Question

Apply the nursing process to patients who are experiencing the positive, negative, cognitive and depressive symptoms of schizophrenia

Answer 1

Nursing process include :-

#. Nursing Assessment :-

Recognize schizophrenia. Note characteristic signs and symptoms of schizophrenia (e.g., speech abnormalities, thought distortions, poor social interactions).

Establish trust and rapport.

Maximize level of functioning. Assess patient’s ability to carry out activities of daily living (ADLs).

Assess positive symptoms. Assess for command hallucinations; explore answers. Assess if the client has fragmented, poorly organized, well-organized, systematized, or extensive system of beliefs that are not supported by reality. Assess for pervasive suspiciousness about everyone and their actions (e.g., vigilant, blames others for consequences of own behavior, argumentative, threatening).

Assess negative symptoms. Assess for the negative symptoms of schizophrenia (as mentioned above).

Assess medical history. Assess if the client is on medications, what these are, and adherence to therapy.

Assess support system. Determine whether the family is well informed about the disease. Does the family understand the need for medication adherence?

#. Nursing Diagnoses :-

Impaired Physical Mobility related to depressive mood state and reluctance to initiate movement.

Impaired Social Interaction related to problems in thought patterns and speech.

Risk for Suicide related to impulsiveness and marked changes in behavior.

Risk for Injury related to hallucinations and delusions.

Risk for Imbalanced Nutrition: less than body requirements related to self-neglect and refusal for self-care.

#. Nursing Care Planning and Goals :-

Reduce severity of psychotic symptoms

Prevent recurrence of acute episodes

Meet patient’s’ physical and psychosocial needs

Help patient gain optimum level of functioning

Increase client’s compliance to treatment and nursing plan

#. Nursing Interventions :-

Establish trust and rapport. Don’t touch client without telling him first what you are going to do. Use an accepting, consistent approach; short, repeated contacts are best until trust has been established. Language should be clear and unambiguous. Maintain a sense of hope for possible improvement, and convey this to the patient.

Maximize level of functioning. Avoid promoting dependence by doing only what the patient can’t do for himself. Reward positive behavior and work with him to increase his personal sense of responsibility in improving functioning.

Promote social skills. Provide support in assisting him to learn social skills.

Ensure safety. Maintain a safe environment with minimal stimulation.

Ensure adequate nutrition. Monitor patient’s nutritional status and if the patient thinks his food is poisoned, let him fix his own food if possible or offer him foods in closed containers that he can open. Institute suicide and/or homicide precautions as appropriate.

Keep it real. Engage patient in reality-oriented activities that involve human contact (e.g., workshops, inpatient social skills training). Clarify private language, autistic inventions, or neologisms.

Deal with hallucinations by presenting reality. Explore the content of hallucinations. Avoid arguing about the hallucinations. Tell them you do not see, hear, smell, or feel it but explain that you know that these hallucinations are real to him.

Promote compliance and monitor drug therapy. Administer prescribed drugs and encourage the patient to comply. Ensure that patient is really taking the drug. Observe for manifestations that warrant hypersensitivity reactions and toxicity.

Encourage family involvement. Involve family in patient treatment and teach members to recognize impending relapse (e.g. nervousness, insomnia, decreased ability to concentrate). Suggest ways how families can manage symptoms.

#. Evaluation :-

Evaluate effectiveness of drug therapy (absence of acute episodes and psychotic symptoms).

Evaluate compliance to health instructions (taking medications on time, showing independence in activities, involvement of family).

Level of patient’s functioning (ability to engage in social interactions).

Patient’s mental status (oriented to reality).