nursing care of schizophrenia is very important topics

1. By
Dr. Atta Allah Khalaf
Associate Professor of Psychiatric Mental Health Nursing
Head of Nursing Department
Dr. Mona Hamdy
Assistant Professor of Psychiatric Mental Health Nursing
Nursing Department
Shaqra University
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2.  Definition of schizophrenia
 Etiology
 Phases of schizophrenia
 Assess S & S of schizophrenia
 Types of schizophrenia according to the DSM-IV-
TR
 Use the nursing care process to develop the
nursing intervention plan for a schizophrenic
patient.
 Common Nursing Diagnoses
 Examples of nursing care plans.
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3. Definition of schizophrenia
 The word Schizophrenia means split of mind
 Schizophrenia is chronic psychotic disorder
characterized by severe disturbance of thinking,
emotions and behaviors. significant loss of contact with
reality, disorganization of the personality and severe
deterioration of social and occupational functioning.
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4. Biological factors
 Genetics : heredity
 Biochemical Influences : The
Dopamine Hypothesis suggests that
schizophrenia may be caused by an
excess or deficiency of dopamine-
dependent neuronal activity in the brain.
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5. Physiological factors
 Viral Infection
 Anatomical Abnormalities
 Histological Changes
 Physical Conditions : such as epilepsy (particularly
temporal lobe), birth trauma
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6. Psychological factors
 Family relationship: dysfunctional family systems
Environmental factors
 Socio-cultural Factors: socioeconomic classes
Stressful Life Events
 There is no scientific evidence to indicate
that stress causes schizophrenia.
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7. 1- Catatonic excitement/ stupor: is characterized by
marked abnormalities in motor behavior in the form of
stupor or excitement.
a- Catatonic stupor is extreme psychomotor retardation
with pronounced decrease in spontaneous movements and
activity resulting in mutism, negativism, and Waxy
flexibility.
b- Catatonic Excitement is a state of psychomotor agitation,
purposeless movements accompanied by incoherent
speech, shouting and aggressive destructive behavior.
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8. Is characterized by presence of delusion of
persecution or grandeur as well as auditory
hallucinations of single theme.
The patient is always tense, suspicious,
aggressive, and argumentative.
The onset is usually in the late 20s or 30s with
good prognosis.
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9. 3- Disorganized:
This type was used to be called hebephrenic. Onset of symptoms
is before 25yrs old, marked primitive behavior, poor contact
with reality, neglected appearance, flat affect, periods of
silliness and incongruous giggling, bizarre mannerism, and
incoherent communication with extreme social impairment.
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10. 4- Undifferentiated:
psychotic behavior with evidence of delusions,
hallucinations, incoherence, and bizarre behavior but
symptoms are not easily classified in any diagnostic
type.
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11. 5- Residual:
Is used when the individual has at least one episode of
schizophrenia with prominent psychotic features which
disappear and leave the patient with social isolation, poverty
of speech, eccentric behavior, impairment in personal hygiene,
and blunted inappropriate affect.
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12. Phases of schizophrenia
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13. Phase I: The Premorbid Phase
Premorbid personality :
 very shy and withdrawn, having poor peer
relationships, doing poorly in school, and
demonstrating, antisocial behavior
 Deviant behaviors tend to become more
prominent in adolescence, a time of life that may
present more socially challenging situations.
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14. Phase II: The Prodromal Phase
 nonspecific symptoms such as a sleep disturbance,
anxiety, irritability, depressed mood, poor
concentration, fatigue
 behavioral deficits such as deterioration in role
functioning and social withdrawal.
 Positive symptoms such as perceptual
abnormalities, ideas of reference, and suspiciousness
develop late in the prodromal phase
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15. Phase III: Schizophrenia
the active phase of the disorder, psychotic symptoms
are prominent.
Positive symptoms
 Hallucinations.
 Delusions.
 Disorganized thinking/speech.
 Disorganized behavior.
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16. Negative symptoms
 Flat affect /apathy
 Alogia (poverty of speech)
 Avolition
 Anhedonia
 Social/Occupational Dysfunction
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17. Phase IV: Residual Phase
 Schizophrenia is characterized by periods of
remission and exacerbation.
 During the residual phase:
◦ symptoms of the acute stage are either absent or
no longer prominent.
◦ Negative symptoms may remain, and flat affect
and impairment in role functioning are common.
