Psychosis Nursing Diagnosis and Nursing Care Plan

Psychosis Nursing Care Plans Diagnosis and Interventions

Psychosis NCLEX Review and Nursing Care Plans

Psychosis is a mental disorder that involves changes on how the brain processes information. It leads individuals to be disconnected from reality. They may see, hear, or imagine things that never happened.

Moreover, physical harm or sickness, substance misuse, or stressful experiences or trauma can trigger psychosis. Mental health disorders such as schizophrenia involve psychosis, typically striking people for the first time in late adolescence or early adulthood.

There are no recent studies that prove why young individuals are more prone to psychosis. Thus, physicians refer to the first episode of psychosis (FEP) as when the patient notices subtle changes in how they behave or think. This condition is known as the prodromal phase which can persist for days, weeks, months, or even longer.

Even if the patient does not have a primary psychotic condition like schizophrenia or bipolar disorder, he/she can experience psychotic episodes and lose connection with reality sometimes. This phenomenon is classified as secondary psychosis.

Hence, psychosis episodes may also be caused by drug usage or other medical problems or comorbidities. Regardless of the source, the psychotic symptoms usually disappear in a short time if the underlying disease is treated immediately.

An individual with psychosis may frequently experience confusion and have disorganized thoughts. Some instances are as follows:

  • Continuous speaking with quick speech patterns
  • Changing topics in the middle of a conversation without explanation
  • An unexpected interruption in their flow of thought that leads them to stop or hesitate

Symptoms of Psychosis

  1. Warning Signs of Psychosis

Early warning indicators of psychosis include subtle changes in how the patients think about and perceive the world. Here are some of the warning signs:

  • A decline in grades or performance at work
  • Having difficulty thinking properly or concentrating
  • Uneasiness or suspicion in the presence of others
  • Inadequate self-care or hygiene
  • The patients start to spend more time alone than usual.
  • Stronger emotions than the situation necessitate
  • There are no emotions at all.
  1. Early Signs of Psychosis

  • Patients start to hear, see, or taste things that others do not.
  • Regardless of what others say, patients hold on to odd beliefs or ideas.
  • Patients start to separate themselves from their family and friends.
  • Patients tend to stop taking care of themselves.
  • Inability to think appropriately or pay close attention
  1. Symptoms of a Psychotic Episode

Patients typically experience all of the symptoms mentioned above, as well as:

  • Hallucinations
  • Auditory hallucinations. This symptom occurs when patients start to hear voices even when no one is nearby
  • Tactile hallucinations. This hallucination is the explainable sensations or feelings that the patient experiences.
  • Visual hallucinations. These symptoms occur when the patients see persons or objects that are not present or when they believe the shape of objects is incorrect.
  • Delusions. These are beliefs that are contrary to one’s culture and do not make sense to others, such as:
  • Feelings and actions are under the control of outside forces.
  • Minor incidents or remarks can have a significant impact.
  • Feelings of having exceptional abilities, special powers, extreme fortunes, belief of being on a specific mission, or being a god.

Types of Psychosis

  1. Brief or Short-term Psychosis. A brief psychotic condition, also known as brief reactive psychosis, can arise amid periods of intense emotional pressure, such as the death of a family member. Depending on the nature of the distress, someone who has brief reactive psychosis will usually feel better in a few days to several weeks.
  1. Drug or Alcohol-related Psychosis. The use of alcohol or narcotics, including stimulants, can sometimes cause psychosis. Hallucinogenic substances frequently lead the user to see objects that are not present, but this impact is very momentary. Several prescription medicines, such as steroids and stimulants, can also trigger psychotic symptoms. Hence, individuals with alcohol or substance use disorders may have psychotic symptoms if they abruptly stop drinking or using drugs.
  1. Organic Psychosis. Signs of organic psychosis can be caused by head trauma, disease, or infection that changes the brain.

