MEDICAL COLLEGES OF NORTHERN PHILIPPINES

Alimannao Hills, Peñablanca Cagayan

College of Nursing

A CASE PRESENTATION ON

SCHIZOPHRENIA

Presented by:

ADRIANO, DECERIE
ARQUIO, DANACEL
ARUALAN, GILIAN
BUHISAN, MARIA JOSEPHINE
BUTACAN, APRIL
CARNATE, JEHENNA
CLIT, DIANA ROSE
CUDAL, THALIA NIÑA
CUSTODIO, RHONA
DANAO, JANE CLARISE

Group 1
BSN III - A

CLINICAL INSTRUCTOR:
CAROL BRAVO, MSN.
 INTRODUCTION

Schizophrenia causes distorted and bizarre thoughts, perceptions, emotions,

movements, and behavior. It cannot be defined as a single illness; rather,
schizophrenia is thought of as a syndrome or as a disease process with many
different varieties and symptoms, much like the varieties of cancer. For
decades, the public vastly misunderstood schizophrenia, fearing it as
dangerous and uncontrollable and causing wild disturbances and violent
outbursts. Many people believed that those with schizophrenia needed to be
locked away from society and institutionalized. Only recently has the mental
health community come to learn and educate the community at large that
schizophrenia has many different symptoms and presentations and is an
illness that medication can control. Thanks to the increased effectiveness of
newer atypical antipsychotic drugs and advances in community-based
treatment, many clients with schizophrenia live successfully in the community.
Clients whose illness is medically supervised and whose treatment is
maintained often continue to live and sometimes work in the community with
family and outside support.

Schizophrenia is usually diagnosed in late adolescence or early adulthood.

Rarely does it manifest in childhood. The peak incidence of onset is 15 to 25
years of age for men and 25 to 35 years of age for women. The prevalence of
schizophrenia is estimated at about 1% of the total population. In the United
States, this translates to nearly 3 million people who are, have been, or will
be affected by the disease. The incidence and the lifetime prevalence are
roughly the same throughout the world (Jablensky, 2017).

The symptoms of schizophrenia are divided into two major categories:

positive or hard symptoms/signs, which include delusions, hallucinations, and
grossly disorganized thinking, speech, and behavior, and negative or soft
symptoms/signs, which include flat affect, lack of volition, and social
withdrawal or discomfort.

PSYCHOSOCIAL ASSESSMENT

Identifying the patient

Alyn is a 65 years old woman from Ormoc, Leyte who has been chained by her
family  for 47 years due to her condition, schizophrenia. She was just 17 years old
when she first experienced the symptoms of her condition. According to her brother
Juanito, she left for Manila to work so she can earn and go to college, but Alyn’s
mental health started to decline after the traumatic event. According to her brother
Juanito she was asked to drink a coffee with bland taste and from there she
experienced some signs of her mental illness. Her employer sent her back to their
province because she’s already out of herself and asked Alyn to seek for check up.
She was brought to mental facility and her condition did’nt get any better. 

Chief of Complaints
Alyn head hurt at first and started to heard buzzing noises and then hear a lot of
voices. She was restless and had some hallucinations.

History of Present Illness

Patient A. was diagnosed with Schizophrenia. She developed this type of mental
illness in the reason of she had a traumatic experience way back when she was 18
years old. At first, she always stare into space and they cannot talk to her properly,
not later then she begin to hear voices and talking to someone even she is only by
herself. She start to wander and became a beggar.

Psychiatric History

-Patient A. was confined to a Mental Institution after she manifested some signs and
symptoms of mental illness but then she told to her parents that she do not want to
stay there anymore in the reason of the induced electricity to her body.

Medication list:

They brought the patient to Eastern Visayas Regional Medical Center (EVRMC)
wherein the psychiatrist injected an intramuscular antipsychosis medicine to the
patient, and she also prescribed and give amisulpride 200mg to the patient.

Alcohol/Drug History
There is no alcohol and drug history mentioned in the video.

Cultural Assessment
Lola Alyn lives in Ormoc, Leyte with her brother Juanito. She's suffering from
schizophrenia, only her brother takes care of her until now. They no longer have a
parents by their side. When she is 17 years old Lola Alyn decided to worked in Manila
and experienced traumatic event. She was asked to drink a coffee with bland taste
and from there she experienced some signs of her mental illness.

Coping skills
Since the client is not in its state of mind the client needs medical attention to cope
up from the said disorder.

Violence Risk Assessment

There seems to be no violence risk since the patient was chained and looked by her
brother. She also doesn’t have any history of harming herself nor the others.

Family or social History

The patient was told to be kind according to her family. Also, no one mentioned to
be having a mental disorder in their family.

