Question

Create a nursing care plan that incorporates evidence-based interventions for key areas of dysfunction in schizophrenia, including hallucinations, delusions, paranoia, cognitive disorganization, anosognosia, and impaired self-care.

Answer 1

In schizophrenia, treatment focuses on meeting both the physical and psychosocial needs of the patient based on his previous level of adjustment and his response to medical and nursing interventions. Treatment typically includes a combination of drug therapy, long-term psychotherapy for the patient and his family, vocational counseling, and the use of community resources

The primary treatment (for more than 30 years), antipsychotic drugs (sometimes called neuroleptic drugs) appear to work by blocking postsynaptic dopamine receptors. These antipsychotic drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, as well as relieve anxiety and agitation. Other psychiatric drugs, such as antidepressants and anxiolytics, may also be prescribed to control associated signs and symptoms. A complete rehabilitation based on these different areas of work include drug therapy as well as community services is to be incorporated for such patients. Moreover family training is a must so that the disorder can later be managed successfully at home. Some of the other points that can be aimed at while dealing with patients of this nature are as follows:

1. The patient will consider an alternative interpretation of a situation without becoming unduly hostile or anxious.
2. The patient will perform bathing and hygiene activities to the fullest extent possible.
3. The patient's family will demonstrate adaptive coping behaviors.
4. The patient will verbalize positive feelings about self.
5. The patient will identify internal and external factors that trigger delusional episodes.
6. The patient will maintain maximum functioning within the limits of his auditory, visual, or kinesthetic impairment.
7. The patient will resume appropriate rest and activity patterns.
8. The patient will identify and perform activities that decrease delusions.
9. The patient will perform dressing and grooming activities to the fullest extent possible.
10. The patient will express fears and concerns.
11. The patient and his family will participate in care and prescribed therapies.
12. The patient will remain free from signs of malnutrition.
13. The patient will develop effective coping behaviors.
14. The patient will maintain usual roles and responsibilities to the fullest extent possible.
15. The patient will recognize symptoms and comply with medication regimen.
16. The patient will demonstrate effective social interaction skills in both one-on-one and group settings.
17. The patient will express his needs.
18. The patient will gradually join in self-care and the decision-making process.
19. The patient will remain free from injury.
20. The patient won't harm others.
21. The patient won't harm self or others.
22. The patient will maintain family and peer relationships. This means that complete independence in different domains is encouraged so that patients are capable of performing self-help and other individual functions expected out of her/him.