Types of Psychotic Disorders

Stress, drug or alcohol usage, injuries, or disease can all trigger psychotic episodes. Psychosis can appear in the following disorders:

  1. Manic-depressive or Bipolar Disorder. When a person has bipolar disorder, they experience severe mood swings. They may exhibit psychotic symptoms while their mood is high and optimistic. They may also be delighted or overconfident. When a person’s mood is significantly depressed, they may experience psychotic symptoms such as anger, sadness, or fear. These symptoms may include the belief that someone is attempting to hurt them.
  2. Delusional Disorder. A person suffering from a delusional condition has strong beliefs in things that never happened, even when presented with contrary evidence.
  3. Depressive psychosis. This type of disorder is profound depression with psychotic symptoms.
  4. Schizophrenia. Schizophrenia is a dangerous mental condition where people have an aberrant interpretation of reality. Schizophrenia can include hallucinations, delusions, and profoundly disturbing thoughts and behavior that interferes with everyday activities and can be severe. Psychosis is common in schizophrenia.

Causes of Psychosis

Doctors are also not sure what causes psychosis. However, some potential triggers include:

  • Genetics. Genes can sometimes play a role in the development of psychosis.
  • Substances: Some prescription medications and the abuse of alcohol or drugs can all trigger psychosis.
  • Trauma. Loss of a loved one, sexual abuse, or war can result in psychosis.
  • Injuries and illnesses. Traumatic head injuries, brain damage, strokes, Parkinson’s disease, Alzheimer’s disease, dementia, and HIV are all known to cause psychosis.

Risks Factors to Psychosis

Some risk factors that may predispose a person to psychosis include:

  • A type of brain injury. such as stroke or severe head trauma
  • A history of schizophrenia, other psychotic diseases, or mood disorders in one’s family
  • Alzheimer’s disease and other forms of dementia
  • A cyst or tumor in the brain
  • Misuse of alcohol and drugs
  • Certain prescribed drugs
  • HIV infection and other infections
  • Infections or brain trauma in childhood
  • Genetic alterations

Diagnosis of Psychosis

A mental health specialist will perform clinical examinations and ask questions to diagnose psychosis. The healthcare professional will inquire about:

  • The individual’s experiences in life, emotions, and everyday routines
  • Any psychological disorder in the family
  • Any drug usage, whether medical and recreational
  • Any other symptoms experienced by the patient

He/she may also conduct tests to confirm other variables, such as:

  • The use of drugs or other narcotics
  • Brain injury
  • Various illnesses, such as multiple sclerosis (MS) or a brain tumor

Among the possible tests are:

  • Urinalysis. The doctor may suggest urinalysis to detect substances in the body that may be causing the psychosis
  • Complete blood tests
  • Electroencephalogram (EEG) that measures brain activity

If the symptoms point to a psychological condition, the doctor will make a diagnosis using criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5).

Treatment for Psychosis

Psychosis treatment may include a combination of drugs and counseling. With treatment, most patients will notice an improvement in their symptoms.

  1. Quick tranquilization. People who have psychosis may become aggressive and endanger themselves or others. It may be vital to calm them down as quickly as possible in these instances. This approach is known as quick tranquilization. A physician or emergency response team will deliver a fast-acting injection or liquid medicine to calm the person swiftly.
  2. Medication. Antipsychotic drugs can be used to treat psychosis. These drugs help patients think more critically and minimize delusions and hallucinations. The doctor will prescribe antipsychotic medications based on the symptoms present on the patient. In many circumstances, patients only need antipsychotic medications for a brief-term until their symptoms disappear. Hence, some may need to use them for a more extended period.
  3. Cognitive-behavioral treatment (CBT). Cognitive behavioral therapy (CBT) is a type of therapy for mental health. Its purpose is to alter people’s beliefs and expectations. CBT entails visiting with a psychiatrist or psychologist regularly. CBT also helps patients manage their mental health conditions more effectively. It is frequently most beneficial for psychotic symptoms that drugs do not fully address.
  4. Supportive psychotherapy. This approach teaches the patient how to cope with and control the manifestations of psychosis. It also teaches healthy thinking habits.
  5. Cognitive enhancement therapy (CET). This intervention uses computer activities and teamwork to improve the capacity to think and comprehend.
  6. Family psychoeducation and support. This type of approach strengthens the family relationship and boosts the ability to solve difficulties together.
  7. Coordinated specialty care (CSC). When psychosis is first identified, coordinated specialty care (CSC) offers a team approach to patient care. CSC integrates therapy and medication with social services and job and education assistance.