Financial assessment
The family of the client belongs to the low income family so they don't have enough
money to send the client to a psychiatrist.

Occupational History
At the age of 17, the patient went to Manila and started working to earn money so
that she can enter to college but unfortunately, she experienced a traumatic event
that caused her to develop a mental disorder. After this incident, she still tried to
work but her employer had to let her go because of her condition.

Educational History
The patient finished her secondary education and was said to be the most inteligent
among her siblings.

Legal History
The patient has no legal history.

Developmental history
The patient was raised by her parents together with her siblings, it was said that she
was the most inteligent among the sibling when she was still studying before she
decided to work in manila at the early age (18 years old) to earn money for her to
study college.

Spiritual Assessment
Not indicated in the video.

Interest and abilities.

There's no interest and abilities indicated in the video.

MENTAL STATUS ASSESSMENT

APPEARANCE
The patient cannot perfor proper hygine on her own, she cannot take a bath alone.
The patient’s clothing was appropritate to age but appeared slightly untidy. The
patient seemed to have a messy hair. She sits with her foot chained, her nails are
long and dirty.

ATTITUDE
Calm and cooperative but not responsive

BEHAVIOR
The patient walks fast as if she was chasing someone/something and does not get
tired easily. The Patient was cooperative but slightly resistant going inside the van,
she is does not responsive to the interviewer, doesn’t answer questions being ask
and eye contact is poor.

SPEECH
She speaks spontaneously and rapidly.

MOOD: Anxious
THOUGHT PROCESS: Disorganized
SUICIDAL IDEATION: NONE
HOMICIDAL IDEATION: NONE
PERCEPTION: The patient manifest Hallucination

PSYCHOPATHOPHYSIOLOGY OF SCHIZOPHRENIA

PREDISPOSING
FACTORS PRECIPITATING
- Age (Late FACTORS
adolescence) - Environmental
- Genetic - Ineffective Coping
 ETIOLOGY
Idiopathic

Neuro-anatomy Neuro-chemicals

Increased Dopaminergic
Less Brain Tissue and activity
CSF

Over-activation of
Enlarged Ventricles in
Mesolimbic Neurons
Brain

Cortical Atrophy Involvement of other

Neurons

Diminished Glucose Increased Serotonin

Metabolism

Diminished Oxygen in Abnormal Glutamate

Frontal Cortical Transmission

Decreased Brain Volume PCP blocks NMDA

receptor
 -Dysfunction in Frontal
-Temporal Alteration in Induces Psychosis
the Neurotransmitter

Changes in Neural
Activity

Schizophrenia

Positive hard symptoms Negative or soft symptoms

-Delusions -Flat affect

-Hallucinations -Lack of volition
-Grossly disorganized -Social withdrawal or
thinking, speech, and discomfort
behavior -Inattentive

NURSING CARE PLAN

ASSESSMEN NURSIN PLANNING INTERVENTIO RATIONALE EVALUATI
T G N ON
DIAGNO
SIS
SUBJECTIVE   Short Term INDEPENDENT   SHORT
: Goal TERM
Disturbed • Establish • To promote a
GOAL:
"Maraming thought After 4 rapport with the development of
naririnig na process hours of patient trusting After 4
boses" as related to nursing relationship hours of
 
verbalized by inability intervention nursing
• Suspicious
the significant to trust the  patient • Use a creative intervention
clients may
others as will be able approach to the patient
believe they are
evidence to develop encourage food was able to
OBJECTIVE: poisoned and
d by trust with intake. ate the
refuse to eat
• Confused suspiciou the staff foods from
  the food from
thought sness  nurse the tray and
the individually
and speech   took
  Long term prepared tray
• Hallucination • Avoid physical medications
goal:
• Avoid physical without
s contact.
After 3 days contact evidenced of
• Talkativenes of nursing   mistrust and
• Suspicious
s intervention • Avoid was
clients
• Hyperactive the patient laughing, appropriatel
frequently
will be whispering, or believe that y interact
• Restlessness abletoexhibi talking quietly with the
others are
  t the where client can talking about staff nurse
application see but not able
them, and  
of more to hear what is secretive
adaptive being said. LONG
behaviors only
coping TERM
serve to confirm
skillsas GOAL:
their paranoid
evidenced
feelings. Patient was
by
  able to
appropriate • Patient may
appraise
interactions • Maintain a respond with
situations
and pleasant and anxious or
realistically
willingness quiet aggressive
and refrain
to environment and behaviors if
from
participate approach patient startled or
projecting
in the in a slow and overstimulated
feelings onto
therapeutic calm manner
the
community.
• Close environment
, recognize
• Promote safety supervision isne
cessary to and clarify
measures
possible
  consider safety misinterpret
of patient ations of the
behaviors
• Verbalization
• Encourage and
of feelings in a
clients to verbalization
nonthreatening
verbalize true s, and
environment
feelings. Avoid cooperates
may help the
becoming with other
client come to
defensive when staff and
terms with long
angry feelings peers in the
unresolved
are directed at therapeutic
issues
him or her. community
• Suspicious setting
• Competitive
clients are
activities should
threatened by
never be
competition acti
included in
vities
activities.
Activities that  
encourage a
 
one-to-one
relationship with  
the nurse or
 
therapies are
best.

