Nursing Care of Schizophrenic Patients.pptx

nursing care of schizophrenia is very important topics

1. Nursing Care of Patients with Schizophrenia 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 11/1/2023 1

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. Outline 11/1/2023 2

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. 11/1/2023 3

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. Etiology 11/1/2023 4

5. Physiological factors Viral Infection Anatomical Abnormalities Histological Changes Physical Conditions : such as epilepsy (particularly temporal lobe), birth trauma 11/1/2023 5

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 . 11/1/2023 6

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. Major Types of Schizophrenia: 11/1/2023 7

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. 2-Paraniod: 11/1/2023 8

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. 11/1/2023 9

10. 4- Undifferentiated: psychotic behavior with evidence of delusions, hallucinations, incoherence, and bizarre behavior but symptoms are not easily classified in any diagnostic type. 11/1/2023 10

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. 11/1/2023 11

12. Phases of schizophrenia 11/1/2023 12

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. 11/1/2023 13

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 11/1/2023 14

15. Phase III: Schizophrenia the active phase of the disorder, psychotic symptoms are prominent . Positive symptoms Hallucinations. Delusions. Disorganized thinking/speech. Disorganized behavior. 11/1/2023 15

16. Negative symptoms Flat affect /apathy Alogia (poverty of speech) Avolition Anhedonia Social/Occupational Dysfunction 11/1/2023 16

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. 11/1/2023 17

18. Common Nursing Diagnoses 11/1/2023 18

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 11/1/2023 19

20. Self care deficit ( bathing, grooming, …….. Ineffective individual coping Knowledge deficit Non adherence to medications and treatment 11/1/2023 20

21. The state in which an individual: participates in an insufficient or excessive quantity or ineffective quality of social exchange I MPAIRED SOCIAL INTERACTION 11/1/2023 21

22. Intervention 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 11/1/2023 22

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 11/1/2023 23

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 11/1/2023 24

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 . 11/1/2023 25

26. Intervention 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 …….. 11/1/2023 26

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 11/1/2023 27

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 11/1/2023 28

29. Intervention Teach the patient new coping skills Reinforce the use of positive coping skills and healthy defense mechanisms Teach skills as decision making , problem solving Teach relaxation techniques Help the patient to set achievable goals 11/1/2023 29

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 DISTURBED SENSORY PERCEPTION: AUDITORY/VISUAL 11/1/2023 30

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. 11/1/2023 31

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 11/1/2023 32

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 11/1/2023 33

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. 11/1/2023 34

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. 11/1/2023 35

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. 11/1/2023 36

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