Prevention of Psychosis

The following preventive measures can be part of the health teaching of the nurse to a patient who is predisposed or are exhibiting the warning signs of psychosis:

  1. Avoid too much intake of alcohol when feeling stress. Some people are drinking to help them cope with emotions of anxiety or solitude, but any improvements in mood are just brief. According to recent research, there is no safe alcohol level consumption, so find a healthy strategy for dealing with stress and mental health issues, such as trying out a new interest or hobby.
  2. Every individual should learn to open up their feelings to their trusted peers. Do not let unexpressed emotions trigger any mental health disorders.
  3. Stay active to improve one’s health. Regular physical activity can help individuals concentrate, sleep longer, and increase self-esteem. This method will keep the brain and vital organs healthy.
  4. Maintain communication with friends. Staying connected with friends — whether in person, on the telephone, or through social media – can help people stay focused, occupied, and encouraged, which can positively affect their mental health.
  5.  Discover a new skill. Every day is a new opportunity to learn! Trying a new skill can help improve overall psychological health and strengthen oneself.
  6. If symptoms of psychosis start to manifest, do not hesitate to consult a specialist to avoid severe complications.

Nursing Diagnosis for Psychosis

Psychosis Nursing Care Plan 1

Impaired Social Interaction

Nursing Diagnosis: Impaired Social Interaction related to communication and concentration difficulties, increased reaction to alarming stimuli, feeling endangered in social interactions, hallucinations or delusions, insufficient emotional reactions, and intrapersonal instability secondary to psychosis as evidenced by dysfunctional relationship with others, poor social interaction behaviors, time spent alone by self, inability to make visual contact, and conveyed or observed uneasiness in public interactions.

Desired Outcomes:

  • The patient will seek out helpful and encouraging support networks.
  • Patient’s social connection with family, friends, and neighbors will improve
  • The patient will employ proper social skills.
  • The patient will be able to complete one activity with his caregiver.
  • The patient will learn to interact with other people.
  • The patient will express a desire in beginning coping training opportunities.
Nursing Interventions for PsychosisRationale
Determine whether the medicine has achieved therapeutic concentrations.      Most of those psychosis manifestations such as hallucinations, delusions, disturbing thoughts will disappear with medication, making social interactions easier.    
Monitor the patient’s psychosis symptoms when he or she starts to feel uneasy around everyone else.  Anxiety can exacerbate irritability, aggression, and suspiciousness.  
Keep the patient clear of distractions, loud noises, and crowds as necessary.  Noises and crowding may cause irritation, anxiety, and an inability to the patient to focus on outside happenings.  
As possible, avoid touching the patient          An unfamiliar person’s touch can be misconstrued as a sensual or menacing gesture. This case is especially true for a patient with psychosis who experiences delusions and hallucinations.  
Remember to acknowledge and recognize positive efforts that the patient takes to improve his or her social skills and proper relationships with others.  Acknowledgement of a patient’s efforts might help to maintain and enhance a particular behavior.  
Allow the patient to practice adaptive interpersonal skills in a non-threatening atmosphere. Basic social practices such as acceptable distance, maintaining good eye contact, calm manner or behavior and moderate voice tone could be included in beginning behavioral therapy.    Social skills training assists the patient in adapting to and functioning at a better level of the society, hence improving the patient’s standard of living.  