• Mouth check • To verify that

maybe client is
necessary after swallowing the
medication tablets or
administration. capsule

   

DEPENDENT  • Amisulpride
works by
• Administereda
improving
milsulpride
disturbed
200mg
thoughts,
as prescribed by
feelings and
the psychiatrist
behaviour
 ASSESSME DIAGNOSI PLANN INTERVENTION RATIONALE EVALUATI
NT S ING ON

Subjective Disturbed Short INDEPENDEN   Short term

Sensory term T goal:
“She can Perception goal:
hear a lot related to • Addressed • To preserved After 4
of voices altered After 4 client by name client’s sense hours of
calling sensory rec hours and introduce of identity and nursing
her” as eption as of self as needed orientation intervention
verbalized by manifested nursing     , the
her S.O by auditory interve patient was 
• Reoriented to • To reduce free from
hallucinatio ntion,
  the person, place, confusion and any injury.
ns 
patient time and events provide sense
Objectives will as necessary  of normalcy to  
be free    client’s daily
-restlessness  life  
from
any
-auditory hall • to promote Long term
injury.
ucinations normalization goal:  
  of response to
-poor • Promoted a After 2-3
stimuli 
concentration stable days of
   
environment nursing
-irritability with contintuity intervention
Long  
term of care   , the patient
-agitation
goal:     • decrease verbalizedth

-threatened potential for at the

After 2- • Eliminated
behavior to anxiety that voices are
3 days extreneous
self and triggers the result of his
of noise and illness and
others. patient’s
nursing stimuli,
hallucinations demonstrat
interve including non edways to
 
ntion, essential   refrain from
the equipment and responding
patient alarms   to
will be   hallucinatio
able to ns
• Monitored
verbaliz
patient • To prevent
e that
frequently sensory
the
deprivation
voices without time and limit
are interval, and confusion 
result avoid isolation  
of of client, physi-
her illne cally or  
ss and emotionally
will • Provided
demons safety measures
trate as needed
ways  
to refrai
n from • Engaged the
respond patient in
ing to reality-based
hallucin activities such
ations. as card playing, • to prevent
writing, drawing injury
and listening to  
music
 
• Redirecting
  the client’s
energies to
  acceptable
activities can
 
decrease the
possibility of
 
acting on
• Mouth check hallucinations
may be and help
necessary after distract from
medication voices
administration  
 
• To verify that
client is
 
swallowing the
  tablets or
capsules.
  Suspicious
clients may
believe they
   are poisoned
with their
  medications.
 
 
• Suspicious
clients may
perceive touch
as a
threatening
 
gesture
• Avoid physical  
contact
• honesty and
 
dependability
promote a
 
trusting
  relationship
 
 
• Verbalization
  of feelings in a
nonthreatenin
• Be honest and g environment
keep all may help client
promises come to
terms with
long-
unresolved
• Enocouraged issues
the client to  
verbalize the
feelings
 

 
Adminstration
  of
antipsychotic
  drugs help in
reducing
 
psychotic
 symptoms like
hallucinations.
Amilsulpride w
orks by
improving
disturbed
thoughts,
feelings and
 
behavior. 

