CU 3 WEEK 3 LEC SCHIZOPHRENIA

John, 33 years old, has been admitted to the hospital for the third time with a diagnosis of
Schizophrenia. John had been taking Haloperidol (Haldol) but stopped taking it 2 weeks ago, telling his
case manager it was, and “The poison that is making me sick” Yesterday John was brought to the
hospital after neighbors called the police because he had been up all-night yelling loudly in his
apartment. Neighbors reported him saying, “I can’t do it. They don’t deserve to die!” And similar
statements. John appears guarded and suspicious and has very 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
temperature is warm. So far, John has been refusing any offers of food and fluids. When the nurse
approached John with a dose of Haloperidol, he said “Do you want me to die? “

DISCUSSION: ANSWER THE FOLLOWING QUESTIONS.

 Discuss your understanding of Schizophrenia Spectrum

- It is a mental disease in which a person has an incorrect interpretation of reality. It can include
hallucinations, delusions, and very disorganized thought and behavior, which can disrupt daily life.

 Describe various theories of etiology of Schizophrenia

- There are two theories about the etiology of schizophrenia. The first one is biological factors which
include genetic predisposition, neuroanatomic and neurochemical, and immunovirological. The second
is psychological factors, these are the nature of significant childhood and adult relationships, the
experience of comfort or stress in social contexts, and the experience of trauma.

 Identify three (3) priority problems of John

- Disturbed thought processes

- Ineffective therapeutic regimen management (medication refusal)
- Self-care deficit

 Make a nursing care plan of John based rom the problem identified

- Disturbed thought process

NURSING INTERVENTION RATIONALE

Attempt to understand the significance of these Important clues to underlying fears and issues
beliefs to the client at the time of their can be found in the client’s seemingly illogical
presentation. fantasies.

Recognizes the client’s delusions as the client’s Recognizing the client’s perception can help you
perception of the environment. understand the feelings he or she is experiencing.

Identify feelings related to delusions. When people believe that they are understood,
anxiety might lessen.
 Explain the procedures and try to be sure the When the client has full knowledge of
client understands the procedures before procedures, he or she is less likely to feel tricked
carrying them out. by the staff.

Do not touch the client; use gestures carefully. Suspicious clients might misinterpret touch as
either aggressive or sexual in nature and might
interpret it as threatening gesture. People who
are psychotic need a lot of personal space.

Initially do not argue with the client’s beliefs or Arguing will only increase client’s defensive
try to convince the client that the delusions are position, thereby reinforcing false beliefs. This
false and unreal. will result in the client feeling even more isolated
and misunderstood.

Show empathy regarding the client’s feelings; The client’s delusion can be distressing. Empathy
reassure the client of your presence and conveys your caring, interest and acceptance of
acceptance. the client.

Teach client coping skills that minimize When client is ready, teach strategies client can
“worrying” thoughts. do alone.

Utilize safety measures to protect clients or During acute phase, client’s delusional thinking
others, if the client believe they need to protect might dictate to them that they might have to
themselves against a specific person. Precautions hurt others or self in order to be safe. External
are needed. controls might be needed.

- Ineffective therapeutic regimen management

NURSING INTERVENTION RATIONALE

Allow patient’s participation in planning the Patients who participate in their care have a
treatment program. greater chance of obtaining a positive result.

Tell the patient about the advantages of adhering Patients who understand the effectiveness of the
to the prescribed regimen. suggested treatment to reduce risk or to promote
health are more likely to engage in it.

Explain the regimen properly yet easy to Patients are more likely to disregard medications
understand by the patient. Suggest long-acting if they are to be taken multiple times daily.
medications and eliminate unnecessary
medications.

Develop with the patient a method of rewards Rewards may consist of verbal recognition,
that follow successful follow-through. monetary rewards, special privileges (e.g., earlier
office appointment, free parking), or telephone
calls.
 Explain that side effects or negative side effects This determines if something needs to be revised.
of the treatment can be managed or eliminated.

Focus on the behavior that will make the greatest Behavior change is never easy. Efforts should be
contribution to the therapeutic effect. directed to activities known to result in specific
benefits.

Involve significant others in explanations and Involving significant others promotes support and
teaching. Encourage their support and assistance assistance in strengthening appropriate
in following plans. behaviors and promoting lifestyle modification.

- Self-care deficit

NURSING INTERVENTION RATIONALE

Assess the patient’s limitations to self-care by To explore the patient’s self-care limitations and
asking open ended questions. needs while allowing him to express his personal
thoughts and feelings related to ADL’s.

Assist the patient to use toiletries and hygiene To promote the patient’s autonomy and increase
aids. Encourage the patient to perform self-care his self-esteem.
and offer help as needed.

Provide gentle instructions to the patient using a Schizophrenia in general can decrease the level of
step-by-step method. For example: “When concentration and cognition for the patient, so
bathing, damp your face first using a washcloth”. breaking down tasks into simple steps can help
organize thoughts and actions.

Educate the patient’s significant others on To provide learning to the significant others and
providing appropriate assistance to the patient to ensure that the patient has a good amount of
while he performs self-care tasks. support while doing ADL’s at home.