The document provides information about a 17-year-old male patient from Oman named Abdulla who is being treated for schizophrenia. It includes details about his symptoms, diagnosis, treatment history and current treatment plan. Specifically, it notes that Abdulla experiences hallucinations and delusions. He has been diagnosed with schizophrenia and has been admitted to the hospital multiple times previously. His current treatment involves antipsychotic medications as well as psychosocial therapies to help manage his symptoms.

1. SULTANATE OF OMAN
MINISTRY OF HEALTH
DIRECTORATE GENERAL OF EDUCATION & TRAINING
AL-DHAHIRA NURSING INISTITUTE
DONE BY :Omar Juma al abri
Year: II Semester: 3
Date of submission: 13072006
Submit to: Mr.Abdullah

2. -Patient Initial: Abdulla -Hospital: Ibri Hospita
-Age: 17years -Sex: Male -Religion: Muslim
-Marital Status: single -Address: Al Murtfi
-Educational level: secondary school
-Occupation: not employed -Unit: Psychiatric OPD
1.Patient personal and social data:
:
Early development
There was no abnormality during pregnancy. He did not
effect from any problem or anything that is lead to cause
psychiatric problem.
dhood:
Nervous problems in chil
He had no problems. He did not report any problem for
example hearing some voice ,or he did not report some
symptom same like it now for example he thought people
can read and know his thoughts
Schooling and higher education:
Mr. Abdullah lived in Al Murtfand. He started with symptom
of hearing voice (Hallucination) in grad 9 in school. Then
he started to thought that people can read his problem
and his thoughts, specially his father and teacher. Also he
left home to sit in their own farm or at mosque in non
prayers time. Now he is 17 old, but he starts to recover
from some symptom.
Present social situation:
He lives with his family which includes his parents and
with tow brothers and one sister. His family is poor. He is in a

3. grad. He is isolation person and did not want to communicate
with his community.
2.Chief complaint:
He complains hallucinations, also he is fear that he is
seeing him especially father and teacher reading his
thoughts, isolation, little or no interest social activity,
impaired grooming, and hygiene, sexual fantasy, also he
thought the dream come into reality. Also he left home to
sit in their own farm or at mosque in non prayers time. He
thought people’s eyes looking at him reading at him
reading his thought he stop breathing to stop palpitation
and thought disturbance.
3. Psychiatric signs/symptoms:
A) - Physical: poor hygiene and impaired grooming, his
facial expression is tired.
B) - Psychosocial: isolation, Also he left home to sit
in their own farm or at mosque in non prayers time
C) - Psychiatric: hallucination (hearing voice),
delusions (Also he left home to sit in their own farm or at
mosque in non prayers time).
4. History of present illness:
He started with symptom of hearing voice (Hallucination)
in grad 9 in school. Then he started to think that people
can read his problem and his thoughts, specially his father
and teacher. Also he left home to sit in their own farm or at
mosque in non prayers time. Then he went to the
psychiatric OPD and he was diagnosis as a schizophrenic,
ICD=F20, Now he is 17 old, but he starts to recover from
some symptom...

4. 5. Past History:
Medical: he has throat pain and running nose in
23/3/2010
Surgical: he does not have any past surgical history.
Psychiatry: He was admitted Ibri Hospital at several
times and they described ,in first time 30/1/2010 his
diagnosis is schizotypal disorder (F21), in second time
15/5/2010 his diagnosis is schizophrenia (F20), also in
third time 8/6/2010 his diagnosis is schizophrenia (F20).
1.Family history in general and in mental
illness in specific:
 General: his father has complains of diabetes
mellitus and the rest of family has normal or good
health.
 Mental illness: no history of mental illness on
his family.
2.PsychiatricDiagnosis:
Diagnosis is schizophrenia.

5. III. Review of literature of present mental
illness and the treatment received:
Definition of the disease:
A mental disorders characterized by disturbances in
thought process, perception and affective invariably
result in a severe deterioration of social and
occupational functioning that persists for at least 6
months.