DEPENDENT  

• Administered   
medications
 
such psychotic
drugs  like
 
Amisulpride as
ordered by the
 
physician
 

 
RATIONALE
ASSESSM DIAGNOSIS PLANNING INTERVENTIO EVALUAT
ENT N ION
SUBJECTI Self-care After 1 weekof INDEPENDENT INDEPENDEN After 1
VE: deficit nursinginterve : T: week of
OBJECTI related ntions the - Determined - This will nursinginte
VE: to altered/im patient will be age and affect the rventions
paired able developmental ability of the the patient
-limited cognitive and to remains issues. individual to was able
bathing perceptual free of participate in to remains
ability thought body odor, her own care. free of
- cognitivel process maintains - Helping the body odor,
y impaired intact skin and patient with maintains
states - Established sho
  setting realistic intact skin
satisfaction rt-term goals
goals will and states
with the patient.
with ability to reduce satisfaction
use adaptive frustration. with ability
devices to to use
- Guided the
bathe. - Patient may adaptive
patient in
require help in devices to
accepting the
determining bathe.
needed amount
the safe limits
of dependence.
of trying to be
  independent
  versus asking
for assistance
when
necessary.
- Closed comfort
room during
-To provide
bathing.
privacy for the
patient.
- Provided same
type of bathrobe
- Use of
and bathing
sensory
articles, such as
channels to
scented dusting
stimulate
powder and bath
memory may
oil, that client
help foster
used previously.
understanding
of bathing and
-Arranged bathin self-care.
g environment to
promote sensory
- Noise
comfort: reduce
discomfort can
noise of voices
result from
and water and
high-echo tiled
decrease glare
walls, loud
from tiles, white
voices, and
walls, and
running water.
artificial lights..
Glare can
cause visual
- When bathing a discomfort,
cognitively especially in
impaired client, clients with
have all bathing visual changes
items ready for or cataracts.
client's needs -Injury often
before bathing occurs when
begins. cognitively
impaired client
-Bathed cognitiv is left alone to
ely impaired obtain
clients before forgotten items
bedtime.

- Bathing a
- Limited bathing cognitively
to once or twice impaired client
a week; provide in the evening
a partial bath at helps improve
other times.  symptoms of
  dementia. 
- Frequent
bathing
promotes skin
- Allowed client
dryness.
or caregiver
Reducing
adequate time to
frequency of
complete the
bathing
bathing activity.
decreases
Significant aging
aggressive
increases the
behavior in
time required to
cognitively
complete a task
impaired
clients.
- Avoided soap
- Elderly
or use only mild
individuals with
soap on genital
a self-care
and axillary
deficit require
areas; rinse well.
more time to
  complete a
- Used tepid task.
water: test water - Soap can
temperature alter skin pH
 before use with a and thus skin
thermometer. defenses, and
it may increase
skin dryness
that results
from decreased
oil and
perspiration
production in
the elderly.
- Used a gentle
- Hot water
touch when
promotes skin
bathing; avoid
dryness and
vigorous
may burn a
scrubbing
client with
motions.
decreased
 
sensation.

 
- Aging skin is
  thinner, more
fragile, and less
  able to
withstand
mechanical
friction than
younger skin.

DRUG STUDY

NAME INDICA CONTRAINDIC MECHA SIDE NURSING

OF TION ATION NISM EFFECTS RESPONSIB
DRUG OF ILITIES
ACTION
Generic It is used  Phaechro Amilsupri  Insom  Take
Name: to treat mocytom de is a nia this
Amisulpri an illness a substitut  Anxiet medici
de called  Concomit ed y ne by
schizoph ant benzami  Agitati mouth
Brand renia. prolactin- de on  Swallo
Name: depende atypical  Drows w the
 Solian Schizoph nt tumors antipsyc iness tablets
renia can (pituitary hotic  Weigh whole
Classific make gland which t gain with a
ation: you feel, prolactino binds  Acute drink
Antipsych see or mas or selectivel dyston of
otic hear breast y with a ia water.
things cancer). high  Parkin Do not
Dosage: which do  Pre- affinity sonis chew
 200mg not exist, pubertal to m the
BID have children. human  Akathi tablets
strange  Combinat dopamin sia .
Route: and ion with ergic D2  Tardiv  Take
Oral frighteni levodopa. and D3 e before
ng receptor dyske a
thoughts subtypes nesia meal.
, change .  QT  If you
how you prolon feel
act, and gation that
make  Hypot the
you feel ension effect
alone.  Brady of
Sometim cardia your
es  GI medici
people disord ne is
with ers too
these (const weak
symptom ipatio or too
s may n, strong
also feel nause , do
tense, a, not
anxious vomiti chang
or ng, e the
depresse dry dose
d. mouth yourse
) lf, but
Solian  Hyper ask
works by glyce your
improvin mia physici
g  Breast an.
disturbed pain  For
thoughts  Erectil elderly
, feelings e , the
and dysfun doctor
behavior. ction will
It is used  Amen need
to treat orrhea to
schizoph  Gynec keep a
renia omasti close
when it a check
starts  Galact on you
and also orrhea as you
over the  Rarely are
long , more
term. allergi likely
c to
reacti have a
ons, low
abnor blood
mal pressu
LFTs re or
and sleepi
seizur ness
es. due to
this
medici
ne.
 People
with
kidney
proble
ms,
will
need
their
physici
an to
give
them
a
lower
dosag
 e.

