Case study evaluation sheet

Student Name: Aya Khalid Hashem Arafa

Title of the case study: Schizophrenia
Date of evaluation : 23/12/2021

Clinical instructor :Dr/Manar Omar

Items Total Score

Score obtained
a-Collect information about patient's illness 1
1
b-Collect information about causes of disease
1
c-Identify psychiatric signs and symptoms
associated with disease
2
d-Identify methods of treatment
2
e-Categories patient's problems and relapse
prevention 3
f-Formulate complete nursing care plan ,and discharge
plan
Total Score 10

..…………………:Student signature
…………:Clinical instructor signature
Personal data
Name: khalid Mohammed Ahmed
Age : 31 years old
Sex :male
Marital status: single
Religion: Muslim
Occupation: not working
Education: secondary school diploma
Date of admission: 2015
Patient's diagnosis: schizophrenia
Sign and symptoms: from the sheet the pt admited the hospital with
irritable, impulses, auditory hallucination, self talking, feel of granditory
suicidal ideas, poor in sleep, poor appetit ,Social isolation, decrease
. concentration and idea of persecution
‫ومدون ايضا بالشيت انه كان لديه الشعور باالضطهاد والعزله ويرفض زياره االهل وكان ال‬
‫ينام لمده طويله ويترك المنزل لفتره طويله و عالقه المريض باالسره سيئه جدا وعالقته سيئه‬
‫جدا بوالديه وشقيقه ولديه هياج وانطوائي منذ الطفوله وال يتعامل مع البشر ومشاهده التلفزيون‬
.‫والبرامج الدينيه خاصه و حاول االنتحار من البلكونه وكان ذلك بدايه المرض النفسي‬

Definition of Schizophrenia 
Schizophrenia is a chronic, severe mental disorder that affects the way a
person thinks, acts, expresses emotions, perceives reality, and relates to
others. Though schizophrenia isn’t as common as other major mental
illnesses, it can be the most chronic and disabling.
People with schizophrenia often have problems doing well in society, at
work, at school, and in relationships. They might feel frightened and
withdrawn, and could appear to have lost touch with reality. This lifelong
disease can’t be cured but can be controlled with proper treatment.
Contrary to popular belief, schizophrenia is not a split or multiple
personality. Schizophrenia involves a psychosis, a type of mental illness in
which a person can’t tell what’s real from what’s imagined. At times, people
with psychotic disorders lose touch with reality. The world may seem like a
jumble of confusing thoughts, images, and sounds. Their behavior may be
very strange and even shocking. A sudden change in personality and
behavior, which happens when people who have it lose touch with reality, is
called a psychotic episode.
How severe schizophrenia is varies from person to person. Some people
have only one psychotic episode, while others have many episodes during a
lifetime but lead relatively normal lives in between. Still others may have
more trouble functioning over time, with little improvement between full-
blown psychotic episodes. Schizophrenia symptoms seem to worsen and
improve in cycles known as relapses and remissions.

Causes

It's not known what causes schizophrenia, but researchers believe that a
combination of genetics, brain chemistry and environment contributes to
development of the disorder.

Problems with certain naturally occurring brain chemicals, including

neurotransmitters called dopamine and glutamate, may contribute to
schizophrenia. Neuroimaging studies show differences in the brain
structure and central nervous system of people with schizophrenia. While
researchers aren't certain about the significance of these changes, they
indicate that schizophrenia is a brain disease.

Risk factors

Although the precise cause of schizophrenia isn't known, certain factors

seem to increase the risk of developing or triggering schizophrenia,
including:

 Having a family history of schizophrenia

 Some pregnancy and birth complications, such as malnutrition or

exposure to toxins or viruses that may impact brain development

 Taking mind-altering (psychoactive or psychotropic) drugs during

teen years and young adulthood
Signs and Symptoms

Schizophrenia involves a range of problems with thinking (cognition),

behavior and emotions. Signs and symptoms may vary, but usually
involve delusions, hallucinations or disorganized speech, and reflect an
impaired ability to function. Symptoms may include:

