SCHIZOPHRENIA

S & Sx

:
(positive symptoms)

Hallucinations

Delusion

Disorganised speech/thinking/ behaviour

Catatonic behaviours

Delusion of reference

(negative symptoms)

Affective Flattening

Alogia

Avolition

Anhedonia

Attention(poor)
NCP

Nursing Diagnosis 1: Disturbed Thought Processes

Defining Characteristics
Inaccurate interpretation of stimuli (people
thinking his thoughts, trying to take
information from his brain).
Cognitive dysfunction, including memory
deficits, difficulty in problem solving and
abstraction.
Suspiciousness
Hallucinations
Confusion/disorientation
Impulsivity

Related Factors
Uncompensated alterations in brain
activity.

Inappropriate social behavior

Outcomes
Initial
1. Recognize changes in thinking and

Discharge
6. 6. Use coping strategies to deal with

behavior.

hallucinations and delusions.

2. Learn coping strategies to deal

7. 7. Communicate clearly with others.

effectively with hallucinations and

8. 8. Agree to take antipsychotic medication

delusions.

as prescribed.

3. Express delusional material less

9. 9. Maintain reality orientation.

frequently.
4. Take Risperdal as prescribed orally.
5. Participate in unit activities according to
treatment plan.
Interventions
Interventions
Initiate a nurse-patient

Rationale
A therapeutic relationship

Ongoing Assessment
Determine whether or not

relationship by

will provide PT support

PT can engage in a

demonstrating an

as he develops an

relationship.

acceptance of PT as a

awareness of

worthwhile human being

schizophrenia and the

through the use of

implications of the

nonjudgmental statements

disorder.

and behavior. Approach in

a calm, nurturing manner.
Be patient (patients brain
is not processing data
normally) and nurturing.
Assist PT in differentiating
between his own thoughts

Initially, PT will be unable

Determine if PT is

and reality. Validate the

to determine whether or

convinced that his

presence of

not his hallucinations are

perceptual experiences

hallucinations. Identify

reality based. Because

are hallucinations.

them as a part of the

hallucinations tend to be

disorder and explain that

repeated, the patient

they are present because

learns that recurring

of the metabolic changes

perceptual experiences

that are occurring in his

that are not confirmed by

brain. Focus on reality-

others are hallucinations.

oriented aspects of the

The patient can learn to

communication.

focus on reality and

ignore the perceptual

Teach PT about his disorder.

Assure him that the

experience.
Helping PT understand his

Assess whether or not PT

symptoms can be

disorder will give him a

can process the

improved and that he can

sense of control over his

information. Has the

manage the disorder.

disorder and give him

confusion been

the information he needs

alleviated?

to manage the
Administer Risperdal as
prescribed. Teach about

symptoms.
Risperdal is a

Observe for relief of

the action, side effects,

monoaminergic

positive symptoms and

and dosage of medication.

antagonist of D2 and 5-

assess for side effects,

Emphasize the importance

HT2 postsynaptic. It is

especially extrapyramidal

of taking medication after

indicated for the

symptoms (specifically

discharge, even if

management of the

acute dystonic reactions,

symptoms go away

manifestations of

akathisia,

completely. Ask patient

psychotic disorders.

pseudoparkinsonism).

for a commitment to take

Observe for orthostatic

the medication.

hypotension.

When patient is
hallucinating, determine

By refocusing PTs

Determine whether or not

the significance to the

attention from

the hallucination is

patient (what are the

hallucinations to reality,

frightening to the patient

voices telling him?), then

he will begin to develop

or giving patient

try to reassure PT that he

coping skills to control

command, especially to

is not alone and then

the perceptual

harm self or others.

redirect him to the here-

experience. It is

Assess patients response

and-now.

important for the nurse

to the hallucination.

to understand the context

Assess his ability to be

of the hallucination to

redirected to the here-

provide the appropriate

and-now.

When patient is making

delusional statements,

supportive intervention.
Delusions, by definition, are Assess the meaning of the

assess the significance of

fixed false beliefs. They

delusion to the patient.

the delusion to the patient

cannot be changed

Determine if the patient

(it is frightening), support

through logical

can be redirected.

patient if necessary, and

argument. Because the

redirect to the here-and-

patient is convinced of

now. Do not try to

the truth of the delusion,

convince PT that the

the individual should be

delusion is false.

supported if the delusion

Assist patient in
communicating

is upsetting to him.
Patients with schizophrenia

Determine situations that

effectively. Encourage

typically have problems

cause PT the most

patient to attend

because of the disordered

problem in

communication groups.

thought process.

communicating.

Improving
communication skills
will help the patient cope
Assess ability for self-care
activities. Identify areas

with the disorder.

The negative symptoms of

Monitor patients actual

of physical care for which

schizophrenia can

ability to complete self-

the patient needs

interfere with the

care activities. Assist

assistance. Note level of

patients ability to

when necessary.

motivation and interest in

complete daily living

appearance.

activities.

Assess sleep and rest

patterns. If problems with

PT was unable to sleep

sleep continue after

before admission. The

initiation of medication,

prescribed medications

explore techniques that

are sedating and may

may promote sleep.

reverse the insomnia.

Observe patients sleep

cycle.

Structure times for sleep,

rest, and diversional
activities.
Evaluation
Outcomes
Within the safety of the
nurse-patient

Revised Outcomes
Continue to learn about
schizophrenia.

