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  Cues NursingDiagnosis Analysis Goal & ObjectivesNursingInterventionRationale Evaluation SUBJECTIVE: - “Pangatlong beses ko na kasidito, kaya ayokona talagabumalik. Gusto kona umuwi OBJECTIVE: >Anger andIrritability> Dark circlesunder eyes>Flushed>Dry mouth>v/s taken andrecorded asfollows:BP: 130/80mmHgPR: 89bpmRR: 14cpmTemp: 36.1degrees Celsius       Anxietyrelated to Changes inenvironmen t androutines Anxiety is a vague uneasyfeeling of discomfort ordreadaccompanied byan autonomicresponse (thesource oftennonspecific orunknown to theindividual); afeeling of apprehensioncaused byanticipation of danger. It is analerting signal that warns of impending dangerand enables theindividual to takemeasures to dealwith the threat. GOAL:  After 2 hours of nursinginterventions,  Patient will appearcalmed andrelaxed OBJECTIVES:    Patient willexhibitbehaviorsof acceptance    Patient willbe able todemonstraterelaxationtechniques( deepbreathing,positivevisualization)    Patient willbe able torecall INDEPENDENT:       Acknowledgebut do notreinforce useof denial. Avoidconfrontations as much aspossible.     Denial canbebeneficialin reducing anxiety butcan delaydealing with the truth orreality of  thecurrentsituation.Confronta tion canpromoteanger andboost useof denialwhicheventuallyreduces EFFECTIVENESS 1.   Was the patientcalmed andrelaxed ?    __Yes __NoWhy?_____________   EFFICIENCY  2.   Were theinterventionsdone withinthe time-frame?  __Yes __NoWhy?_____________    APPROPRIATENESS Were the interventionsrealistic to the norms? __Yes __NoWhy?_____________ ACCEPTABILITY Was the patientcooperative and willingto the interventions  positivebehaviorsto reducestress  Acknowledge patient’s awareness of anxiety. Answer allquestions truthfully. Provideinformation thatis consistent;repeat asnecessary.  As patient’s levelof anxietysubsides,encourageexploration of specific eventsprior to both thebeginning andreduction of theanxious feelings. Assist the patientin developing anxiety-reducing cooperation andrecoverymay bedelayed. Acknowledgment of the patient’s feelings confirms the feelings andcorrespondsacceptance of  those feelings.  Acknowledgment of the patient’s feelings confirms the feelings andcorrespondsacceptance of  those feelings.  Recognition andexploration of causative factorsleading to orreducing anxiousfeelings areessential steps indeveloping alternativereactions.Using anxiety-reduction done? __Yes __NoWhy?_____________    skills (e.g.,relaxation, deepbreathing, positive visualization, andreassuring self-statements). Assist the patient to identify orrecall positivecoping behaviorsused in the past. Be empathic andnonjudgmentalwhile working withpatient and family. strategies enhances patient’s sense of personalmastery andconfidence.Successfulbehaviors in thepast can bereinforced indealing withcurrentproblems/stress,enhancing  patient’s sense of  self-control.Showing empathyand nonjudgmentalattitude enhancescooperation of  the patient andfamily.    Given this symptom profile, it is quite possible that Teddy is suffering from Dissociative Identity Disorder. However, some symptoms do not directly matchthose which are set out in the DSM. According to the DSM, a person may be officially diagnosed with Dissociative Identity Disorder if the following criteriaare met;  A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, andthinking about the environment and self). B . At least two of these identities or personality states recurrently take control of the person's behaviour. C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. D. The disturbance is not due to the direct physiological effects of a substance. Based on these criteria, it is quite evident that Teddy is in-fact suffering with Dissociative Identity Disorder. Teddy'sother symptoms can also be accounted for. It is known that persons suffering with this illness may be vulnerable toauditory and visual hallucinations, in Teddy's case these are mostly visual. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice givinginstructions) . (DSM-IV-TR, 2000). Also, Teddy's recurrent migraines can also be seen as a common feature of Dissociative Identity Disorder. Individuals with this type of disorder may have migraine and other types of headaches,irritable bowel syndrome and asthma . (DSM-IV-TR, 2000). Behavioural theorists generally consider dissociation as an avoidance response that protects the person from stressfulevents and memories of these events. Because the person does not consciously confront these painful memories, the fearthey elicit has no opportunity to extinguish . (Davison et al, 2004). It seems apparent then, that the case of Teddy Daniels fits mostly with the behavioural model. There is no evidence in the film that suggests that Teddy was physically or sexually abused as a child. It may simply be that Teddy is avoiding the stressful and traumatic memories of his wifeand children's murder by creating this personality in which he believes his wife died in a fire. Teddy may simply beavoiding the stress of recognising that he in fact murdered his wife. It can be said then that the etiology of Teddy's mentalillness is an accurate portrayal of real life understanding.
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