6. In my patient
According to books
Serial
No
My patient
has family
factor
problem
(double-bind
patterns).
BIOLOGIC FACTORS:
- Heredity & Genetic
- Defects in structure and function of
nervous system.
- Abnormal neurotransmitters-
endocrine interaction.
- Too much dopamine.
- Viral exposure in pregnancy.
- High arousal level from diseases,
trauma and drugs.
Psychoanalytic and developmental
factors.
-Distortion in mother-child
relationship.
-Ego disorganization.
FAMILY FACTORS:
-Repressed unhappiness.
- Double- bind patterns.
- Marital problems between parents.
- Destructive, expressed emotion
communication pattern.
CULTURAL & ENVIRONMENTAL
FACTORS:
- Low socio- economic status.
- Lessened social support.
LEARNING THEORIES:
- Irrational problems-solving methods,
distorted thinking.
- Deficient communication pattern
learned from parents.
1
2
3
4
5

7. In my patient
According to books
Serio
l .No
-The patient has
auditory and visual
hallucination. He
hears some voices.
-he thought people
can read or know his
thought.
-There was poor eye
contact during the
interview.
-The patient prefers to
isolate himself to
prevent him from
people who can read
or know his thought.
POSITIVE SYMPTOMS:
HALLUCINATION:
 Auditory ( most frequent)
 Visual
 Olfactory
 Gustatory
 Tactile
DELUSIONS:
 Persecution
 Grandeur
 Reference
 Control or influence
Somatic
DISORGANIZED
THINKING:
 Resulting in speech
 Loose association
 Incoherence
 Clang association
 Word salad
 Neologism
 Concrete thinking
 Echolalia
DISORGANIZED
BEHAVIOUR:
 Disheveled appearance
 Inappropriate sexual
behavior
 Restless,agitated
 Waxy flexibility.
I.
1
2
3
4

8. -he want every time to
pray and sit in home
and mosque.
- The patient has
diminished sexual
interest.
NEGATIVE SYMPTOMS:
AFFECTIVE SYMPTOMS:
 Unchanging facialexpression
 Poor eyecontact
 Reduced body language
 Inappropriateaffect
 Diminishedemotionalexpression
ALOGIA ( poverty of speech)
 Brief empty responses
 Decreased fluency and contentof
speech
AVOLITION ( Apathy )
 Inability to initiategoal-direct
activity
 Little or no interest in work or
socialactivities
 Impairedgrooming,hygiene
ANHEDONIA
 Absence of pleasurein social
activities
 Diminishedintimacysexual
interest
 Socialisolation
II.
5
6
7
8

9. Treatment:
How is schizophrenia treated?
Because the causes of schizophrenia are still unknown,
treatments focus on eliminating the symptoms of the
disease. Treatments include antipsychotic medications
and various psychosocial treatments.
Antipsychotic medications
Antipsychotic medications have been available since the
mid-1950's. The older types are called conventional or
"typical" antipsychotics. Some of the more commonly used
typical medications include:
 Chlorpromazine (Thorazine)
 Haloperidol (Haldol)
 Perphenazine (Etrafon, Trilafon)
 Fluphenazine (Prolixin).
In the 1990's, new antipsychotic medications were
developed. These new medications are called second
generation, or "atypical" antipsychotics.
One of these medications, clozapine (Clozaril) is an
effective medication that treats psychotic symptoms,
hallucinations, and breaks with reality. But clozapine can
sometimes cause a serious problem called
agranulocytosis, which is a loss of the white blood cells
that help a person fight infection. People who take
clozapine must get their white blood cell counts checked
every week or two. This problem and the cost of blood
tests make treatment with clozapine difficult for many
people. But clozapine is potentially helpful for people who
do not respond to other antipsychotic medications.

10. Other atypical antipsychotics were also developed. None
cause agranulocytosis. Examples include:
 Risperidone (Risperdal)
 Olanzapine (Zyprexa)
 Quetiapine (Seroquel)
 Ziprasidone (Geodon)
 Aripiprazole (Abilify)
 Paliperidone (Invega).
When a doctor says it is okay to stop taking a medication,
it should be gradually tapered off, never stopped
suddenly.
What are the side effects?
Some people have side effects when they start taking
these medications. Most side effects go away after a few
days and often can be managed successfully. People who
are taking antipsychotics should not drive until they adjust
to their new medication. Side effects of many
antipsychotics include:
 Drowsiness
 Dizziness when changing positions
 Blurred vision
 Rapid heartbeat
 Sensitivity to the sun
 Skin rashes
 Menstrual problems for women.
Atypical antipsychotic medications can cause major
weight gain and changes in a person's metabolism. This
may increase a person's risk of getting diabetes and high
cholesterol. A person's weight, glucose levels, and lipid
levels should be monitored regularly by a doctor while
taking an atypical antipsychotic medication.

