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As appropriate, meet his needs for adequate food, fluid, exercise, and elimination; follow orders with respect to nutrition, urinary
catheterization, and enema use.
Stay alert for violent outbursts; if these occur, get help promptly to intervene safely for yourself, the patient, and others.
Administer appropriate medications and monitor for effectiveness and side effects.
Have staff with the ability to restrain patient if needed and create a safe environment.
Maintain a calm demeanor towards the patient and set boundaries for unacceptable actions.
2. Nursing Diagnosis for Schizophrenia: Altered Thought Processes
Delusional thinking
Shifting from one topic to another
Unable to stay focused
Escalated reaction to normal stimuli
Inconsistent communication
Hallucinations
Difficulties in problem solving
Interventions
Explain all treatments, tests and medications to patient before using them.
Maintain consistent expectations and rules for acceptable and non-disruptive behavior.
Discuss patients' feelings when they are experiencing disturbing and delusional thoughts.
Provide words of encouragement and praise for all social interaction attempts.
4. Nursing Diagnosis for Schizophrenia: Sensory and Perceptual Alterations Related to Hallucinations
Strange body sensations
Little or no interaction with nurse or others
Unable to concentrate
Unsuitable reactions and responses to reality
Interventions
Encourage patient to speak about their hallucinations and communicate with patient during event but do not counsel until
episode has ended.
Do not argue with patients, but explain others don't share their sensory perceptions.
Monitor for symptoms and signs of hallucinating, such as looking around or talking to themselves.
Help identify and deal with triggers and feelings that bring on hallucinations or illusions.
Teach patient distraction techniques and involve them in concrete activities so as to bring them back to reality.
5. Nursing Diagnosis for Schizophrenia: Impaired Verbal Communication
Lack of emotion in verbal communication
Inability to think abstractly
Little use of speech
Unable to express cause of agitation
Incongruent non-verbal communication
Interventions
Inform patient when you are unable to understand what they are trying to convey.
Speak with patient about personal interests, favorite activities and hobbies.
Look out for open communication on topics that are meaningful and important to patient.
6. Nursing Diagnosis for Schizophrenia: Ineffective Individual Coping
Feelings of loneliness and rejection
Avoidance of interaction and people
Regression and projection defenses
Unable to perform daily self-care tasks
Physical and emotional withdrawal
Interventions
Assist patient in identifying bizarre or impulsive actions and how to control them.
Give patient appropriate medications and monitor side effects and effectiveness.
Discuss negative feels and how to keep these emotions from escalating.
Teach patient how to depart from situations that will trigger agitation.
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Diagnostic Test
Clinical diagnosis is developed on historical information and thorough mental status examination.
No laboratory findings have been identified that are diagnostic of schizophrenia.
Routine battery of laboratory test may be useful in ruling out possible organic etiologies, including CBC, urinalysis, liver function
tests, thyroid function test, RPR, HIV test, serum ceruloplasmin ( rules out an inherited disease, wilsons disease, in which the body
retains excessive amounts of copper), PET scan, CT scan, and MRI.
Rating scale assessment:
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SCHIZOPHRENIA
CONCEPT
TYPES/
SUBTYPES
PARANOID
FEATURES
Schizophrenia is a group of psychotic disorders that affect thinking, behavior, emotions, and the ability to perceive reality.
The term Psychosis refers to the presence of hallucinations, delusions, or disorganized speech or catatonic behavior.
The typical age at onset is late teens and early twenties, but schizophrenia has occurred in young children and may begin in later adulthood.
Characterized by
suspicion
toward others
Dominant:
Hallucinations
and Delusions
(positive
symptoms)
NO
Disorganized
speech,
disorganized
behavior,
catatonia or
inappropriate
affect present.
(No negative
symptoms)
DISORGANIZED
Characterized by
withdrawal from
society and very
inappropriate
behaviors, such as
poor hygiene, or
muttering constantly to
self.
Frequently seen in the
homeless population
Dominant:
Disorganized speech,
disorganized behavior,
and inappropriate
affect.
Marked regression
Poor Reality Testing
Poor social skills
Inappropriate
emotional responses
Outbursts of laughter
Silly behavior
CATATONIC
RESIDUAL
Active-phase (positive)
symptoms are not
longer present
(Delusions,
hallucinations,
disorganized speech and
behaviors)
However, the client has
two or more residual
symptoms (some
negative symptoms) such
as:
o Marked social
isolation or
withdrawal
o Impaired role
function (wage
earner, student,
homemaker)
o Anergia,
Anhedonia, or
Avolition
o Alogia (speech
problems)
o Odd behavior, such
as walking in a
strange way
o Impaired personal
hygiene
o Lack of initiative,
interest or energy
o Blunted or
inappropriate affect
UNDIFFERENTIATED
(MIXED TYPE)
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ASSESSMENT
DISEASE
PROGRESSION
:
CHARACTERIS
TIC
DIMENSIONS
OF
SCHIZOPHREN
IA
(No single
symptom is
always present in
all cases)
POSITIVE SYMPTOMS:
These are the most easily identified symptoms
o
o
o
COGNITIVE SYMPTOMS:
Problems with thinking make it very difficult for the
client to live independently
DEPRESSIVE SYMPTOMS:
o AFFECT: usually Blunted (narrow range of normal expression) or Flat (Facial expression
never changes).
o ALOGIA: Poverty of thought or speech; client may sit with a visitor but may only mumble
or respond vaguely to questions
o AVOLITION: Lack of motivation in activities and hygiene
o ANHEDONIA: Inability to find pleasure in life; the client is indifferent to things that often
make others happy
o ANERGIA: Lack of energy, chronic fatigue
o
o
o
o
o
o
Disordered thinking
Poor problem-solving skills
Poor decision-making skills
Inattention; easily distracted (Difficulty concentrating to perform tasks)
Impaired judgment
Impaired memory
Long-term memory loss
Working Memory loss (such as inability to follow directions to find an address)
o Hopelessness
o Suicidal Ideation
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EXPECTED
OUTCOMES
INTERVENTIO
NS
MEDICATIONS
ACTIVE PHASE:
-Client safety and medical stabilization
MAINTENANCE PHASE:
-Adherence to medication regimen
-Understanding schizophrenia
-Participation of client and family in psycho
educational activities
ACUTE PHASE: (Hospitalization, Client Safety,
Stabilization Of Symptoms)
1. Administer antipsychotic medication as prescribed
2. Observe client behavior closely
3. Set limits on inappropriate behavior
4. Increase reality testing when delusional or hallucinating
5. Do not touch without warning
6. Offer foods that are not easily contaminated
7. Assist with ADLs as needed
8. Supportive counseling
9. Milieu Therapy
10. Family psycho education
TYPICAL (CLASSIC) ANTISYCHOTICS (Treatment of
positive symptoms)
o HALDOL (Haloperidol)
o THORAZINE (Chlorpromazine)
o PROLIXIN (Fluphenazine)
o SERENTIL (Mesoridazine)
o TRILAFON (Pherphenazine)
o MELLARIL (Thioridazine)
STABILIZATION PHASE:
-Target negative symptoms
-Anxiety Control
-Relapse prevention
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