Psychosis Nursing Care Plan 2

Disturbed Sensory Perception (Auditory or Visual)

Nursing Diagnosis: Disturbed Sensory Perception related to the inability to focus, chemical changes (electrolyte imbalances), cognitive impairment or biochemical changes, and psychologic distress secondary to psychosis as evidenced by changes in communication patterns, hearing distortions, changes in problem-solving patterns, confusion to person, place, or time, frequent blinking and grimacing, paranoid delusions, and disproportionate responses.

Desired Outcomes:

  • The patient will continue performing his or her role.
  • The patient will sustain his or her social relationships.
  • The patient will keep track of the level of anxiety.
  • The patient will recognize several stressful issues that trigger hallucinations.
  • The patient will demonstrate techniques for distracting himself or herself from the voices.
Nursing Interventions for PsychosisRationale
Keep an eye out for increased worry, anxiety, or irritability signs.      The patient may experience hallucinogenic activity, which can be very disturbing, and the patient may act on command hallucinations and harm himself or others.  
Assist the patient in identifying the needs underlying the psychotic episode. Evaluate other options for meeting these needs.  Hallucinations may convey frustration, strength, self-esteem, or sexual needs.  
Investigate how the patient perceives the psychotic symptoms, such as hallucinations and delusions.  Examining the hallucinations and sharing experiences can provide the individual with confidence that he may be able to handle the auditory hallucinations.  
Assist the patient in identifying times when auditory or visual hallucinations are most prominent and disturbing.      This intervention assists both the nurse and the patient identify situations and instances that may be most stressful and provoking to the patient.  
Stay with patients when they begin to lose touch with reality and instruct them to tell the “voices they hear” to leave them alone. Repeat several times in a matter-of-fact tone.  When given repetitive directions, the patient can sometimes learn to push voices aside. particularly in the context of a trusting relationship  
When applicable, minimize the environmental stimuli such as reduced noise and minimal activity.    This intervention reduces the possibility of anxiety causing hallucinations and aids in the patient’s relaxation.  

Psychosis Nursing Care Plan 3

Disturbed Thought Process

Nursing Diagnosis: Disturbed Thought Process related to insufficient support networks, overwhelming potentially stressful experiences, the probability of a genetic factor, panic level of anxiousness, and unexpressed fears are all possible secondary to psychosis as evidenced by false beliefs, incorrect interpretation of the environment, unsuitable non-reality-based thinking, memory deficits or conflicts, and self-centeredness.

Desired Outcomes:

  •  The patient will learn to acknowledge deluded beliefs if they continue.
  • The patient will accurately interpret his or her surroundings.
  • The patient will display healthy relationships with genuine people.
  • The patient’s anxiety level will reduce.
  • The patient will abstain from acting on his or her deluded thoughts.
  • The patient will maintain focus and attention to accomplish the task or activities.
  • The patient will report that the “thoughts” are becoming less severe and less recurring with medications and treatments.
  •  The patient will be able to talk about concrete events in his or her environment without mentioning illusions.
  • The patient will demonstrate two appropriate coping methods that will help to reduce paranoid delusions.
Nursing Interventions for PsychosisRationale
Make an effort to comprehend the relevance of the patient’s false beliefs and fantasies during discussion or conversation with them.      The patient’s seemingly nonsensical fantasies contain important insights into underlying mental issues and concerns.  
Recognize the patient’s illusions as a reflection of the patient’s perspective of the surroundings.  Acknowledging the patient’s perspective might assist the nurse or other health professionals in understanding his or her feelings.
Recognize feelings associated with delusions. As an example: The patient is afraid if he or she fears somebody is trying to harm him or her.If the patient believes that someone or something is directing his or her thoughts, the patient feels helpless.    Anxiety may decrease when patients believe they are acknowledged.  
Explain the processes and ensure that the patient understands them before conducting them.  When a patient is fully aware of the processes or treatments, he or she is less likely to feel deceived by the healthcare personnel.    
Interact with patients based on what is going on around them. Try to divert the patient’s attention away from their illusions by engaging them in reality-based activities such as card games, simple arts, and handmade projects.  When the patient’s thoughts are concentrated on reality-based activities, he or she is free of deluded thinking. It aids in focusing attention externally.  
Encourage the patient to observe healthy practices that will help them function better, such as: Maintain their medication schedule.Maintain their consistent sleep schedule.Maintain their self-care.Reduce their intake of alcohol and drugs.    All of these interventions are necessary to maintain the patient’s recovery.
If a patient believes they need to defend themselves from a specific person, use safety precautions to safeguard them or others. Precautions must be taken.  During the acute phase, the patient’s episodes of psychosis may dictate that they must harm others or themselves to be secure. External precautions may be necessary.    