11. Typical antipsychotic medications can cause side effects
related to physical movement, such as:
 Rigidity
 Persistent muscle spasms
 Tremors
 Restlessness.
Long-term use of typical antipsychotic medications may
lead to a condition called tardive dyskinesia (TD). TD
causes muscle movements a person can't control. The
movements commonly happen around the mouth. TD can
range from mild to severe, and in some people the
problem cannot be cured. Sometimes people with TD
recover partially or fully after they stop taking the
medication.
TD happens to fewer people who take the atypical
antipsychotics, but some people may still get TD. People
who think that they might have TD should check with their
doctor before stopping their medication.
How are antipsychotics taken and how do
people respond to them?
Antipsychotics are usually in pill or liquid form. Some anti-
psychotics are shots that are given once or twice a month.
Symptoms of schizophrenia, such as feeling agitated and
having hallucinations, usually go away within days.
Symptoms like delusions usually go away within a few
weeks. After about six weeks, many people will see a lot
of improvement.
However, people respond in different ways to
antipsychotic medications, and no one can tell beforehand
how a person will respond. Sometimes a person needs to
try several medications before finding the right one.
Doctors and patients can work together to find the best

12. medication or medication combination, as well as the right
dose.
Some people may have a relapse -- their symptoms come
back or get worse. Usually, relapses happen when people
stop taking their medication, or when they only take it
sometimes. Some people stop taking the medication
because they feel better or they may feel they don't need it
anymore. But no one should stop taking an antipsychotic
medication without talking to his or her doctor. When a
doctor says it is okay to stop taking a medication, it should
be gradually tapered off, never stopped suddenly.
How do antipsychotics interact with other
medications?
Antipsychotics can produce unpleasant or dangerous side
effects when taken with certain medications. For this
reason, all doctors treating a patient need to be aware of
all the medications that person is taking. Doctors need to
know about prescription and over-the-counter medicine,
vitamins, minerals, and herbal supplements. People also
need to discuss any alcohol or other drug use with their
doctor.
To find out more about how antipsychotics work, the
National Institute of Mental Health (NIMH) funded a study
called CATIE (Clinical Antipsychotic Trials of Intervention
Effectiveness). This study compared the effectiveness and
side effects of five antipsychotics used to treat people with
schizophrenia. In general, the study found that the older
typical antipsychotic perphenazine (Trilafon) worked as
well as the newer, atypical medications. But because
people respond differently to different medications, it is
important that treatments be designed carefully for each
person.

13. Psychosocial treatments
Psychosocial treatments can help people with
schizophrenia who are already stabilized on antipsychotic
medication. Psychosocial treatments help these patients
deal with the everyday challenges of the illness, such as
difficulty with communication, self-care, work, and forming
and keeping relationships. Learning and using coping
mechanisms to address these problems allow people with
schizophrenia to socialize and attend school and work.
Patients who receive regular psychosocial treatment also
are more likely to keep taking their medication, and they
are less likely to have relapses or be hospitalized. A
therapist can help patients better understand and adjust to
living with schizophrenia. The therapist can provide
education about the disorder, common symptoms or
problems patients may experience, and the importance of
staying on medications.
Illness management skills. People with schizophrenia
can take an active role in managing their own illness.
Once patients learn basic facts about schizophrenia and
its treatment, they can make informed decisions about
their care. If they know how to watch for the early warning
signs of relapse and make a plan to respond, patients can
learn to prevent relapses. Patients can also use coping
skills to deal with persistent symptoms.
Integrated treatment for co-occurring substance
abuse. Substance abuse is the most common co-
occurring disorder in people with schizophrenia. But
ordinary substance abuse treatment programs usually do
not address this population's special needs. When
schizophrenia treatment programs and drug treatment
programs are used together, patients get better results.
Rehabilitation. Rehabilitation emphasizes social and
vocational training to help people with schizophrenia

14. function better in their communities. Because
schizophrenia usually develops in people during the
critical career-forming years of life (ages 18 to 35), and
because the disease makes normal thinking and
functioning difficult, most patients do not receive training in
the skills needed for a job.
Rehabilitation programs can include job counseling and
training, money management counseling, help in learning
to use public transportation, and opportunities to practice
communication skills. Rehabilitation programs work well
when they include both job training and specific therapy
designed to improve cognitive or thinking skills. Programs
like this help patients hold jobs, remember important
details, and improve their functioning.
Family education. People with schizophrenia are often
discharged from the hospital into the care of their families.
So it is important that family members know as much as
possible about the disease. With the help of a therapist,
family members can learn coping strategies and problem-
solving skills. In this way the family can help make sure
their loved one sticks with treatment and stays on his or
her medication. Families should learn where to find
outpatient and family services.
Cognitive behavioral therapy. Cognitive behavioral
therapy (CBT) is a type of psychotherapy that focuses on
thinking and behavior. CBT helps patients with symptoms
that do not go away even when they take medication. The
therapist teaches people with schizophrenia how to test
the reality of their thoughts and perceptions, how to "not
listen" to their voices, and how to manage their symptoms
overall. CBT can help reduce the severity of symptoms
and reduce the risk of relapse.
Self-help groups. Self-help groups for people with
schizophrenia and their families are becoming more

