Question

Schizophrenia Mrs. Maine, age 56, is brought to the emergency department (ED) by her son, who is very concerned. The son tells Stephen, the ED nurse, that he found his mother wandering in the house, aimlessly talking to the furniture. She apparently had not eaten in days. Envelopes covered the kitchen table, along with reams of paper with unintelligible writings. An unopened bottle of Clozaril was found in the kitchen. The son states that his mother was diagnosed with undifferentiated schizophrenia 2 years after her husband died, 20 years ago. She usually suffers one occurrence every year related to discontinuation of her medication. She lives at home and is assessed by a home aide daily. Apparently, her home aide left for vacation without informing Mrs. Maine’s son. Mrs. Maine has no contact with her neighbors. She displays no eye contact and speaks in a singsong voice. She asks, “Why am I here? There’s nothing wrong with me. I don’t know why that man brought me here; he’s obviously a prison guard and wants to put me in jail.” She states that she is hearing “four or five” voices. “They tell me I’m a bad person, and they plan to beat me and take my shoes,” she says, adding, “Sometimes they turn my mother parts around.” At this she pats her abdomen and giggles. Otherwise her affect is flat, and she demands to be discharged. Discuss Clozaril. Discuss name, dosage, major side-effects, patient teaching, any pertinent labs.

Nurse’s Personal Perspective

Nursing Diagnosis

A.

1.

2.

B.

1.

C.

1.

2.

Outcomes Identification (Write an appropriate goal for the client.)

1.

Planning

Implementation

Short-Term Goals	Interventions	Rationale	Evaluation
1.	1.	1.	1.
	2.	2.
	3.	3.
2.	1.	1.	2.
	2.	2.
	3.	3.

Answer 1

Clozaril (clozapine) is an antipsychotic medicine. It works by changing the actions of chemicals in the brain. Clozaril is used to treat schizophrenia after other treatments have failed. Clozaril is also used to reduce the risk of suicidal behavior in people with schizophrenia or similar disorders.Pharmacological class: Antipsychotic.

The starting dose is 12.5 mg once daily or twice daily. The total daily dose can be increased in increments of 25 mg to 50 mg per day

Common Clozaril side effects

• weight gain
• dizziness, tremor, feeling light-headed, or fainting
• fast heart rate
• headache, drowsiness
• nausea, constipation
• dry mouth, or increased salivation

Clozapine can have long lasting effects on your body. You may need frequent medical tests for a short time after you stop using this medicine

Absolute neutrophil count (ANC). If the number of neutrophils, or ANC, is too low, youmay have to stop clozapine.

Nursing Diagnosis:

1. Impaired Verbal Communication
2. Impaired Social Interaction
3. Disturbed Sensory Perception: Auditory/Visua
4. Disturbed Thought Process
5. Defensive Coping

Expected outcomes or patient goals for impaired verbal communication nursing diagnosis

• Patient will express thoughts and feelings in a coherent, logical, goal-directed manner.
• Patient will demonstrate reality-based thought processes in verbal communication.
• Patient will spend time with one or two other people in structured activity neutral topics.
• Patient will spend two to three 5-minute sessions with nurse sharing observations in the environment within 3 days.