A patient was admitted to the mental health unit after arguing with co-workers and threatening to kill them. He is diagnosed with paranoid schizophrenia. On the unit he is aloof and suspicious
He mentioned that two physicians he saw talking were plotting to kill him. On the basis of data gathered at this point, which two primary nursing diagnoses should the nurse consider? a. Disturbed thought processes and Risk for other-directed violence
b. Spiritual distress and Social isolation
c. Risk for loneliness and Knowledge deficit
d. Disturbed personal identity and Nonadherence
A
Delusions of persecution and ideas of reference support a nursing diagnosis of Disturbed thought processes. Risk for other-directed violence is substantiated by the patient's feeling endangered by persecutors. Fearful individuals may strike out at perceived persecutors or may attempt self-harm to get away from persecutors. Data are not present to support the diagnoses in the other options.
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