15. common. Professional therapists usually are not involved,
but group members support and comfort each other.
People in self-help groups know that others are facing the
same problems, which can help everyone feel less
isolated. The networking that takes place in self-help
groups can also prompt families to work together to
advocate for research and more hospital and community
treatment programs. Also, groups may be able to draw
public attention to the discrimination many people with
mental illnesses face.
Once patients learn basic facts about schizophrenia and
its treatment, they can make informed decisions about
their care.
How can you help a person with schizophrenia?
People with schizophrenia can get help from professional
case managers and caregivers at residential or day
programs. However, family members usually are a
patient's primary caregivers.
People with schizophrenia often resist treatment. They
may not think they need help because they believe their
delusions or hallucinations are real. In these cases, family
and friends may need to take action to keep their loved
one safe. Laws vary from state to state, and it can be
difficult to force a person with a mental disorder into
treatment or hospitalization. But when a person becomes
dangerous to himself or herself, or to others, family
members or friends may have to call the police to take
their loved one to the hospital.
Treatment at the hospital. In the emergency room, a
mental health professional will assess the patient and
determine whether a voluntary or involuntary admission is
needed. For a person to be admitted involuntarily, the law

16. states that the professional must witness psychotic
behavior and hear the person voice delusional thoughts.
Family and friends can provide needed information to help
a mental health professional make a decision.
After a loved one leaves the hospital. Family and
friends can help their loved ones get treatment and take
their medication once they go home. If patients stop taking
their medication or stop going to follow-up appointments,
their symptoms likely will return. Sometimes symptoms
become severe for people who stop their medication and
treatment. This is dangerous, since they may become
unable to care for themselves. Some people end up on
the street or in jail, where they rarely receive the kind of
help they need.
Family and friends can also help patients set realistic
goals and learn to function in the world. Each step toward
these goals should be small and taken one at a time. The
patient will need support during this time. When people
with a mental illness are pressured and criticized, they
usually do not get well. Often, their symptoms may get
worse. Telling them when they are doing something right
is the best way to help them move forward.
It can be difficult to know how to respond to someone with
schizophrenia who makes strange or clearly false
statements. Remember that these beliefs or hallucinations
seem very real to the person. It is not helpful to say they
are wrong or imaginary. But going along with the
delusions is not helpful, either. Instead, calmly say that
you see things differently. Tell them that you acknowledge
that everyone has the right to see things his or her own
way. In addition, it is important to understand that
schizophrenia is a biological illness. Being respectful,
supportive, and kind without tolerating dangerous or
inappropriate behavior is the best way to approach people
with this disorder.

17. People with schizophrenia can get help from professional
case managers and caregivers at residential or day
programs.
VI. HEALTH EDUCATION:
According to my patient the health education is :-
 Patient:
1. Encourage the patient to share with the social
activity, such as, to make for hisself such friends to
promote his behavior/skills & to reduce his isolated.
2. Encourage his to expresses his feeling to his
favorite/nearest family member or follow various way
to express his feeling outwards such as physical
activities. to reduce his anxiety or fear.
3. Encourage his to practice his habits/hobbies (this
patient his hobby is reading), by always tell him
that he can do something for his society and he is an
important individual in it even with his hobbies.
4. Explain to the patient the need to continue therapy
and avoid abrupt withdrawal of therapy the patient
had past experiences
5. Encourage the patient gradually increase the
amount of time that he spends with others and family
members and avoid isolate himself in a room for
along time.