 Delusions. These are false beliefs that are not based in reality. For
example, you think that you're being harmed or harassed; certain
gestures or comments are directed at you; you have exceptional
ability or fame; another person is in love with you; or a major
catastrophe is about to occur. Delusions occur in most people with
schizophrenia.
 Hallucinations. These usually involve seeing or hearing things that
don't exist. Yet for the person with schizophrenia, they have the full
force and impact of a normal experience. Hallucinations can be in
any of the senses, but hearing voices is the most common
hallucination.
 Disorganized thinking (speech). Disorganized thinking is inferred
from disorganized speech. Effective communication can be
impaired, and answers to questions may be partially or completely
unrelated. Rarely, speech may include putting together meaningless
words that can't be understood, sometimes known as word salad.
 Extremely disorganized or abnormal motor behavior. This may
show in a number of ways, from childlike silliness to unpredictable
agitation. Behavior isn't focused on a goal, so it's hard to do tasks.
Behavior can include resistance to instructions, inappropriate or
bizarre posture, a complete lack of response, or useless and
excessive movement.
 Negative symptoms. This refers to reduced or lack of ability to
function normally. For example, the person may neglect personal
hygiene or appear to lack emotion (doesn't make eye contact, doesn't
change facial expressions or speaks in a monotone). Also, the
person may lose interest in everyday activities, socially withdraw or
lack the ability to experience pleasure.
Symptoms can vary in type and severity over time, with periods of
worsening and remission of symptoms. Some symptoms may always be
present.

In men, schizophrenia symptoms typically start in the early to mid-20s. In

women, symptoms typically begin in the late 20s. It's uncommon for
children to be diagnosed with schizophrenia and rare for those older than
age 45.. 

Methods of treatment

 Types of Psychotherapy
 Individual psychotherapy. 
 Cognitive behavior therapy (CBT)
 Cognitive enhancement therapy (CET)

 Types of Psychosocial Therapy

 Social skills training
 Rehabilitation
 Family education
 Self-help groups
 Coordinated specialty care (CSC).
 Assertive community treatment (ACT)
 Social recovery therapy

 Newer Antipsychotic Drugs

 Aripiprazole (Abilify)
 Brexpiprazole (Rexulti)
 Clozapine (Clozaril)
 Olanzapine (Zyprexa)
 Quetiapine (Seroquel)
 Risperidone (Risperdal)
 Ziprasidone (Geodon)

Pt nursing diagnosis
  Impaired in social interaction Lack of trust and Delusional
thinking
 DISTURBED THOUGHT PROCESSES related to Inability to
trust

 Disturbance in sleep pattern relate to Hallucinations and

Delusional thinking

 Risk for suicide related to social isolation and previous try to

suicide

 RISK FOR SELF-DIRECTED OR OTHER-DIRECTED

VIOLENCE related to Lack of trust (suspiciousness of others),

Command hallucinations and Delusional thinking

Nursing care plans for pt's nursing diagnosis

[1]
Nursing Evidence Goal Evaluation
Diagnosis
  Impaired in ‫لمريض بيعاني‬ Client will 1. Client
social ‫من العزله وبيقعد‬ voluntarily demonstrates
interaction ‫في اوضه ضلمه‬ spend time with willingness and
‫على طول لوحده‬ other clients desire to socialize
Lack of
‫يرفض زياره‬ and staff with
trust and ‫االهل‬ members in others.
Delusional ‫ منذ‬e‫وانطوائي‬ group activities. 2. Client voluntarily
thinking ‫الطفولة وال‬ attends group
‫يتعامل مع البشر‬ activities.
3. Client approaches
others in appropriate
manner for oneto-
one interaction.

Nursing Interventions Rationale

1-Convey an accepting attitude by An accepting attitude increases
making brief, frequent contacts. feelings of self-worth
and facilitates trust.

Show unconditional positive regard. This conveys your belief

in the client as a worthwhile human
being.
Be with the client to offer support The presence
during group activities that of a trusted individual provides
may be frightening or diffi cult for emotional security for the
him or her. client.

Be honest and keep all promises. Honesty and dependability

promote a trusting relationship.
Orient client to time, person, and
place, as necessary
Be cautious with touch. Allow client A suspicious
extra space and an client may perceive touch as a
avenue for exit if he or she becomes threatening gesture
too anxious.

