Adjustment disorder is a psychological condition that develops in response to identifiable stressors, causing significant emotional or behavioral symptoms that impact daily functioning. This nursing diagnosis focuses on identifying and treating adjustment disorder symptoms, promoting healthy coping mechanisms, and preventing complications.
Causes (Related to)
Adjustment disorder can develop due to various stressors and contributing factors:
- Life Changes:
- Divorce or relationship problems
- Job loss or career changes
- Moving to a new location
- Financial difficulties
- Death of a loved one
- Health-Related Issues:
- Chronic illness diagnosis
- Physical disability
- Surgery recovery
- Pregnancy complications
- Terminal illness
- Social Factors:
- Cultural adjustment
- Family conflicts
- Academic pressure
- Workplace stress
- Social isolation
Signs and Symptoms (As evidenced by)
Adjustment disorder presents various manifestations that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Anxiety and worry
- Depressed mood
- Feeling overwhelmed
- Difficulty concentrating
- Sleep disturbances
- Loss of interest in activities
- Social withdrawal
- Hopelessness
Objective: (Nurse assesses)
- Changes in appetite
- Decreased attention span
- Tearfulness
- Psychomotor agitation
- Poor eye contact
- Flat affect
- Changes in hygiene
- Decreased participation in care
Expected Outcomes
The following outcomes indicate successful management of adjustment disorder:
- The patient will demonstrate improved coping mechanisms
- The patient will report decreased anxiety and depression symptoms
- The patient will maintain activities of daily living
- The patient will establish support systems
- The patient will verbalize understanding of stressors
- The patient will engage in therapeutic interventions
- The patient will return to baseline functioning
Nursing Assessment
1. Psychological Status
- Assess mental status
- Evaluate mood and affect
- Monitor anxiety levels
- Check for suicidal ideation
- Document behavioral changes
2. Functional Assessment
- Evaluate ADL performance
- Assess sleep patterns
- Monitor appetite and nutrition
- Check social engagement
- Document activity levels
3. Support Systems
- Assess family support
- Evaluate social networks
- Check community resources
- Document coping mechanisms
- Review cultural factors
4. Stressor Evaluation
- Identify precipitating factors
- Assess ongoing stressors
- Monitor stress response
- Document coping strategies
- Review environmental factors
5. Risk Assessment
- Check for self-harm risk
- Assess substance use
- Monitor for complications
- Document safety concerns
- Review protective factors
Nursing Care Plans
Nursing Care Plan 1: Ineffective Coping
Nursing Diagnosis Statement:
Ineffective Coping related to situational crisis and inadequate coping mechanisms as evidenced by anxiety, social withdrawal, and verbalized inability to handle stress.
Related Factors:
- Situational crisis
- Limited coping strategies
- Inadequate support system
- Poor problem-solving skills
Nursing Interventions and Rationales:
- Assess current coping mechanisms
Rationale: Identifies areas for improvement and intervention - Teach stress management techniques
Rationale: Provides tools for managing stressors effectively - Encourage the expression of feelings
Rationale: Promotes emotional processing and awareness
Desired Outcomes:
- The patient will demonstrate effective coping strategies.
- The patient will report decreased stress levels
- The patient will utilize support systems appropriately
Nursing Care Plan 2: Anxiety
Nursing Diagnosis Statement:
Anxiety related to situational crisis and life changes as evidenced by restlessness, increased worry, and difficulty concentrating.
Related Factors:
- Life changes
- Uncertain future
- Limited control
- Inadequate resources
Nursing Interventions and Rationales:
- Implement anxiety reduction techniques
Rationale: Reduces physiological and psychological symptoms - Provide supportive environment
Rationale: Creates safe space for healing - Teach relaxation methods
Rationale: Gives tools for self-management
Desired Outcomes:
- The patient will report decreased anxiety
- The patient will use relaxation techniques effectively
- The patient will maintain daily functioning
Nursing Care Plan 3: Disturbed Sleep Pattern
Nursing Diagnosis Statement:
Disturbed Sleep Pattern related to psychological distress as evidenced by difficulty falling asleep, frequent awakening, and daytime fatigue.
Related Factors:
- Psychological stress
- Ruminating thoughts
- Environmental changes
- Altered routine
Nursing Interventions and Rationales:
- Establish a sleep hygiene routine
Rationale: Promotes regular sleep patterns - Implement relaxation techniques
Rationale: Reduces bedtime anxiety - Monitor sleep patterns
Rationale: Tracks improvement and identifies issues
Desired Outcomes:
- The patient will report improved sleep quality
- The patient will maintain a regular sleep schedule
- The patient will demonstrate decreased daytime fatigue
Nursing Care Plan 4: Social Isolation
Nursing Diagnosis Statement:
Social Isolation related to adjustment difficulties as evidenced by withdrawal from social activities and decreased communication.
Related Factors:
- Adjustment difficulties
- Low self-esteem
- Fear of rejection
- Altered support systems
Nursing Interventions and Rationales:
- Encourage social interaction
Rationale: Maintains support networks - Facilitate group participation
Rationale: Provides peer support opportunities - Promote communication skills
Rationale: Enhances social functioning
Desired Outcomes:
- The patient will increase social interactions
- The patient will participate in group activities
- The patient will maintain supportive relationships
Nursing Care Plan 5: Risk for Decreased Self-Esteem
Nursing Diagnosis Statement:
Risk for Decreased Self-Esteem related to life transitions and perceived failures as evidenced by negative self-statements and decreased confidence.
Related Factors:
- Life transitions
- Perceived failures
- Role changes
- Identity disruption
Nursing Interventions and Rationales:
- Promote positive self-talk
Rationale: Builds self-confidence - Identify personal strengths
Rationale: Enhances self-awareness - Set achievable goals
Rationale: Creates successful experiences
Desired Outcomes:
- The patient will demonstrate improved self-esteem
- The patient will express positive self-statements
- The patient will achieve personal goals
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Bachem R, Casey P. Adjustment disorder: A diagnosis whose time has come. J Affect Disord. 2018 Feb;227:243-253. doi: 10.1016/j.jad.2017.10.034. Epub 2017 Oct 23. PMID: 29107817.
- Baumeister H, Maercker A, Casey P. Adjustment disorder with depressed mood: a critique of its DSM-IV and ICD-10 conceptualisations and recommendations for the future. Psychopathology. 2009;42(3):139-47. doi: 10.1159/000207455. Epub 2009 Mar 11. PMID: 19276640.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- O’Donnell ML, Agathos JA, Metcalf O, Gibson K, Lau W. Adjustment Disorder: Current Developments and Future Directions. Int J Environ Res Public Health. 2019 Jul 16;16(14):2537. doi: 10.3390/ijerph16142537. PMID: 31315203; PMCID: PMC6678970.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