18. 6. Encourage him to follow up his treatments and the
hospital appointments, { on Sunday, 2 July 2006}.
 Family:
1. It is important that family members learn about
schizophrenia and understand the difficulties and
problems associated with the illness.
2. It is also helpful for family members to learn ways to
minimize the patient's chance of relapse – for
example, by using different treatment adherence
strategies, and to be aware of the various kinds of
outpatient and family services available.
3. Family "psychoeducation," which includes teaching
various coping strategies and problem-solving skills,
is a cognitive-behavioural treatment approach to
family therapy. This approach can help families deal
more effectively with their ill relative and may
contribute to an improved outcome for the patient.
4. Encourage them to do not keep the patient alone in
his room.
5. Encourage them to follow up his treatments and the
hospital appointments, {2 July 2006}.
6. Encourage them to accept him as he is.
7. Encourage them to keep any medications/sharp
materials far away from him.

20. VII. CONCLUSION:
Prognosis:
I spent 15 minuteswith my patientin Psychiatric OPD and Iobserved
thathefelt quitetrust and comfortableon spooking with us. Also, hesaid
thattheheis OK as long as hetakes hismedicationsand hishealth status
is improvingdaily and it'smuch better thanbefore. accordingto thebook
there areseveral factors associated with a more positiveprognosis. They
include:
Good premorbid adjustment
Laterageatonset
Being female
Abruptonset of symptomsprecipitated by stressful event
Associated mood disturbance
Brief duration of activephasesymptoms
Minimalresidualsymptoms
Absenceof structuralbrain abnormalities, normalneurological
functioning
A family history of mood disorders and nofamily history of
schizophrenia.
Self Evaluation:
I get many benefitsfrom thiscasestudy. Ilearned whatisthe
schizophrenia, itssings& symptoms, causes& treatments. Also, I learn
how I can careof theschizophrenics’patientsandwhatcertainhealth
education I should gavethem/theirfamily. Also, my fear to givecareto
these typesof psychiatric patientsis reduced, becausewhileI interviewed
my patientI understandthatthey areasany medical/surgicalpatientsif
we treat them in humanity andon therightway.

23. Nursing Diagnosis:
Anxiety, related to lack of impulse control over self
manifested by facial expression ofpatient.
Self-esteem disturbance,related to, Low socio- economicstatus
manifested by withdrawal into social isolation & lack of eyes
contact.
Social isolation, r/t poorinterpersonal relationships and
Hallucination manifested by patient reports that he prefers isolation
rather than harm others by bad comments
Sleep pattern disturbance,related visual and auditory
hallucination manifested by patientreports that he is unable to
sleep at night because he sees pictures of frightens animals and
faces.
Potential for disrupted homeostasis related to effects of
medications.

24. Nurse's responsibilities
Possible Side
Effects
Action
Indication
Dose
Classification
Name Of
Drug
Give with meals if GI
upset occur.
May be taken before
food if dry mouth is
troublesome.
Advise the patient to
consult the physician
immediately if any
rashes develop.
Advise the patient that
the drug therapy is best
withdrawn gradually to
reduce risk of inducing
Parkinsonian Crisis.
Blurred vision, dry
mouth, constipation,
urinary retention,
drowsiness,
confusion, nausea,
vomiting, rash. With
high doses mental
confusion and
excitement.
Anticholinergic
action in CNS,
which helps to
normalize the
imbalance of
cholinergic/dopam
ine-rgic
neurotransmission
-management
of
manifestation
s of psychotic
disorders.
Treatment of
nonpsychotic
anxiety
5 mg
OD
oral
Antipsychotic
Antianxiety
agent
Procyclidine
(kemadrin)

25. Nurse's responsibilities
Possible Side
Effects
Action
Indication
Dose
Classification
Name Of
Drug
Avoid prolonged exposure
to sunlight or sunlamps; use a
sunscreen or protective
garments.
Antacids should be given
one hour before or two hour
after antipsychotics.
Handel injectable
preparations using gloves to
avoid contact dermatitis.
Do not crush the tablets/skin
contact with crushed tablets
may lead to dermatitis.
Give IM injections slowly
and deeply to avoid irritation
to subcutaneous tissues.
Rotate injection sites.
Observe carefully to
differentiate between return of
psychotic behavior and the
ones of EPS.
CNS: Headache,
insomnia, drowsiness,
vertigo, weakness,
tremor.
RESP: bronchospasm,
laryngospasm, dyspnea.
CV: hypotension,
orthostatic hypotension
, hypertension,
tachycardia.
EENT: glaucoma,
blurred vision,
photophobia, miosis.
AUTONOMIC: dry
mouth, salivation,
nausea, vomiting, and
anorexia.
ENDOCRINE:
hyperglycemia or
hypoglycemia.
Mechanism of action
not fully understood:
antipsychotic drugs
block postsynaptic
dopamine receptors
in the brain, but this
may not be necessary
and sufficient for
antipsychotic
activity; depresses the
RAS, including the
parts of the brain
involved with
wakefulness and
emesis,
Anticholinergic,
antihistaminic H1 and
adrenergic
blocking activity also
may contribute to
some of its
therapeutic actions.
-management of
manifestations
of psychotic
disorders.
Treatment of
nonpsychotic
anxiety
5 mg
OD
oral
Antipsychotic
Antianxiety agent
Trifuloperazine
hydrochloride
( Stelazine)

