Psychiatric Mental Health Nursing by Videbeck

These clients often slouch and are sullen and unwill-
ing to be interviewed. They may use profanity, call
the nurse or physician names, and make disparaging
remarks about parents, teachers, police, and other
authority figures.

MOOD AND AFFECT

Clients may be quiet and reluctant to talk or openly
hostile and angry. Their attitude is likely to be dis-
respectful toward parents, the nurse, or anyone in a
position of authority. Irritability, frustration, and
temper outbursts are common. Clients may be un-
willing to answer questions or to cooperate with the
interview; they believe that they do not need help or
treatment. If a client has legal problems, he or she
may express superficial guilt or remorse but it is un-
likely that these emotions are sincere.

THOUGHT PROCESS AND CONTENT

Thought processes are usually intact—that is, clients
are capable of logical, rational thinking. Nevertheless,
they perceive the world to be aggressive and threat-
ening and they respond in the same manner. Clients
may be preoccupied with looking out for themselves
and behave as though everyone is “out to get me.”
Thoughts or fantasies about death or violence are
common.

SENSORIUM AND

INTELLECTUAL PROCESSES

Clients are alert and oriented with intact memory
and no sensory-perceptual alterations. Intellectual
capacity is not impaired, but typically these clients
have poor grades because of academic underachieve-
ment, behavioral problems in school, or failure to
attend class and to complete assignments.

JUDGMENT AND INSIGHT

Judgment and insight are limited for developmental
stage. Clients consistently break rules with no re-
gard for the consequences. Thrill-seeking or risky
behavior is common such as use of drugs or alcohol,
reckless driving, sexual activity, and illegal activities
such as theft. Clients lack insight and usually blame
others or society for their problems; they rarely be-
lieve that their behavior is the cause of difficulties.

SELF-CONCEPT

Although these clients generally try to appear tough,
their self-esteem is low. They do not value them-
selves any more than they value others. Their iden-

tity is related to their behaviors such as being cool

if they have had many sexual encounters or feeling

important if they have stolen expensive merchandise

or been expelled from school.

ROLES AND RELATIONSHIPS

Relationships with others, especially those in author-

ity, are disruptive and may be violent. This includes

parents, teachers, police, and most other adults. Ver-

bal and physical aggression is common. Siblings may

be a target for ridicule or aggression. Relationships

with peers are limited to others who display similar

behaviors; these clients see peers who follow rules

as dumb or afraid. Clients usually have poor grades,

have been expelled, or have dropped out. It is unlikely

that they have a job (if old enough) because they

would prefer to steal they want or needed. Their idea

of fulfilling roles is being tough, breaking rules, and

taking advantage of others.

PHYSIOLOGIC AND SELF-CARE

CONSIDERATIONS

Clients are often at risk for unplanned pregnancy and

sexually transmitted diseases because of their early

and frequent sexual behavior. Use of drugs and alco-

hol is an additional risk to health. Clients with con-

duct disorders are involved in physical aggression

and violence including weapons; this results in more

injuries and deaths than compared with others of the

same age.

Data Analysis and Planning

Nursing diagnoses commonly used for clients with

conduct disorders include the following:

• Risk for Other-Directed Violence


• Noncompliance


• Ineffective Coping


• Impaired Social Interaction


• Chronic Low Self-Esteem

Outcome Identification

Treatment outcomes for clients with conduct dis-

orders may include the following:

• The client will not hurt others or damage
  property.


• The client will participate in treatment.


• The client will learn effective problem-solving
  and coping skills.


• The client will use age-appropriate and
  acceptable behaviors when interacting with
  others.


• The client will verbalize positive, age-
  appropriate statements about self.

20 CHILD ANDADOLESCENTDISORDERS 497