Name of student: GROUP 1

PROCESS RECORDING

Name (Initials only): F.P.A

Age: 48 years old
Address: Pag- asa, Quezon City
Date of Birth: February 11, 1973
Date of Admission:
Educational Attainment: College graduate Diagnosis: Schizophrenia
Setting:
Date/Time of Interaction:

PATIENT
NURSE THERAPEUT (VERBAL ANALYSIS/
IC AND NON- INTERPRETATION
TECHNIQUE VERBAL)
Good giving Magandang -to establish rapport with the
Morning po! recognition Umaga patient/
-the pt. is acknowledging
you
Ako po si
Juana De la giving eye contact -informing the client what to
Cruz. Ako information expect with you, giving him
po ay isang information/
3rd year -the patient is acknowledging
nursing you and listening
student.

Ano po
masasabi When clients deal with topics
niyo sa Exploring Masarap yung superficially, exploring can help
kinain niyo lugaw! them examine the issue more
kanina? fully.

Ano pong When clients deal with topics

madalas superficially, exploring can help
niyong Exploring Nood ng tv. them examine the issue more
ginagawa fully.
dito sa
homecare?

kamusta po? It allows the patient to take the

initiative to introduce the topic.
It also simplifies that the patient
broad opening okay naman has the lead in the
interaction and to think of an
interesting topic for them.
 This means concentrates on a
Ferdinand, single important point.
ano ang ibig
sabihin ng
okay Focusing
naman? Ayos lang,
Strong, alert
and alive!
kamusta po Seeking information helps the
ang tulog nurse to get more information to
niyo kagabi? the patient and to ensure that the
patient have a good sleep at
seeking night and it is therapeutic
information Ayos naman. because the patient response
Maaga ako directly
natulog
anong oras Seeking information helps the
po kayo nurse to get more information to
natulog? the patient and to ensure that the
patient have a good sleep at
night and it is therapeutic
Seeking because the patient response
information 9 pm directly

Nakapag- This technique would help to

breakfast na examine the issue more fully.
po ba kayo?

Makakasam Giving schedule information to

a niyo po Exploring the client to know what to
ako tuwing Oo, tapos na expect
Wednesday Patient is active in listening and
(Miyerkules shows acceptance to the nurse
) hanggang
Friday
(Biyernes) Giving
mula 8 am information Eye contact
hanggang 11
am sa loob
ng 2 linggo.

Maari niyo
po bang
ipakilala ang Patient is taking intiative to
inyong sarili introduce his name, his favorite
sa amin? hobbies and birthday

Broad opening
Ako si
Ferdinand from
Pag-asa,
Sir Quezon City.
Ferdinand, Favorite color
matanong ko ay Black,
lang po Yellow, Red, at To help the patient examine the
namin, Blue. Mahilig issue fully and not only
gaano napo ako sa superficial
kayo katagal basketball,
dito sa home volleyball,
care? baseball.
Birthday ko ay
Ano po ang February 11,
iniinom niyo Exploring 1973.
na mga
gamut? Mga 1 month. 5
months. 5 years
Gaano po na. To help the patient examine the
niyo ito issue fully and not only
kadalas superficial
iniinom?

Bale po Sir
Ferdinand,
dito po Patient is active in responding
nagtatapos Exploring when being asked. Patient is
ang ating aware to a drug he's taking and
unang ½ Clozapine the dose to be taken per day.
interaction Informing the client of facts
po. increases his or her knowledge
about a topic or lets the client
know what to expect and also
Katulad po Giving help to builds trust with the
ng sinabi ko information client.
kanina, Once a day.
makakasam
a niyo po
kami tuwing Giving
Wednesday informatin Informing the client of facts
(Miyerkules) Eye contact increases his or her knowledge
hanggang about a topic or lets the client
Friday know what to expect and also
(Biyernes) help to builds trust with the
mula 8 am client.
hanggang 11
am sa loob
ng 2 linggo.
Giving
Maaari niyo information
po bang Eye contact
ibahagi
samin kung
ano pong
nangyari
sainyo bago
po kayo
dinala dito.

Asking the patient can help to

assess his memory and this is an
Okay po. effective way to get more
information and keep the
conversation focused.

nakapag
breakfast na
po kayo po
ba kayo? Seeking
infromation
May operation An accepting response indicates
ano pong sa old building that the nurse is listening and
kinaing sa opisina. following what the patient
ninyo. saying.
This technique would helps to
examine the issue more fully.
ano pong
madalas
niyong
ginagawa sa
bahay. Accepting This technique would helps to
Eye contact. examine the issue more fully.

ano pong
paborito Explring This technique would help to
niyong Oo, tapos na. examine the issue more fully.
niluluto.