26. Nursing Diagnosis Objectives/Goals Nursing intervention Rationale Outcome Criteria
Self-esteem
disturbance,related to,
Low socio-economic
status manifested by
withdrawal into social
isolation & lack of eyes
contact.
The Client Will:
short term
goal:
voluntarily
spend time with
peers in
dayroom
activities within
1 week.
long term goal:
exhibitincrease
feelingof self-
worth.
Encourage the patient
to participate in group
activities.
Offer support &
empathywhen patient
expresses embarrassment
at inabilityto remember
people,event,places.
Encourage patientto be
as independentas
possible by lookingafter a
simple job to earn money.
Eg. Work as a farmer
Positive
feedbackfrom
group members
will increase self-
esteem.
Lift self-esteem.
The abilityto
perform
independently
preserves self-
esteem.Also, to
have good income.
The Patient:
Initiates own self-
care according to
written schedule and
willing accept as
assistance as needed.
Interact with others
in group activities.
Look for job to secure
his family financially

27. Nursing Diagnosis Objectives/Goals Nursing intervention Rationale Outcome Criteria
Social isolation, related
to poorinterpersonal
relationships and
Hallucination
manifested by patient
reports that he prefers
isolation rather than
harm others by bad
comments
The Client Will:
short term
goal:
Increased
feelings of self-
worth.
long term goal:
Engage in social
interaction.
Provide attention in a
sincere, interested
manner.
Support any successes
or responsibilitiesfulfilled,
projects,interactions with
staff members and others.
Avoid trying to convince
the client verbally of her or
her own worth.
Teach the client social
skills. Describe &
demonstrate specificskills,
such as eye contact,
attentive listening, nodding
and so forth.
If the client appearto
hallucinating,attempt to
engage the client's
attention and provide
conversation.
Flattery can be
interpreted as
belittling by the
client.
Sincere &
genuine praise that
the client has
earned can improve
self-esteem.
Demonstrate a
positive behavior
before the nurse
can genuinely
recognize it.
Provides a
concrete example
of the desired skills.
Help the patient
to contact with
reality
The Patient:
Patient demonstrates
willingness and desire
to socialize with others.
Patient voluntarily
attends group activities.
Patient approaches
others on appropriate
manner forone-to-one
interaction.
Experience
decreased frequencyof
hallucinations

28. Nursing Diagnosis Objectives/Goals Nursing intervention Rationale Outcome Criteria
Sleep pattern
disturbance,related
visual and auditory
hallucination
manifested by patient
reports that he is
unable to sleep at
night because he sees
pictures of frightens
animals and faces.
The Client Will:
short term
goal:
experience
decreased
hallucinations
long term goal:
be able to
achieve 6 to 7
hours of
undisturbed
sleep per night.
Be aware of all
surroundingstimuli,
includingsounds from
other rooms,e.g. TV
sounds.
If the client appearto
hallucinating,attempt to
engage the client's
attention and provide
conversation.
Avoid conveyingto the
client the belief that
hallucinations are real.
Do not converse with
voices or otherwise
reinforce the client's
beliefin the hallucination
as reality
Interrupt the
client's pattern of
hallucinations
Help the patient
to contact with
reality
Interrupt the
client's pattern of
hallucinations
The Patient:
Able to fall a sleep
within 30 minutes for
retiring and sleep for
6-7 hours without a
wakening
Avoid all drinks that
can cause CNS
stimulant
Experience
decreased frequencyof
hallucinations

29. Set with patientuntil
he falls in a sleep
Establish routine hours
of sleep and discourage
deviation from this
schedule.
Ensure that foods and
drinks that contain
caffeine are omitted from
patient's diet
Presence of a
trusted individual
provides a feeling
of security.
The body
responds and
adjusts to a
routine cycle of
rest and activity.
Caffeine is a
central nervous
system stimulant
that can interfere
with sleep