Nurse's Pocket Guide

• Note nonverbal body language. Incongruencies between verbal/nonverbal
communication requires clarification.
• Assess for self-destructive/suicidal behavior. (Refer to ND risk
for Suicide, as appropriate.)
• Identify previous adaptations to illness/disruptive events in
life. May be predictive of current outcome.
• Assess family/SO(s) dynamics and support of client.
• Note availability/use of resources.
NURSING PRIORITY NO.2.To assist client to deal with loss/change
and recapture sense of positive self-esteem:
• Assist with treatment of underlying condition when possible.
For example, cognitive restructuring and improved concentration
in mild brain injury often result in restoration of
positive self-esteem.
• Encourage expression of feelings, anxieties. Facilitates grieving
the loss.
• Active-listen client’s concerns/negative verbalizations without
comment or judgment.
• Identify individual strengths/assets and aspects of self that
remain intact, can be valued. Reinforce positive traits, abilities,
self-view.
• Help client identify own responsibility and control or lack of
control in situation. When able to acknowledge what is out
of his or her control, client can focus attention on area of
own responsibility.
• Assist client to problem solve situation, developing plan of
action and setting goals to achieve desired outcome.
Enhances commitment to plan, optimizing outcomes.
• Convey confidence in client’s ability to cope with current
situation.
• Mobilize support systems.
• Provide opportunity for client to practice alternative coping
strategies, including progressive socialization opportunities.
• Encourage use of visualization, guided imagery, and relaxation
to promote positive sense of self.
• Provide feedback of client’s self-negating remarks/behavior,
using I-messages, to allow the client to experience a different
view.
• Encourage involvement in decisions about care when possible.
NURSING PRIORITY NO. 3. To promote wellness (Teaching/
Discharge Considerations):
• Encourage client to set long-range goals for achieving necessary
lifestyle changes. Supports view that this is an ongoing process.
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
Diagnostic Studies Pediatric/Geriatric/Lifespan Medications 593
situational low SELF-ESTEEM