kayo po ano
tramaho This technique would help to
niyo dati? Exploring examine the issue more fully.
Lugaw
saan po
kayo nag
aaral. This technique would help to
Exploring examine the issue more fully.
napansin ko Nagluluto,
po sir namamalengke,
Ferdinand grocery. This technique would help to
kanina niyo examine the issue more fully.
pa po
hinahawaka The nurse is verbalizing what is
n yung braso Exploring observe. This encourages the
niyo. Lugaw patient to recognize specific
behaviors and make
comparisons with the nurses
dati po nung perceptions.
nasa bahay
nyo, sino Exploring
sino po Nurse
kasama nyo?
Any problem or concern can be
better understood if explored in
Pang ilan po Exploring depth.
kayo sa Olfishield iold.
magkakapati

Making
Asan na po observation Oo makati may
mga kapatid mga rashes. Any problem or concern can be
ninyo? better understood if explored in
depth.
ano po
trabaho
nila?
This will help the client to share
more information.
Bilang
pagtatapos Exploring Mga kapatid ko.
po maari
niyo po This will help the patient to
bang share information and details
isummarize about the topic.
o ibuod ang
ating mga
napag Bunso ako pang The technique brings out the
usapan Exploring walo. important points of the
ngayong discussion, increase awareness
araw. and provides a sense of closure
at the completion of each
discussioncfor both client and
Nasa America. nurse.
Exploring

Nurse sila.
 Exploring

May activities
po kami. Okay
Summarizing po sa amin.

DRUG STUDY

NAME MECHANI INDICATIO ADVERSE CONTRAINDI NURSING

OF THE SM OF N EFFECTS CATION RESPONSIBI
DRUG ACTION LITIES
Generic Antagonize  Schiz CNS: •Hypersensitivi Patient
Name: s ophre tremor, ty to drug monitoring
Risperid serotonin2 nia parkinsonis • Renal or > Closely
one and m, hepatic monitor
 Short
dopamine2 aggressive impairment, neurologic
-term
Brand receptors behavior, cardiovascular status,
Name: in CNS. mana dizziness, disease, especially for
Risperdo Also binds geme drowsiness, prolonged QT mood
l to alpha1- nt of extrapyrami interval, changes or
and acute dal dysphagia, suicidal
Classific alpha2- mani reactions, hyperprolactine ideation,
ation: adrenergic headache, mia, neuroleptic
c or
Atypical receptors increased hypothermia or malignant
mixe
antipsyc and d dreams, hyperthermia, syndrome
hotics histamine episo longer sleep Parkinson's (high fever,
H1 des periods, disease, sweating,
Route: receptors. insomnia, phenylketonuri unstable
assoc
Oral, IM sedation, a, tardive blood
iated
fatigue, dyskinesia, pressure,
with nervousnes metabolic stupor,
bipol s, agitation, changes that muscle
ar 1 anxiety, may increase rigidity, and
disor tardive cardiovascular autonomic
der dyskinesia, or dysfunction),
hyperkinesi cerebrovascula extrapyramid
as
a, akathisia, r risk (such as al reactions,
mono
transient hyperglycemia, TIA, CVA,
thera ischemic dyslipidemia, and tardive
py or attack weight gain), dyskinesia.
as (TIA), previous > Closely
adjun cerebrovasc diagnosis of monitor CBC
ular breast cancer with
ct to
accident or differential,
lithiu
(CVA), prolactindepen especially
m or
neuroleptic dent tumors during first
valpr malignant • history of few months
oate syndrome, seizures, drug of therapy;
 Short suicide abuse, or discontinue
-term CV: suicide attempt drug if
orthostatic • elderly or severe
mana
hypotension debilitated neutropenia
geme
, chest patients occurs.
nt of
pain, • pregnant > Monitor
bipol tachycardia, patients blood
ar 1 arrhythmias • breastfeeding pressure,
disor EENT: patients particularly
der vision • children for
disturbance younger than orthostatic
as
s, rhinitis, age 5 with hypotension.
mono
sinusitis, autistic > Assess
thera pharyngitis disorder, body
py GI: nausea, younger than temperature.
 Irrita vomiting, age 10 with Check for
bility diarrhea, bipolar fever and
due constipation disorder, or other signs
to , abdominal younger than and
autist pain, age 13 with symptoms of
dyspepsia, schizophrenia infection.
ic
dry mouth, > Monitor
disor
increased patient with
der salivation, diabetes
anorexia, mellitus for
dysphagia worsening of
GU: glucose
difficulty control.
urinating, Reassess
polyuria, patients
galactorrhe periodically
a, to determine
dysmenorrh need for
ea, maintenance
menorrhagi treatment.
a, Patient
decreased teaching
libido > Instruct
Hematolo patient to
gic: remove orally
leukopenia, disintegrating
neutropenia tablet from
, blister pack,
agranulocyt place on
osis tongue
Metabolic: immediately,
dyslipidemi and swallow
a, as tablet
hyperprolac dissolves.
tinemia, > Tell patient
hyperglyce to mix oral
mia, solution with
worsening water,
of diabetes coffee,
mellitus orange juice,
Musculosk or low-fat
eletal: milk. Tell him
joint or solution isn't
back pain compatible
Respirator with cola or
y: cough, tea.
dyspnea, > Advise
upper patient to
respiratory use effective
tract bedtime
infection routine to
Skin: avoid sleep
pruritus, disorders.
diaphoresis, > Teach
rash, dry patient to
skin, recognize
seborrhea, and
increased immediately
pigmentatio report signs
n, and
photosensiti symptoms of
vity serious
Other: adverse
toothache, reactions,
fever, mood
impaired changes or
temperatur suicidal
e ideation,
regulation, including
weight tardive
changes dyskinesia,
and
neuroleptic
malignant
syndrome.
> Instruct
patient to
move slowly
when sitting
up or
standing, to
avoid
dizziness
from sudden
blood
pressure
decrease.
> Tell patient
that
excessive
fluid loss (as
from
sweating,
vomiting, or
diarrhea) and
inadequate
fluid intake
increase risk
of light-
headedness
(especially in
hot weather).
> Caution
patient to
avoid driving
and other
hazardous
activities until
he knows
how drug
affects
concentration
and
alertness.
> Advise
female
patient to tell
prescriber if
she is or
plans to
become
pregnant.
Caution her
not to
breastfeed
 during
therapy.
> Advise
patient not to
drink alcohol.

