Southern Luzon State University

College of Allied Medicine

Lucban, Quezon
Hizon, Dan Melton Anthony A

BSN3B

ACTIVITY SCHIZOPHRENIA 
I. Case Scenario
John Jones, age 33 has been admitted to the hospital for the third time with a diagnosis of
paranoid schizophrenia. John had been taking haloperidol (Haldol) but stopped taking it weeks
ago, telling his wife it was “the poison that making me sick”. Yesterday, John was brought to the
hospital after neighbors reported him saying, “I can’t do it! They don’t deserve to die!”
John appears guarded and suspicious and has little to say to anyone. His hair is matted, he
has a strong body odor and he is dressed in several layers of heavy clothing even though the
weather is warm. So far, John has been refusing any offers of food or fluids. When the nurse
approached John with a dose of haloperidol, he said “Do you want me to die?”
1. What additional assessment data does the nurse need to plan care for John?

 The nurse should assess the amount of sleep during the past few days.
 Assess for positive symptoms that the client is manifesting.
 Assess the client’s medical history, aside from the medication, the nurse can
assess if the client had been hospitalized previously.
 Assess support system. Determine whether the family is well informed about the
disease. 
 Assess the reason why the client is no longer complying to medication.

2. Identify the three priorities, nursing diagnosis and expected outcomes for John’s
care with your rationales for the choices.

PRIORITIES NURSING Dx EXPECTED RATIONALE

OUTCOMES
1. Risk for 1. Risk for 1. The client will 1. it would be a
imbalanced imbalanced start to verbalize major issue if
nutrition nutrition what food that he we do not
2. Risk for related to likely to eat stimulate the
insufficient psychological 2. The client will patient's
fluid volume disorder as take at least 3 appetite then
3. Disturbed manifested by glasses of water. the client will
thought insufficient 3. The client will not eat for an
processes interest in food have 5 minute extended period
2. Risk for interactions that of time. This
insufficient are based from might intensify
 fluid volume reality his anxiety.
related to 2. Adequate oral
psychological fluid intake is
disorder as important and if
manifested by it is not
refusal of prioritized, it
water intake will have a
3. Disturbed significant
thought impact on his
processes body and
related to increase his
diagnosis of anxiety.
psychological 3. When the
disorder as client's thoughts
manifested by are focused on
inappropriate reality-based
non-reality- events, he or
based thinking she is free of
delusional
thinking. Helps
focus attention
externally.

3. Identify at least two nursing interventions for the three priorities listed in question
no. 2.

PRIORITIES INTERVENTION
1. Risk for imbalanced nutrition  Assess the client preference for
food and why he is refusing to eat.
 Emphasize importance of food
intake to the client and assure him
that the food to be offered will not
harm him

2. Risk for insufficient fluid volume  Identify the cause of refusal of oral
fluid.
 Assess skin turgor and administer
IV fluids as ordered

3. Disturbed thought processes  Initially do not argue with the

client’s beliefs or try to
convince the client that the
 delusions are false and
unreal.
 Interact with clients on the
basis of things in the
environment. Try to distract
client from their delusions by
engaging in reality-based
activities.

4. Formulate a teaching plan for John and his family upon discharge. 

1. Emphasize to the family the importance of social interaction to the patient.

2. Emphasize the importance of having adequate sleep to reduce the client’s
environment.
3. Emphasize importance of encouraging the patient’s compliance to treatment
regimen.
4. Educate and develop support networks for the families reduces the family's
anxiety, increases their physical and mental health.
5. Educate the family members about the disease and medications used to treat the
disease.
6. Provide information on disease and treatment strategies at the family’s level of
understanding.
7. Instruct the family to keep the patient from a lot of stimulus that might increase
his anxiety.
8. Instruct to report any violence behaviours that the client is manifesting.