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18. Common Nursing Diagnoses
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19.  Disturbed Sensory / perceptual : visual /
auditory
 Disturbed thought processes (specify)
 Risk for violence directed at self and
others
 Impaired verbal communication
 Impaired social interaction
 Low self – Esteem
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20.  Self care deficit ( bathing, grooming,
……..
 Ineffective individual coping
 Knowledge deficit
 Non adherence to medications and
treatment
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21. The state in which an individual:
participates in an insufficient or
excessive quantity or ineffective
quality of social exchange
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22. Intervention
1. Assess if medications has reached therapeutic
level
Rational: subside of positive symptoms will facilitate
interactions
2. Ensure that the goals set are realistic
Rational: avoid pressure on the patient
3. Keep environment free from stimuli
Rational : to decrease patient’s anxiety & improve
concentration
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23. 4. Start with one – to- one activities with safe person
then increase structured group activity gradually
Rational : the patient learns to feel safe
5. Structure daily time for brief interactions
Rational: help the patient to develop sense of safety
6. Provide simple concrete activities
rational: to avoid patient’ sense of failure and keep
him interested
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24. 7. Avoid touching the patient without warning
Rational : to avoid threatening misinterpretation
8. Teach the patient to remove himself briefly when
feels agitated
9. Teach the patient anxiety relief exercises
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25. IMPAIRED VERBAL COMMUNICATION
 Definition: Decreased, delayed, or absent
ability to receive, process, transmit, and use
a system of symbols to communicate.
Evidenced by: incoherence, alogia, neologism,
perseveration, loss of association .
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26. Intervention
1. Use simple words and keep directions simple
Rationale: the patient may have difficulty in processing
2. Keep voice low and speak slowly.
rational: loud voices increase patient's anxiety
3. When you do not understand the patient, tell him that you
have difficulty understanding him
Rational : to avoid mistrust
4. Use therapeutic techniques such as “ are you saying ……..
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27.  Maintain consistency of staff assignment over
time,
Rational: to facilitate trust and the ability to
understand client’s actions and communication
 Anticipate and fulfill client’s needs until
satisfactory communication patterns return.
Rational: Client comfort and safety are nursing
priorities
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28. INEFFECTIVE INDIVIDUAL COPING
Defining characteristics
 Verbalization of inability to cope
 Inability to make decisions
 Inability to solve problems
 Inability to ask for help
 Destructive behavior toward self
 Inappropriate use of defense mechanisms
 Inability to meet basic needs
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29. Intervention
1. Teach the patient new coping skills
2. Reinforce the use of positive coping skills
and healthy defense mechanisms
3. Teach skills as decision making , problem
solving
4. Teach relaxation techniques
5. Help the patient to set achievable goals
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30. Evidence :
 Talking and laughing to self
 Listening pose (tilting head to one side as if
listening)
 Stops talking in middle of sentence to listen
 Rapid mood swings
 Inappropriate responses
 Poor concentration
 Sensory distortions
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31. EXPECTED OUTCOMES
The patient will be able to:
 discuss content of hallucinations with nurse or
therapist.
 Interact verbally with staff for specified time period.
 Participate in unit activities according to treatment
plan.
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32.  Use coping strategies to deal with hallucinations
 Interact on reality-based topics such as daily
activities or local events.
 verbalize understanding that the voices are a result
of his or her illness and demonstrate ways to
interrupt the hallucination.
Select the most appropriate expected outcomes for your
patient & use it as short term or long term objective
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33. Intervention
 Observe client for signs of hallucinations (listening
pose, laughing or talking to self, stopping in mid-
sentence).
Early intervention may prevent aggressive responses
to command hallucinations.
 Avoid touching the client without warning
Client may perceive touch as threatening and respond
in an aggressive manner
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34.  An attitude of acceptance will encourage the client to
share the content of the hallucination with you.
 This is important in order to prevent possible injury
to the client or others from command hallucinations.
 Do not reinforce the hallucination. Use words such as
“the voices” instead of “they” when referring to the
hallucination.
 Words like “they” validate that the voices are real.
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35.  connect the times of the hallucinations to times of
increased anxiety. Help the client to understand this
connection.
If client can learn to interrupt escalating anxiety,
hallucinations may be prevented.
 Divert the client’ attention away from the hallucination.
Involvement in interpersonal activities and explanation
of the actual situation will help bring the client back to
reality.
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36.  Listening to the radio or watching television helps
distract some clients from attention to the voices.
 voice dismissal technique,
the client is taught to say loudly, “Go away!” or
“Leave me alone!”, thereby exerting some conscious
control over the behavior.
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