using the least amount of control needed, like asking others to leave or taking the client to the quiet room. Repeatedly tell the client what will going to happen before external control begins.

- Explore what precipitates the client's out of control. Assist the client to recall the physical  symptoms associated with anger. Teach the use of deep breaths and relaxation breathing.

- Encourage increased recreational activities.

Evaluation:

After 2 hours of nursing intervention, the client refrained from threatening, loud language towards others and identified calming strategies.

If you like nursing care plan right in your hand, I highly recommend this handbook Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 8e to you. This book provides the latest nursing diagnosis and it is much cheaper than the other books (others are $66 above). Professors and professional nurses also recommend this book (you can check their reviews on comments' section). Get this book here to have a free shipping!

WANDERING Nursing Care Plan

       Wandering is persistent locomotion or continuous movement from place to place. A person that wanders has scanning and searching behaviors, hyperactivity, and unable to locate significant landmarks in a familiar setting. This is usually related to impaired cerebral function or mental retardation and other mental dysfunction like dementia and Alzheimer's disease. In addition, physiologic factors such as hunger, thirst, pain, urination and constipation may cause wandering. Anxiety, boredom, depression and agitation or even separation to someone may lead to wandering condition.

Here is a sample of nursing care plan for wandering:

ASSESSMENT:
Subjective
"I want to go home, but I don't know exactly where I am now. I've been walking for almost 2 hours." client said.

Objective:
- Poor eye contact
- Keep looking around
- Looks anxious
- Pale
- Dry mouth
- Dry skin
- Persistent walking
- Weakness
- Fatigue

DIAGNOSIS:
       Wandering related to persistent walking for almost 2 hours as manifested by weakness and fatigue.

PLANNING:
After 4 hours of nursing intervention, the client will return to home safely and the caretakers will anticipate and prevent wandering behaviors.

INTERVENTIONS:
- Assess the contributing factors such as anxiety, confusion, frustration, boredom, agitation and physiological urge like hunger, thirst, urination and constipation. Reduced or eliminate the assessed contributing factors, if possible. 

For anxiety intervention, go to ANXIETY Nursing Care Plan.

- Always redirect the client when he or she is lost. Provide him or her a safe route for walking.

- Provide regular opportunities for the client to walk with a caregiver or a companion in a safe area. 

- To provide safety and restrictions, install locks on doors and windows. If you try to provide electronic devices such as buzzers on doors and pressure sensitive alarms, make sure your neighbors, police and other residence are aware of the client's wandering behavior. Also encourage them to notify the caregiver or the relatives when the client is wandering. Provide them a picture or image of the client in order to familiarize the client's identity.

EVALUATION:
After 4 hours of nursing intervention, the client returned to home safely and the caretakers will anticipate the prevent client's wandering behavior.


Above is just a sample of nursing care plan in wandering. According to Linda Juall Carpenito, this approved NANDA-I diagnosis is more useful than risk for Injury, which was previously used. Risk for Injury focuses on strategies to protect a client from injury. Wandering directs interventions to protect the client from injury in addition to addressing the factors for the wandering behavior, if possible.

If you like nursing care plan right in your hand, I highly recommend this handbook Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 8e to you. This book provides the latest nursing diagnosis and it is much cheaper than the other books (others are $66 above). Professors and professional nurses also recommend this book (you can check their reviews on comments' section). Get this book here to have a free shipping!