Name of Mechani Indicatio Adverse Contraindica Nursing

drug sm of n effect tion responsibili
action ties
Brand Unknown Indicated CNS: -  Alert:
Name: . Binds for drowsiness, Contraindicate Clozapine
Clozapine selectivel Schizophre sedation, d in patients carries
50 mg BID y to nia in seizures, diz with uncon significant
dopamine severely ill ziness, trolled risk of
Generic r gic patients syncope, epilepsy, agranulocyto
Name: receptors unresponsi vertigo, history of sis. If
Clozaril in the ve to other headache, clozapine possible,
CNS and therapies; tremor, induced give patient
Classificati may to re duce disturbed agranulocytosi at least two
on: interfere risk of sleep or s, WBC count trials of
Atypical with recurrent nightmares, be low standard
Antipsycho adrenergi suicidal restless ness, 3,500/mm³, antipsy
tics, 2nd c, behavior in hypokinesia severe CNS chotic before
Generation cholinergi schizophre or akinesia, depression or starting
c, hista nia or agitation, ri coma, and clozapine.
minergic, schizoaffec gidity, myelosuppres Obtain
and tive dis akathisia, sive disorders. baseline
serotoner orders confusion, - WBC and
gic Adults: fatigue, in Contraindicate differential
receptors Initially, somnia, d in patients counts be
. 12.5 mg hyperkinesia, taking other fore
P.O. once weakness, drugs that clozapine
daily or lethargy, suppress bone therapy.
b.i.d. If ataxia, marrow Monitor WBC
using the slurred function. counts
orally speech, -Use weekly for at
disintegrati depression, cautiously in least 4
ng tablet, myoc lonus, patients with weeks after
cut in half anxiety, prostatic clozapine
and fever. hyperplasia or therapy
discard the CV: angle-closure ends.
unused tachycardia, glaucoma be  Continue
half. hypotension, cause drug monitoring
Adjust cardiomy has potent WBC and
dose opathy, anticholinergic differential
upward by hypertension, ef fects. counts twice
25 to 50 chest pain, weekly until
mg daily ECG changes, WBC count
(if orthostatic exceeds
tolerated) hypotension, 3,500/mm³.
to 300 to myocar ditis,  If WBC
450 mg pulmonary count drops
daily by embolism, below
end of 2 cardiac ar 2,000/mm³
weeks. rest. and
Individual EENT: visual granulocyte
dosage is disturbances. count drops
based on GI: dry below 1,000/
clinical mouth, mm³, patient
response, constipation, may need
patient nausea, vom protective
toler ance, iting, isolation.
and excessive Bone
adverse salivation, marrow
reactions. heartburn, di aspiration
Subsequen arrhea. may be
t dosage GU: urinary needed to
shouldn't frequency or assess bone
be urgency, marrow
increased urine function.
more than retention, Future
once or incontinence, clozapine
twice abnormal therapy is
weekly and ejacula tion. contraindicat
shouldn't Hematologic: ed in these
exceed 50- leukopenia, patients.
to 100-mg agranulocyto  Alert:
increments sis, Drug
. Many granulocytop increases the
patients enia, risk of fatal
respond to eosinophilia. myocarditis
dosages of Metabolic: especially
200 to 600 weight gain, during, but
mg daily, hyperglycemi not lim ited
but some a. to, the first
may need Musculoskele month of
as much tal: muscle therapy. In
as 900 mg pain or patients in
daily. spasm, whom
Don't muscle myocarditis
exceed weakness. is suspected
900 mg Respiratory: (unexplained
daily. respiratory fatigue,
arrest. dyspnea,
Skin: rash, tachypnea
diaphoresis. chest pain,
tachycardia,
fever, palpita
tions, and
other signs
or symptoms
of heart
failure or
ECG
abnormalitie
s such as ST-
T wave
abnormalitie
s or arrhyth
mias), stop
clozapine
therapy
immediate
and don't
restart.
 Alert:
Drug may
cause
hyperglycemi
a. Monitor
patients with
diabetes
regularly. In
patients with
risk factors
for diabetes,
obtain
fasting blood
glucose test
results at
baseline and
periodically.
 Monitor
patient for
signs and
symptoms of
cardiomyopa
thy.
 Seizures
may occur,
especially in
patients
receiving
high doses.
 Some
patients
experience
transient
fever with
temperature
higher than
100.4° F
(38° C),
especially in
the first 3
weeks of
therapy.
Monitor
these
patients
closely. After
abrupt
withdrawal
of long-term
therapy,
abrupt
recurrence of
psychotic
symptoms is
possible.
 Alert:
Don't
confuse
clozapine
with clo
nidine,
clofazimine,
or Klonopin.
Orally
disintegratin
g tablets
contain
phenylalanin
e.

