Nursing Care Plan Ineffective impulse control Definition:Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resourcesObserve for changes in behavior and mentation: lethargy, confusion, drowsiness, slowing or slurring of speech, and irritability. Arouse client at intervals, as indicated.Rationale: Ongoing assessment of behavior and mental status is important because of fluctuating nature of hepatic encephalopathy or impending hepatic coma.Review current medication regimen.Rationale: Adverse drug reactions or interactions may potentiate or exacerbate confusion.Note development or presence of asterixis, fetor hepaticus, and seizure activity.Rationale: Suggests elevating serum ammonia levels and increased risk of progression to encephalopathy.Consult with SO about client’s usual behavior and mentation.Rationale: Provides baseline for comparison of current status.Have client write name periodically and keep this record for comparison. Report deterioration of ability. Have client do simple arithmetic computations.Rationale: Easy test of neurological status and muscle coordination.Reorient to time, place, person, and situation, as needed.Rationale: Assists in maintaining reality orientation, reducing confusion and anxiety.Maintain a pleasant, quiet environment and approach in a slow, calm manner. Encourage uninterrupted rest periods.Rationale: Reduces excessive stimulation and sensory overload, promotes relaxation, and may enhance coping.Provide continuity of care. If possible, assign same nurse over a period of time.Rationale: Familiarity provides reassurance, aids in reducing anxiety, and provides a more accurate documentation of subtle changes.Reduce provocative stimuli and confrontation. Refrain from forcing activities. Assess potential for violent behavior.Rationale: Avoids triggering agitated, violent responses; promotes client safety. Discuss current situation and future expectations.Rationale: Client and SO may be reassured that intellectual as well as nemotional function may improve as liver involvement resolves.Nursing Care Plan Ineffective impulse control
- Change in communication patterns
- Decreased use of social support
- Destructive behavior toward self or others
- Difﬁculty asking for help
- High illness rate
- Inability to meet basic needs and role expectations
- Statements indicating inability to cope
- High degree of threat
- Inability to conserve adaptive energies
- Inadequate resources available
Expected Outcomes The Patient Will
- Verbalize increased ability to cope.
- Expand support network to meet social and emotional needs.
- Locate and use appropriate resources for help in problem solving.
- Report increased ability to meet demands of daily living.
- Make changes to environment to ensure enhanced coping or move into long-term care facility, as needed.
Suggested Noc Outcomes
Coping; Decision Making; Impulse Self-Control; Information Processing; Social Interaction Skills
Interventions And Rationales
Determine: Monitor physiological responses to increased activity level, including respirations, heart rate and rhythm, and blood pres-sure. Vital signs are likely to change as the patient deals with the frustration from poor coping strategies. Assess understanding of the current health problem and desire to participate in treatment.Perform: Listen to the patient. Respond in a matter-of-fact, nonjudg-mental manner. Judgmental responses will impede the development of a trusting relationship. Practice guided imagery and deep breath-ing with the patient to help the patient relax.89 Inform: Provide patient with information about relaxation techniques. These techniques take practice. Information will help the patient understand the beneﬁt.Teach patient about her disease process and explain treatments to allay fear and allow the patient to regain sense of control.Teach positive coping strategies and have patient role-play them and give praise for successful modeling. This will help to reinforce coping behaviors.Attend: Assist patient to develop short- and long-term goals to encourage better coping and a roadmap to measure progress.Provide emotional support and encouragement to help improve patient’s negative self-concept and motivate the patient to perform ADLs. Involve patient in planning and decision making. Having the ability to participate will encourage greater compliance with treatment plan. Encourage patient to engage in social activities withpeople of all age groups. Participation once a week will help relieve the patient’s sense of isolation.Manage: Refer patient for professional psychological counseling. For-mal counseling helps ease the nurse’s frustration, increases objectiv-ity, and fosters collaborative approach to patient’s care.Before discharge, refer patient to case manager who can help patient become involved in informal community programs, such as volunteer, foster grandparents, or religious groups, to provide peer and social contact and decrease the patient’s loneliness and isolation.Refer patient to a support group. In the context of a group, the patient may develop a more positive view in the present situation.
Suggested Nic Interventions
Coping Enhancement; Decision-Making Support; Emotional Support;Environmental Management; Impulse Control Training; Support Sys-tem Enhancement
Popejoy, L. (2005, September). Health-related decision-making by older adults and their families: How clinicians can help. Journal of Gerontological Nurs-ing, 31(9), 12–18.