Question

What do you think the patient have Schizophrenia or Bipolar? (Worth an extra point) 1 point that you can add to any assignment

Assessment: Included at least 3 Subjective and Objective Date-

Diagnosis: Give me 3 Mental Health Nursing Diagnosis

Outcomes: Give me 3 Expected Outcomes with measurable goals

Planning: Give me 3 interventions, 1 must be evidence-based

Implementation: Give me 3 ways you implemented the plan

Evaluation: Give 3 ways you evaluated the care plan

Answer 1

Schizophrenia refers to a group of severe, disabling psychiatric disorders marked by withdrawal from reality, illogical thinking, possible delusions and hallucinations, and emotional, behavioral, or intellectual disturbance

Objective data

Schizophrenia Signs and Symptoms

Signs and symptoms are divided into three clusters: positive, negative, and cognitive symptoms.

Positive symptoms are associated with temporal lobe abnormalities.

Negative symptoms are associated with frontal cortex and ventricular abnormalities.

Positive Symptoms

Deviant symptoms. These are symptoms that are present but should be absent. They indicate that patient has lost touch with reality.

Primarily include delusions and hallucinations.

Hallucinations are the most common feature of schizophrenia. These involve hearing, seeing, smelling, tasting, and feeling touched by things in the absence of stimuli. An example is hearing voices that command the patient to do certain things, usually abusive and self-destructive.

Delusions are fixed false beliefs. They cannot be changed by logic or persuasion. An example is a patient believing that people can read his mind. Several categories of delusions include:

Persecutory delusions. Patient thinks he is being tormented, followed, tricked, or spied on.

Reference delusions. Patient thinks that passages in books, music, TV shows, and other sources are directed at him.

Delusions of thought withdrawal/thought insertion. Patient believes others can read his mind, his thoughts are being transmitted to others, or outside forces are imposing their thoughts or impulses on him.

Negative Symptoms

Deficit symptoms. These symptoms reflect the absence of normal characteristics.

Apathy is lack of interest in people, things, and activities.

Anhedonia is diminished capacity to feel pleasure.

Blunted affect is characterized by patient’s face appearing immobile and inexpressive; this is the flattening of emotions and becomes more pronounced as the disease progresses.

Poverty of speech is a speech that is brief and lacks content.

Cognitive Symptoms

Reflect the patient’s abnormal thinking, poor decision-making skills, poor problem-solving skills, and ability to communicate and his strange behavior.

Thought disorder is characterized by confused thinking and speech (e.g., incoherent ramblings,)

Nursing Management

Nursing Assessment

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

Establish trust and rapport. Don’t tease or joke with patients. Expect that patient is going to put you through rigorous testing periods. Introduce yourself and explain your purpose.

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.

Decreased Cardiac Output related to orthostatic hypotensive drug effects.

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

Desired Outcomes

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.

Patient will be able to communicate in a manner that can be understood by others with the help of medication and attentive listening by the time of discharge.

Patient will learn one or two diversionary tactics that work for him/her to decrease anxiety, hence improving the ability to think clearly and speak more logically.

Nursing Interventions

Reduce inhibited behavior, provide a structured goal-directed activity:

Spend time with the patient even if it can not respond verbally or do in inconsistently. Direct our concern and care.

Promise only what you can accomplish realistically.

Providing the opportunity to learn that their feelings are valid and do not differ much from others

Limit the patient’s environment to increase their feelings of safety.

Assign team members to attend the patient therapeutic.

Start with interactions one by one, and then make progress for the patient to join small groups as tolerated (enter slowly).

Establish and maintain a daily routine; explain any variation in this patient.

Increase patient’s self-esteem and feelings of worth:

Provide care in a sincere way forward.

Support you in all your successes-enforcement responsibilities within the service, projects, interactions with members of the treatment team and other patients, and so on.

Helping the patient to improve their appearance help him when necessary torque to shower, get dressed, try washing their clothes, etc..

Assist the patient to accept greater responsibility for their personal hygiene to the extent that it can do.

Spend enough time with the patient.

orient the patient in reality:

Reorient the patient in person, place and time as needed (call it by name, say the name of the nurse, tell where you are, give the date, etc..).

Increase the ability of the patient to differentiate between the concept of self and the external environment:

Helping the patient to distinguish what is real and what is not. Assess the patient’s actual perceptions and sensory perception correct errors in a form that is attached to the facts. Do not argue with the limited validity of patient perceptions nor provide support for them.

Helping the patient to restore the boundaries of the self:

Stay with the patient if you are afraid, sometimes touching the patient can be therapeutic. Evaluate the effectiveness of physical contact dcl use in each patient before use consistently.

Be simple, honest and concise when speaking with the patient.

Talk with the patient specific issues and simple, avoid ideological or theoretical discussions.

Direct the activities to help the patient to accept the reality and keep in touch with her, using creative occupational therapy when appropriate.

Ensuring a safe environment for the patient.

Reafirmnar the patient that the security environment is explaining the procedures followed in the service, routines, tests, etc., In a brief and simple.

Protect the patient from self-destructive tendencies (removing objects that could be used in self-destructive behavior).

Realize that the patient is up actions that are harmful to themselves and others in response to auditory hallucinations.

7. – Keep a safe, therapeutic for other patients.

Remove the patient from the group if their behavior becomes too crowded, annoying or dangerous to others.

Help the group of patients to accept behavior ‘strange’ patient newcomer simple explanation to the group of patients when necessary (for example, “the patient is very ill at this time, needs our understanding and support”).

Consider the needs of other patients and plan at least one member of the treatment team is available to other patients if others are needed for patient care newcomer.

Helping the patient to overcome his regressive behavior.

Remember: The regression is a purposeful return (conscious or unconscious) to a lower level of functioning-an attempt to eliminate anxiety and restore balance.

Assess the current level of functioning of the patient and go from that point to your attention.

Contact the patient’s level of behavior, then try to encourage him to leave his regressive behavior and integrated into adult behavior. Help identify unmet needs or feelings that cause regressive behavior. Encouraging children to express these feelings and help relieve anxiety.

Establish realistic. Mark the objectives and expectations everyday.

Ensure that the patient becomes aware of what is expected from him.

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).