Administer tranquilizing medications Antipsychotic medications help to

as ordered by physician. reduce psychotic symptoms
Monitor for effectiveness and for in some individuals, thereby
adverse side effects. facilitating interactions

Discuss with client the signs of
increasing anxiety and
techniques to interrupt the response
(e.g., relaxation
exercises, thought stopping).
with others.
Maladaptive behaviors such
as withdrawal and suspiciousness are
manifested during
times of increased anxiety.

Give recognition and positive Positive reinforcement enhances

reinforcement for client’s voluntary self-esteem and encourages repetition
interactions with others. of acceptable
behaviors.

]2[

Nursing Evidence Goal Evaluation

Diagnosis
 DISTURBED ‫المريض بيعاني‬ By time of 1. Verbalizations
THOUGHT ‫من هلوسة‬ discharge reflect thinking
‫سمعية وبصرية‬ from processes oriented in
PROCESSES reality.
‫ودايما بيشك ف‬ treatment,
related to 2. Client is able to
‫ الناس‬, client’s speech maintain activities of
Inability to trust ‫وبيتهياله ان فيه‬ will reflect daily living (ADLs) to
‫حد عايز يقتله‬ reality-based his or her maximal
‫وفيه حد قاله انه‬ thinking. ability.
‫ينتحر وحاول‬ 3. Client is able to
refrain from
‫ والقفز م‬e‫االنتحار‬
responding to
‫البلكونة‬. delusional
thoughts, should they
occur.

intervention
Convey your acceptance of client’s
need for the false belief,
while letting him or her know that
you do not share thebelief..
Do not argue or deny the belief.
Use reasonable doubt as a
therapeutic technique: “I
rational
It is important to communicate to
the client that you
do not accept the delusion as
reality
Arguing
with the client or denying the belief
serves no useful purpose,
understand that you believe this
is true, but I personally fi nd it hard
to accept.”
Help client trye to connect the false . If the client
beliefs to times of increased
anxiety. Discuss techniques that
could be used to control anxiety
(e.g., deep-breathing exercises,
other relaxation
exercises, thought stopping
techniques.
Reinforce and focus on reality.
Discourage long ruminations
about the irrational thinking. Talk
about real events and real
people.
Assist and support client in his or
her attempt to verbalize
feelings of anxiety, fear, or
insecurity.
because delusional ideas are not
eliminated by this
approach, and the development of a
trusting relationship
may be impeded
can learn to interrupt escalating
anxiety, delusional
thinking may be prevented
Discussions that focus on the false
ideas are purposeless
and useless, and may even
aggravate the psychosis
Verbalization of feelings
in a nonthreatening environment
may help client come
to terms with long-unresolved
issues

]3[
Nursing Evidence Goal Evaluation
Diagnosis
 Disturbance in ‫المريض‬ By time of 1. Client is able
sleep pattern e‫ انه مش بيعرف‬e‫اخبرني‬ discharge to fall asleep
relate to ‫ينام ووالدته اكدت الكالم‬ from within 30
‫وقالت انه بقاله حوالي تلت‬ treatment, minutes after
Hallucinations
‫ايام منمش ومكتوب ف‬ client will retiring.
and ‫الشيت انه بيعاني من‬ be able to 2. Client sleeps
Delusional ‫صهوبة ف النوم‬ fall at least 6
asleep consecutive
thinking within 30 hours without
minutes of waking.
retiring and 3. Client does
sleep 6 to 8 not require a
hours sedative to fall
without asleep.
 a sleeping
aid.

intervention rational
Keep strict records of sleeping data are important in planning care
patterns. Accurate baseline to assist client with this
. problem
Discourage sleep during the day to promote more restful
. sleep at night
Administer antipsychotic so client
medication at bedtime does not become drowsy during the
. day
Assist with measures that promote
sleep, such as warm,
nonstimulating
drinks; light snacks; warm baths;
and back rubs.

Performing relaxation exercises to

soft music may be helpful
.prior to sleep
Limit intake of caffeinated drinks Caffeine is a CNS stimulant and
such as tea, coffee, and may interfere with
colas. the client’s achievement of rest and
. sleep

[4] Risk for suicide related to social isolation and previous try
to suicide
 Goal prevent the pt from tring to suicide again

Nursing Interventions Rationale

Render close patient supervision by

Suicide may be an impulsive act with little or no
sustaining observation or awareness of
warning. Close supervision is a must.
the patient at all times.
 Provide a safe environment. Weapons Removing potentially harmful objects prevents
and pills should be removed by friends, the patient from acting or sudden self-destructive
relatives, or the nurse. impulses.