PATIENT
TEACHING

 Tell
patient
about need
for weekly
blood tests
to check for
blood cell
deficiency.
Advise him
to report
flulike
symptoms,
fe ver, sore
throat,
lethargy,
malaise, or
other signs
of infection.
 Warn
patient to
avoid
hazardous
activi ties
that require
alertness
and good
coordi nation
while taking
drug.
 Tell
patient to
check with
prescriber be
fore taking
alcohol or
nonprescripti
on drugs.
Advise
patient that
smoking may
decrease
drug
effectiveness
. Tell patient
to rise slowly
to avoid dizzi
ness.
 Tell
patient to
keep orally
disintegratin
g tablets in
the blister
package until
ready to take
it.
  Inform
patient that
ice chips or
sugar ess
candy or
gum may
help relieve
dry mouth.

Name of Mechanis Indicatio Adverse effect Contraind Nursing

drug m of n ication responsi
action bilities
Diphenhyd Competes  Ni CNS: drowsiness, Contraindic  Warn
ramine with gh sedation, ated in patient
HCl histamine tti sleepiness, patients not to
for H1- dizziness, hypersensit take this
m
HCl50 mg receptor incoordination, ive to drug drug with
e
capsule sites.Preven seizures, and other any other
HS, PRN ts,but sle confusion,insomni similar produets
doesn't ep a, antihistami that
Therapeuti reverse, aid headache, nes, in contain
c class: histamine- vertigo,fatigue newborns, diphenhyd
Antihistam mediated restlessness, and in ramine
ines responses,  Ad tremor, premature （includin
particularly ult nervousness. neonates. g topical
those of the s CV:palpitations,hy Use therapy)
bronchial an potension, cautiously because
tubes, GI tachycardia. in patients of in-
d
tract,uterus EENT:diplopia,blur with angle- creased
chi
, and blood red vision, closure adverse
ldr
vessels. nasal congestion, glaucoma, reactions.
en tinnitus. stenosing 
ag GI: dry mouth, peptic
e nausea, epigastric ulcer, Instruct
12 distress, symptomat patient to
vomiting,diarrhea, ic prostatic take drug
an
constipation,anore hyperplasia 30
d
xia. , bladder minutes
old
er: GU: dysuria, urine neck before
50 retention, urinary obstruction travel to
m frequency,early , prevent
menses. pyloroduod motion
g
Hematologic: enal sickness.
P.
thrombocytopenia, obstruc-  Tell
O agranu- locytosis, tion, or patient to
at hemolytic anemia. asthma. take
be Respiratory: diphenhyd
dti thickening of ramine
m bronchial with food
secretions. or milk to
e
Skin:urticaria,phot reduce GI
o-sensitivity, rash. distress.
Other: Warnpatie
anaphylactic shock nt to
avoid
alcohol
and haz-
ardous
activities
that
require
alertness
until CNS
effects of
drug are
known.
 Tell
patient to
notify
prescriber
if
tolerance
develops
because a
different
antihistam
ine may
need to
be
prescribed
.
 Drug
is in many
OTC sleep
and cold
prod-
ucts.Advis
e patient
to consult
prescriber
before
using
these
products.
 Warn
patient of
possible
photosens
itivity
reactions.
Advise
use of a
sunblock.