Sample NCP: Defensive Coping

Assessment	Diagnosis	Scientific Explanation	Planning	Interventions	Rationale	Evaluation
Subjective:      “Okay lang naman, kahit sino dinadapuan ng ganitong sakit.” (refers to mental dysfunction) Objective: ·   Client portrays delusions of grandeur ·   He rationalizes failure ·   He talks loudly, and has a very distinct upright posture, as if to portray himself as superior	Defensive coping related to perceived lack of self as evidenced by grandiosity, rationalization of failures, superior attitude towards others	Genetic vulnerability Prenatal, drugs, alcohol, etc.   Chronic heightened glucocorticoid release   Impaired feedback system   Disturbed thought processes Inability to accept failures Copes defensively	Discharge outcome      Upon discharge, the client will be able to: a.   State that he feels safe and more in control in interactions with environment gatherings b.  Demonstrate ability to remove himself with situations when anxiety begins to escalate (executing relaxation techniques etc) Short Term outcome      After 2 weeks of nursing interventions, the client will be able to: a. Identify one action that helps client feel more in control of his life. c.   Demonstrate two newly learned constructive ways to deal with stress and feelings of powerlessness. d.  Show focus and participation in reality based activities	Independent: ·   Use a nonjudgmental, respectful and neutral approach with the client ·   Be honest and consistent with the client regarding expectations and enforcing rules ·   Assess and observe client regularly for signs of increasing anxiety. ·   Provide verbal and physical limits when anxiety escalates ·   Set limits in a clear matter-of-fact way, using a calm tone ·   Diffuse angry and hostile attacks with a nondefensive stand ·   Maintain low level of stimuli and a nonthreatening environment Collaborative: ·   Maintain medication regimen. -          haloperidol -          chlorpromazine	There is less chance for a suspicious client to misread intent or meaning if content is neutral and approach is respectful and nonjudgmental. Suspicious people are quick to discern dishonesty. Honesty and consistency provide an atmosphere when trust can grow. Intervene before the client loses control This will help the client gain self-control Calm and neutral approach may diffuse escalation of anger. When a nurse becomes defensive, anger escalated for both the client and the nurse. A nondefensive and nonjudgmental attitude provides an atmosphere in which feelings can be explored more easily. Noisy environments may be perceived as threatening. Aims to have the client stay in remission. Alters the effects of dopamine in the CNS Block dopamine receptors in the brain; also alter dopamine release and turnover. Reference: Varcarolis, Elizabeth M., Psychiatric NCP, pp. 242- 245	Discharge outcome Outcome Achieved    Upon discharge, the client was able to state that he feels safe and more in control in interactions with environment gatherings and demonstrate the capability to remove himself with situations when anxiety begins to escalate like executing relaxation techniques when anxious or simply walking away from the stressful event. Short Term outcome Outcome Achieved      After 2 weeks of nursing interventions, the client was able to identify one action that helps client feel more in control of his life, which was to walk away from stressful situations and ignoring the stressors. He was also able to demonstrate two newly learned constructive ways to deal with stress and feelings of powerlessness. Lastly, he was also able to show focus and participation in reality based activities like group games and nurse-patient interactions. Recommendation: Terminate the Plan