Monitor for adverse effects. Teach about importance of compliance. Assess for improvement of symptoms. Provide support and education.

1. SCHIZOPHRENIA
A Case Study
Presented to The
Faculty of the College of Nursing
Of the St. Anthony’s College
San Jose, Antique
In Partial Fulfillment
Of the Requirements for the
Degree of Bachelor of Science in Nursing
Submitted By:
Toledo, John Carlo P.
Mosquera, Rainy Rose M.
BSN 3

2. TABLE OF CONTENTS
I. INTRODUCTION --------------------------------------------------1
II. OBJECTIVES -------------------------------------------------------2
III. BASELINE DATA -------------------------------------------------3
IV. HISTORY OF PRESENT ILLNESS ---------------------------4
V. MENTAL STATUS EXAM --------------------------------------5
VI. PSYCHOPATHOLOGY ------------------------------------------6
VII. DRUG STUDY -----------------------------------------------------7
VIII. NURSING CARE PLAN ------------------------------------------8
IX. TREATMENT ------------------------------------------------------9
X. NURSE-PATIENT INTERACTION --------------------------10
XI. PROGRESS REPORT -------------------------------------------11
XII. RECOMMENDATION ------------------------------------------12
XIII. REFERENCES ----------------------------------------------------13

3. I. INTRODUCTION
Schizophrenia
Patient L.L was 54 years old female, who started showing symptoms
of auditory hallucination. The patient stated that she worked for 2 years in
Hong Kong. After a series of event including violent behavior in her
household, she was admitted to PMHU on April 12, 2019. She was
diagnosed with Schizophrenia and complied with treatment.
BSN 3 was given the opportunity to go on a psychiatric exposure at
Pototan Mental Health Unit on April 22 – May 3, 2019. The students chose
this case study to present to the St. Anthony’s College of Nursing. The
student chose this case becauseit gave them the opportunity to expand their
learning on psychiatric nursing. This case provided the student nurses
motivation to gain better understanding on mental illness. Moreover, this
case study help the student nurses to enhance their ability to care for
patients with mental disorders, especially schizophrenia. Lastly, the student
nurses hope that this case study will be a bridge in order to stop the stigma
on mental illness.

4. VI.PSYCHOPATHOLOGY
Predisposing Factors:
Age: 54
Sex: Female
Family history of schizophrenia
Loss of mother figure
Precipitating Factors:
Occupation: housewife
Civil Status: Separated
Socioeconomic Status
Non-compliance to medication
Neurodevelopmental abnormalities and target features
Physical and Psychological changes
Imbalance in the neurotransmitters in the brain
High dopamine activity in the Mesolimbic System
Dysfunctional cortico-limbic Dopaminergic pathways
Increase Serotonin
Increase acetylcholine
Increase Gamma-Aminobutyric Acid
Pre-fontal Cortex deficits
Positive Signs and Symptoms
1. Delusion of Persecution
2. Delusion of Grandeur
3. Auditory Hallucination
Negative Signs and Symptoms
1. Manic Behavior
2. Depressed mood
3. Anhedonia
Nursing Diagnosis:

5. Psychosexual Theory by
Sigmund Freud
Psychosocial Development by
Erik Erikson
Interpersonal Theory
By Henry Sullivan
Anamnesis
Infancy (Birth 1 year)
Oral Stage- Putting all sort of
things in the mouth to satisfy the
libido, and thus its id demands.
Which at this stage in life are oral,
or mouth oriented, such as
sucking, and breastfeeding.
Infancy: Trust vs. Mistrust
Value: Hope
The infant is uncertain about the
world in which they live. To
resolve these feelings of
uncertainty, the infant looks
towards their primary caregiver for
stability and consistency of care.
Infancy (Birth- 18 months):
Characteristics:
Gratification of needs
A time when the child receives
tenderness from mothering, one
while also learning anxiety
through an empathic linkage with
mother.
Toddler (1-3 years)
Anal stage – Libido is now
becomes focused on the anus, and
child derives great pleasure from
defecating.
Toddler: Autonomy vs. shame
Value: Will
The child is discovering that he or
she has many skills and abilities
such as putting on clothes and
shoes, playing with toys. Such
skills illustrate the child’s growing
sense of independence.
Childhood (18 mos.-6 yrs.):
Characteristics: Delayed
gratification
The need of playmates of equal
status is call childhood. The
child’s primary interpersonal
relationship continues to be with
the mother, who is now
differentiated from other persons
who nurture the child
Preschool (3-6 years)
Phallic Stage – Sensitivity now
becomes concentrated in the
genitals and masturbation (in both
sexes) becomes a new source of
pleasure
OEDIPUS COMPLEX
Pre- school: Initiative vs. Guilt
Value: Purpose
The primary feature involves the
child regularly interacting with
other children at the school.
Juvenile era (6-9 yrs.):
Characteristics: formation of a
peer group.
Begins with the need fro peers of
equal status and continues until the
child develops a need for an
intimate relationship with a single
best friend,

6. School age (6 years to puberty)
Latency Stage – The superego
continues to develop while id’s
energies are suppressed. Children
develop social skills, values and
relationship with peers and adults
outside of the family
School age: Industry vs
Inferiority
Value: Competency
It is at this stage that the child’s
peer group will gain greater
significance will become a major
source of the child’s self-esteem.
Preadolescence (9-12 yrs.)
Characteristics: Development of
relationship within the same
gender.
Puberty: Identity vs Role
Confusion
Value: Fidelity
This is a major stage of
development where the child has
to learn the roles he will occupy
as an adult.
Early adolescence (12-14 yrs.)
Characteristics: Development of
an identity
Early Adulthood: Intimacy vs
Isolation
Value: Love
Once people have established
their identities, they are ready to
make long term commitments to
others. If they cannot, a sense of
isolation may result.
Late Adolescence (14-21 yrs.)
Characteristics: Formation of
lasting, intimate relationships.
Adulthood: Generatively vs
Stagnation
Value: Care
Has broad application to family,
relationships, work and society.

7. VII. DRUG STUDY
Name of Drug Dosage, Route, and
Frequency
Mechanism of Action Indication and
Contraindication
Adverse Effect Nursing Responsibilities
Generic Name:
Olanzapine
Brand Name:
Zyprexa
Classification:
Atypical
Antipsychotics
Dopamine blocker
Dosage: 10 mg
Frequency:
ODT
Route: Oral
Olanzapine’s antipsychotic
activity is likely due to a
combination of antagonism D2
receptors in the mesolimbic
pathway and 5HT2A receptors
in the frontal cortex.
Antagonism at D2 receptors
relieves positive symptoms
while antagonism at 5HT2A
receptors relieves negative
symptoms of schizophrenia.
Indication:
Treatment of acute mixed
or manic episodes
associated with Bipolar I
disorder and maintenance
of Bipolar I disorder as
monotherapy or combined
with Lithium or
Valproate.
Contraindication:
 Contraindicated with
allergy to
Olanzapine.
 Severe CNS
depression.
 Comatose states.
 Lactation
CNS: Somnolence,
dizziness, nervousness,
headache, akathisia,
personality disorder.
CV: Orthostatic
hypotension, peripheral
edema, tachycardia
Respiratory: Cough,
Pharyngitis
GIT: Constipation,
Abdominal pain
Other: Fever,
development of Diabetes
Mellitus