It is helpful for the patient to talk about suicidal

Present opportunities for the patient to thoughts and intentions to harm themselves.
express thoughts, and feelings in a Expressing their thoughts and feelings may lessen
nonjudgmental environment. their intensity. Also, they need to see that staff are
open to discussion.

Create a verbal or written contract

This method establishes permission to talk about
stating that the patient will not act on
the subject.
impulse to do self-harm.

This approach provides the patient with a sense of

Stay with the patient more often.
security and strengthens self-worth.

Patients can learn to recognize mood changes that

Disincline the patient in making
indicate problems with impulsivity or indicate a
decisions during severe stress.
deepening depressive state.

Patients can get to identify situational,

Help the patient with problem-solving interpersonal, or emotional triggers and learn to
in a constructive manner. assess a problem and implement problem-solving
measures before reacting.

Arrange for the client to stay with

family or friends. A hospitalization is
considered if there is no one is Relieve isolation and provide safety and comfort.
available especially if the person is
highly suicidal.
Educate the patient in the appropriate
Drug therapy may benefit the patient endure
use of medications to facilitate his or
underlying health problems such as depression.
her ability to cope.

Contact family members, arrange for

Reestablishes social ties. Diminishes sense of
individual and/ or family crisis
isolation, and provides contact from individuals
counseling. Activate links to self-help
who care about the suicidal person.
groups.

Educate the patient cognitive- Patient learns to identify negative thoughts and
behavioral self-management responses develops positive approaches and positive
to suicidal thoughts. thinking.

Patients are better to acknowledge and safely

Introduce the use of self-expression
handle suicidal feelings by programs such as
methods to manage suicidal feelings.
keeping journals and calling hotlines.

[5] RISK FOR SELF-DIRECTED OR OTHER-DIRECTED

VIOLENCE related to Lack of trust (suspiciousness of others),
Command hallucinations and Delusional thinking
 Goal Client will not harm self or others.

Intervention rational

Maintain low level of stimuli in Anxiety

client’s environment (low level rises in a stimulating
lighting, few people, simple environment. A suspicious,
decor, low noise level). agitated client may perceive
individuals as threatening.

Observe client’s behavior so as to avoid

frequently (every 15 minutes). creating suspiciousness in the
Do this while carrying out individual. Close observation
routine activities is necessary so that intervention
 can occur if required to
ensure client’s (and others’)
safety.

Remove all dangerous objects that in his or her agitated,

from client’s environment so confused state client may not use
them to harm self or others.

Try to redirect the violent Physical exercise is

behavior with physical outlets a safe and effective way of
for relieving pent-up tension.
the client’s anxiety (e.g.,
punching bag).

Staff should maintain and Anxiety is contagious and can be

convey a calm attitude toward transmitted from
client. staff to client.

Have suffi cient staff available This shows the client

to indicate a show of strength evidence of control over the
to client if it becomes necessary. situation and provides some
physical security for staff.

Administer tranquilizing The avenue of the “least

medications as ordered by
physician.
Monitor medication for its
effectiveness and for any
adverse side effects.
restrictive
alternative” must be selected
when planning interventions
for a psychiatric client.

If client is not calmed by

“talking down” or by
medication, use
of mechanical restraints may be
necessary. Restraints should
be used only as a last resort,
after all other interventions have
been unsuccessful, and the
client is clearly at risk of harm
to self or others. Be sure to have
sufficient staff available to
assist.

Observe the client in restraints Client safety is a nursing

every 15 minutes (or according priority.
to institutional policy). Ensure
that circulation to
extremities is not compromised
(check temperature, color,
pulses). Assist client with needs
related to nutrition, hydration,
and elimination. Position client
so that comfort is
facilitated and aspiration can be
prevented. Continuous
one-to-one monitoring may be
necessary for the client who
is highly agitated or for whom
there is a high risk of self- or
accidental injury.

As agitation decreases, assess This minimizes risk of injury to

client’s readiness for restraint client and staff.
removal or reduction. Remove
one restraint at a time while
assessing client’s response.