Psychosis Nursing Care Plan 4

Defensive Coping

Nursing Diagnosis: Defensive Coping related to apparent lack of self-efficacy or weakness, possible danger to self, and doubts about others’ intentions secondary to psychosis as evidenced by avoidance of evident problems, trouble checking reality perceptions, difficulties in establishing or maintaining friendships, mistaken ideas about others’ intentions, dread, and excessive pride.

Nursing Stat Facts
Nursing Stat Facts

Desired Outcomes:

  • The patient will avoid high-risk circumstances and places.
  • The patient will suitably engage with others.
  • The patient will continue to follow medical advice.
  • The patient will exhibit newly learned constructive coping strategies for anxiety and helplessness.
Nursing Interventions for PsychosisRationale
Before carrying out certain procedures, the nurse should explain them to the patient.      This intervention prepares the patient ahead of time and reduces the possibility of completely misunderstanding the nurses’ purpose as unfriendly or confrontational.  
Approach the patient in a nonjudgmental, courteous, and neutral way.    A skeptical patient is less likely to mistake intention or meaning if the content is unbiased and the attitude is polite and nonjudgmental.
Patients should be assessed and observed regularly for rising anxiousness and aggression indicators.  The nurse or other healthcare practitioner must intervene before the patient loses control.  
When talking with a patient with psychosis, use plain and primary language.    This intervention reduces the possibility of misunderstanding and misinterpretation of the statement’s meaning.  
Be honest and transparent with the patient when setting objectives and enforcing standards.    Patients who have psychosis are extremely aware of deception. Honesty and consistency foster an environment in which trust can flourish.

Psychosis Nursing Care Plan 5

Interrupted Family Process

Nursing Diagnosis: Interrupted Family Process related to a developmental conflict or change, a shift in family responsibilities, a physical or mental illness in a member of the family, a change in a family member’s general health, and a situational crisis or transformation secondary to psychosis as evidenced by modifications in family conflict expressions, communication styles, mutual aid, decision-making, and problem-solving involvement, stress-reduction behaviors, and knowledge deficiency on health care and community support.

Desired Outcomes:

The patient, family, and significant others will be knowledgeable in the important aspects of psychosis such as:

  • Learning about community programs such as self-care assistance and private respite.
  • Assisting the sick family member in sustaining good mental and physical health.
  • Recognizing the significance of medical adherence.
Nursing Interventions for PsychosisRationale
Determine each family member’s current degree of knowledge regarding psychosis and the medicines used to manage it.    Family members may have assumptions and misinformation about psychosis and treatment or are entirely unaware. Assess the patient’s and family’s degree of comprehension and readiness to learn.  
Educate the patient and his or her family on the signs of a recurrence.        When quick medical assistance is provided, rapid awareness of early warning indicators might help fight probable relapse.
Allow the family to express their sentiments about the sick family member and outline their urgent concerns.  When nurses and staff recognize the family’s experience and needs, they can intervene more effectively.  
Provide symptoms and treatment information that is appropriate for the family’s level of comprehension.  It is necessary to meet the informational needs of family members.
Inform the patient’s family about psychopharmacologic therapy in plain, basic terms: dosage, frequency, indication, adverse, and hazardous effects. Provide written information to the patient as well as family members.  Recognizing the disease and its therapy promotes higher support from family and patient compliance.  

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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