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Paranoia

QuestionAnswer
What is paranoia? They are always suspicious, but have no reason to be - they are responding in a way that is consistent with their paranoid beliefs
The onset of paranoid behavior may be precipitated by _________________. STRESSFUL EVENTS (loss of a real or imaginary love object; experience of failure, leading to loss of self esteem & feelings of inadequacy)
What is the PRIMARY mental mechanism of paranoia? PROJECTION
What should the nurse look for when assessing a patient with paranoia? 1)extreme suspiciousness & withdrawl from emotional contact with others 2)frequent complaining by letter writing or instigating legal action 3)resentment, anger, possible violence 4)hypercritical of others 5)misinterpretation or distortion of reality
What is an example of misinterpretation or distortion of reality? They may refuse food & medications, insisting that they are being poisoned despite evidence to the contrary
What kind of delusions should the nurse assess for in a paranoid client? Delusions of GRANDEUR & PERSECUTION. They may also experience hypochondriasis.
What are other s/s of paranoia? gaurded relationships (they don't trust others), pathologic jealousy, hypersensitive (you just can't say anything to them), unemotional, can't relax, no humor, crave recognition, life is unfair, everybody else has the problem (not them), reacts with rage
What is one of the most important things that the nurse should remember about paranoid clients? BUILD TRUST - BE RELIABLE - BE ON TIME - IF YOU SAY YOU WILL DO SOMETHING, YOU MUST DO IT [KEEP PROMISES] - BE HONEST - AVOID WHISPERING OR ACTING SECRETIVE - INVOLVE CLIENT IN TREATMENT PLAN (ALLOW A CHOICE OF ACTIVITIES & FOODS)
What kind of attitude should the nurse have with the paranoid client? Maintain a CALM, MATTER-OF-FACT attitude
Paranoid clients need ___________ nurses. The nurse should not be _____________. Paranoid clients need CONSISTENT nurses (1 or 2 nurses - anymore than that is too many). Having consistent nurses helps the client to establish trust. The nurse should not be OVERFRIENDLY. Paranoid clients cannot handle overfriendly nurses.
Which would be better for a paranoid client: 4 (15 minute) visits or 2 (30 minute) visits? BRIEF VISITS - Would rather 4 (15 minute) brief visits as opposed to 2 (30 minute) visits.
With a paranoid client, it is important for the nurse to remember to respect their _________________ and to be careful with ___________. RESPECT THEIR PERSONAL SPACE (they have a much larger personal space) and to be careful with TOUCHING PARANOID CLIENTS.
What is important for the nurse to remember when administering a paranoid client their medications and food? ALWAYS ID their medications - DO NOT MIX MEDICATIONS (they know everything about their medications - what they look like, how many they get, etc...) - Give them SEALED FOODS TO EAT (so they don't think anyone poisoned them)
What kind of activities should a paranoid client AVOID? AVOID COMPETITIVE, AGGRESSIVE ACTIVITES INVOLVING PHYSICAL CONTACT (e.g., football, basketball).
What kind of activities should the paranoid client be involved in? Involve client in SOLITARY ACTIVITIES (e.g. drawing, photography, typing) and progress to INTELLECTUAL ACTIVITIES WITH OTHERS INVOLVING GAMES (e.g., chess, bridge, scrabble)
***NURSING ALERT*** Use therapeutic interventions to increase client's understanding of behavior. The lack of trust in the paranoid client is often a focus of test questions surrounding the serving of meals or the administration of medications.
**** NCLEX HINT **** TRUST is the #1 problem with paranoid clients!!
**** NCLEX TIP **** ALWAYS look at the nursing action answers before jumping & choosing medication administration answers
**** NCLEX TIP **** REMEMBER: You cannot explain away delusions or false beliefs.
Created by: pnutbtrnjilly