Nursing Care and Management of Client With Schizophrenia

8/12/2019 Nursing Care and Management of Client With Schizophrenia

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NURSING CARE ANDMANAGEMENT OF CLIENT WITH

SCHIZOPHRENIA

By : Haryati Osman


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DEFINITION

Schizophrenia is a mental disorder

characterized by a breakdown of thought

processes and by poor emotional

responsiveness.(Wikipedia dictionary)
http://en.wikipedia.org/wiki/Mental_disorderhttp://en.wikipedia.org/wiki/Mental_disorder


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SYMPTOMS

Positive Symptoms

Delusions

Hallucinations

Disorganized thinking

Agitation


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Negative Symptoms

Affective flattening- The person's range of

emotional expression is clearly diminished;

poor eye contract; reduced body language

Alogia - A poverty of speech, such as

brief, empty replies

Avolition - Inability to initiate and persist ingoal-directed activities (such as school or

work)


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CAUSES

Genetic Environment

Substance misuse

Developmental factors Mechanisms

Psychological

Neurological


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PREVENTION

earlier diagnosis and earlier treatment. taking proactive steps

avoiding illegal drug use,

reducing stress, getting enough sleep

and starting antipsychotic medications


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MANAGEMENT

Psychopharmacology ECT

Psychosocial therapy

Cognitive Behavior Therapy Family Education


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CASE PRESENTATION

PATIENT WITH

SCHIZOPHRENIA


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DEMOGRAPHIC DATA

Miss S 23 years old

Single

Malay Diagnosis : Schizophrenia

Last Date of Admission : 13 February,

2013 Onset of Mental Illness : 21 years old


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FAMILY BACKGROUND

Parent divorced since patient young First child in the family

Has brother, 19 years old

Stay with family,father, step mother andbrother

Her own mother married again, stay in

Sarawak


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EDUCATION AND SOCIAL

BACKGROUND

Study until SPM- grade 3

Further study in University for 6 months

Stopped due to illness Had a boyfriend - father not agreed

Then stay with mother for 3 years

Stay with uncle for 2 months


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MEDICAL HISTORY

History of Gastritis- on follow up HSA

SURGICAL HISTOR

No surgical history


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HISTORY OF ADMISSION

1st admission - Hospital Bukit Padang,Sarawak due to aggressive behavior,auditory hallucination in 2009.

2nd admission -Hospital Permai-

aggressive, abnormal behavior-July 2010 3rd admission- Hospital Sultanah Aminah-August 2011-allerged rape, paranoidtoward father "kena bomoh"

4th admission- Hospital Permai-refer byCPU for job placement.


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PHYSICAL EXAMINATION

GC- calm and comfortable.

Height : 150cm

Weight : 60kg

Body Mass Index : 24

Vital signs: Blood pressure : 114/78 mmHg

Pulse : 90 bpm

Respiration : 22 /min Temperature : 36.4 C


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MENTAL STATE EXAMINATION

General Apperarance calm andcomfortable

Auditory hallucination

No disturbance in thought

Able to maintain eye contact

No disturbance in memory

No disturbance in bahevior

No disturbance in insight


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MANAGEMENT

OFPATIENT


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PSYCHOSOCIAL

INTERVENTIONS

Individual Therapy and Group Therapy

Health education

Occupational Therapy


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NURSING DIAGNOSIS AND

NURSING INTERVENTIONS


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1. Patient loss of focus and concentrationrelated to hallucinations or delusions.

Goals : Patients experience less hallucinations anddelusions and able to concentrate on reality.

Nursing Interventions:

Do not focus on hallucinations or delusions. Performan interrupt to initiate interaction with the patients

hallucinatory one-on-one based on reality.

do not agree with the perception of the client, but the

validation that you believe that the hallucinations arereal to the patient.

Do not argue with the patient about the hallucinations

or delusions.


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Respond to the feelings that are

communicated to the patient when he was

having hallucinations or delusions.

Switch and the patient focus on a

structured activity or task-based reality.

Move the patient to a more quiet, less

stimulating.

Wait until the patient does not have

hallucinations or delusions before startingthe counseling session about it.


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Explain that hallucinations or delusions are

symptoms of psychiatric disorders. Help patient to control hallucinations by

focusing on reality and take medication as

prescribed.

If hallucinations persist, help patient ignore itand continue acting remedy properly despite

a hallucination.

Teach a variety of cognitive strategies and tellthe patient to use self talk ("voices that makes

no sense") and the cessation of the mind ("I

will not think about it").


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2. Patient who are suspicious and rude related

to paranoid

Goals : patients will be able to cooperate and communicatein a good manner with the staff


Form professional relationships; too friendly to bet the

threat.

Be careful with the touch because it can be considered a

threat.

Give as much control and autonomy to the client within

the therapeutic limits.

Create a sense of trust through brief interactions that

communicate caring and respect.


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Describe any treatment, medication andlaboratory tests before the start.

Do not focus or strengthen the suspicionor delusional ideas.

Identify and provide a response to theunderlying emotional needs of suspicion or

delusional Intervene when the client shows signs of

increasing anxiety and potentially expressan unconscious behavior.

Be careful to not behave in a way thatcould be misinterpreted client.


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3. Communication disorder related to social

isolation and withdrawal personality.

Goals : patients will be able to communicateand able to understand by the staff


Keep your own communication to keep itclear and unambiguous.

Maintain consistency of your verbal and

nonverbal communication. Clarification of any meaning ambiguous or

not clearly related to client communication.


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4. Patient show regressive behaviour or unfair

related to low self esteem.

Goals : Patients can live a normal life morevibrant, competitive and do the daily routineby himself.


Do approach, it is strange behaviour (do notreinforce this behaviour).

Treat the client as an adult, even though theclient regresses.

Monitor the client's diet, and give support andassistance when necessary.


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Assist the client in terms of hygiene and dress

up, only when the client can not do it alone.

Be careful with the touch because it can be

considered a threat

Create a regular schedule of activities of dailyliving.

Give a simple choice of two things for clients

who experience ambivalence.


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CONCLUSION

Miss S suffering from schizophrenia.

Family support is important in patientmanagement.

It would require multidisciplinary team toprovide collaborative care to meet Miss Scomplex needs.

The aim for management of schizophrenia

is to minimize of the negative effects ofschizophrenia and enhances quality life.


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REFERENCES

US Department of Health and Human Services (2001).

The Impact of Mental Illness on Society (NIH Publication

01-4586), National Institutes of Health.

Stefan, M., Travis, M. & Murray, R. M. (2002). An Atlasof Schizophrenia, Parthenon Publishing.

NARSAD (2003). Understanding Schizophrenia, National

Alliance for Research on Schizophrenia and Depression.


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THANK YOU

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Nursing Care and Management of Client With Schizophrenia