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NURSING DIAGNOSIS F1: Impaired Social Interaction r/t inappropriate sensory stimulation F2: Impaired Verbal Communication r/t

physical conditions impairing language skill development F3: Risk for Injury r/t impulsive behavioral swings F4: Risk for self-mutilation r/t accelerated motor activity F5: Risk for impaired caregiver role-strain r/t increasing care needs and dependency NURSING CARE PLAN PROPER F1: Impaired Social Interaction r/t inappropriate sensory stimulation F2: Impaired Verbal Communication r/t physical conditions impairing language skill development EXPECTED OUTCOME The client will: Participate appropriately in interactive play with another child or group of children. Develop a mutual relationship with another child or adult. Successfully complete tasks or assignments with assistance INTERVENTIONS Identify the factors that aggravate and alleviate the clients performance. RATIONALE The external stimuli that exacerbate the clients problems can be identified and minimized. Likewise, any that positively influence the client be effectively used. May have skill with many forms of communication, yet they will prefer one method for important communication It important to assess if patient can understand English, Filipino or other language. Autistic patients lacks social contact which hinders them The clients ability to deal with external stimulation is impaired. EVALUATION Goal fully met if the patient was able to achieve 4-5 out of 5 expected outcomes. Goal partially met if the patient was able to achieve 1-3 out of 5 expected outcomes. Goal not met if the patient was not able to achieve the set expected outcomes. Goal partially met because patient was able to:

Asses the primary and referred means of communication such as verbal, written, gestures Assess the ability to understand words

Provide an environment as free from distractions as possible. Institute interventions on a one-toone basis.

Demonstrate acceptable social skills while interacting with staff or family member Demonstrate the ability to complete tasks with reminders

Engage the clients attention before giving instructions (i.e., call the clients name and establish eye contact). Separate complex tasks into small steps. Encourage attempts to communicate; praise attempts and achievement. Provide positive feedback.

The client must hear instructions as a first step toward compliance. The likelihood of success is enhanced with less complicated components of a task. The clients opportunity for successful experiences is increased by treating each step as an opportunity for success. Positive feedback enhances the patients effort to overcome communication barriers The clients restless energy can be given an acceptable outlet, so that he or she can attend to future tasks more effectively. they need feedback about the success of their communication attempts. The client must understand the request before he or she can attempt task completion. If the client is unable to complete a task independently, having assistance will allow success and will demonstrate how to complete the task. Sequencing questions provide a structure for discussions to increase logical thought and decrease tangentiality. Successful interventions can be instituted by the clients family or caregivers by using this process. This will promote consistency and enhance the clients chances for success.

Successfully complete tasks or assignments with assistance. Demonstrate acceptable social skills while interacting with staff or family member.

Allow breaks during which the client can move around. Listen attentively when the client attempts to communicate. Clearly state expectations for task completion. Initially assist the client to complete tasks.

Assist the client to verbalize by asking sequencing questions to keep on the topic (Then what happens? and What happens next?). Teach the clients family or caregivers to use the same procedures for the clients tasks and interactions at home.

F3: Risk for injury related to episodes of impulsive behaviorial swings EXPECTED OUTCOME The client will be able: -To perform tasks without harming himself or others -Complete given independently task INTERVENTIONS Identify the factors that easily distracts the client RATIONALE Stimulation brought about by certain environmental factors or stimuli may trigger the impulsiveness of the childs behavior, predisposing him to different hazards. Asses availability of support systems To determine if there is sufficient guidance to the child. Assess the extent of the childs impulsive To determine the degree of interventions needed behavioral swings (e.i. locking the doors or gates, need of a constant chaperone, etc.) Provide a child-friendly environment A child-friendly environment is one wherein it is free from hazards such as sharps, poisons, or the like. Provide activities which does require excessive To minimize stress-related stimulation of the child mental stimulation which in turn, can possibly lead to another episode of an impulsive behavior. Allow breaks during which the client can move The clients impulsive behavior uses a lot of his around. energy that may lead to fatigue that may cause him to be at risk for injury or fall. Administer recommended medications such as: Blocks post-synapic dopamine receptors in the Haloperidol brain; depressing the RAS, including those parts of the brain involved in wakefulness. Acts in the CNS to release norepinephrine from nerve terminals, also releases dopamine. Suppresses appetite, increases alertness, elevates mood and often improves physical performance EVALUATION Goal fully met if the client will be able to do the given activities of daily living without harming himself and would be able increase attention span.

-To increase attention span during classes as manifested by: -Maintaining focus to the activity he started doing

Goal partially met if the client will be able to increase attention span to activities of daily living but still he cannot control intensity of impulsive behavior.

Goal not met, the client cannot control the intensity of impulsive behavior and he is still easily distracted to outside stimulants and he is not able to accomplish given task.

Dextroamphetamine

Adapted from Schultz, J. M. & Videbeck, S. L. (2002). Lippincotts Manual of Psychiatric Nursing Care Plans (6th ed.). Philadelphia: Lippincott Williams & Wilkins.