Interventions
Refer to symptom
management group at the

relationship, PT

mental health center.

acknowledges that his

thinking and behavior
have changed from the
beginning of school
until now. He is
perplexed by the
change.
PT continues to have

Use strategies to reduce

Encourage PT to practice

hallucinations and

hallucinations and

strategies that reduce

delusional thinking. He

delusions. Structure daily

hallucinations and

is beginning to develop

activities to avoid

delusions. Discuss the

strategies for dealing

isolation, withdrawal,

development of a daily

with the unusual

and negative symptoms.

routine with PT and his

perceptual experiences.

parents.

He is also having
problems with being
motivated to complete
daily activities.
PT understood that he had a
disorder called

Continue to learn about

schizophrenia.

Refer to case manager and

recommend individual

schizophrenia, but was

supportive therapy at the

not sure what it meant.

mental health clinic.

The medication has

decreased the intensity

Continue to take medication

as prescribed.

of the hallucinations and

Refer to medication group

at the mental health
center.

the frequency of
delusional thoughts. He
agrees to take the
Risperdal as prescribed.
Through attending the unit

Develop communication

Discuss the possibility of a

activities, PT was able

skills to interact with

day treatment program for

to improve his

others.

PT that will help him

communication skills

improve his

and maintain reality

communication skills.

orientation.

Nursing Diagnosis 2: Risk for Violence

Defining Characteristics
Assaultive toward others, self, and

Related Factors
Frightened, secondary to auditory

environment

hallucination and delusional thinking

Presence of pathophysiologic risk factors:

delusional thinking

Excessive activity and explosive agitated

comments (catatonic excitement)
Poor impulse control
Dysfunctional communication patterns

Outcomes
Initial
1. Avoid hurting self or assaulting other
patients or staff, with assistance from

Discharge
3. Control behavior with assistance from
staff and parents.

staff.
2. Decrease agitation and aggression.
Interventions
Interventions
Acknowledge patients fear,

Rationale
Hallucinations and

Ongoing Assessment
Determine if patient is able

hallucinations, and

delusions change an

to hear you. Assess his

delusions. Be genuine and

individuals perception of

response to your

empathetic. Assure patient

environmental stimuli.

comments and his ability

that you will help him

Patient is truly frightened

to concentrate on what is

control behavior and keep

and is responding out of

being said.

him safe. Begin to

his need to preserve his

establish a trusting

own safety.

relationship.
Offer patient choices of

By giving patient choices,

Listen for his response to

maintaining safety:

he will begin to develop a

choices. Is he able to

staying in the seclusion

sense of control over his

make choices at this

room, medications to help

behavior. Seclusion and

time? Is he starting to

him relax. Avoid

restraint are options only

engage in the nurse-

mechanical restraints and

for persons exhibiting

patient relationship?

a show of force by having

serious, persistent

several persons

aggression. The persons

approaching him at once.

safety must be protected at

all times.

Administer Ativan 2 mg.

The exact mechanisms of

Observe for relief of

Offer oral medication

action are not understood,

agitation and side effects:

first. If IM necessary, give

but the medication is

drowsiness, dizziness,

injections deep into

believed to potentiate the

constipation, diarrhea, dry

muscle mass; monitor

inhibitory neurotransmitter

mouth, nausea.

injection sites.

aminobutyric acid. It
relieves anxiety and
produces a sedative effect.
Ativan is rapidly absorbed,
thus produces desired
effects quickly.
Evaluation

Outcomes
PT was placed in seclusion

Revised Outcomes
Demonstrate control of

Interventions
Teach PT about the effects

with constant observation.

behavior by resisting

of hallucinations and

Ativan decreased his

hallucinations and

delusions. Problem-solve

agitation and was

delusions.

with him ways of

administered three times.

controlling auditory

After 2 days he was less

hallucinations if they

agitated and less

continue.

aggressive. On his third

day in the hospital, he was
able to come out of the
seclusion room for brief
periods of time. At these
times he would stand in
one spot for as long as 20
minutes without moving
except to shake his head
once in a while.
Nursing Diagnosis 3: Imbalanced Nutrition: Less than Body Requirements
Defining Characteristics
Inadequate food intake less than
recommended daily requirement.

Related Factors
Refusal to eat because of delusional
thinking: He has the Power.
Outcomes

Initial

Discharge

1. Food intake will match energy

3. Weight will be between 160 and 174 lb.

expenditures (roughly 2,000-3,000

4. PT will be able to describe the food

calories)

pyramid and identify foods he likes and

2. PT will eat at least 3 meals per day, with

amounts for each section.

snacks in late afternoon and late evening.

Interventions
Interventions
Offer small frequent meals.

Rationale
For someone who has not

Ongoing Assessment
Intake and output and a

been eating well, small

calorie count until fluid

meals are easier to

intake is adequate and

tolerate.

calorie intake is 2,500 to

3,000 cal.

Suggest parents bring meals

Familiar foods are more

Intake and output when

that PT likes when they

likely to be eaten.

family members present.

visit; encourage family to

Observe family interaction.

visit at mealtimes
occasionally.
Allow PT to eat alone

Being comfortable when

Observe PTs interaction

initially; gradually allow

eating is important. A

with others to know when

him to eat with increasing

patient who is

he should be encouraged to

numbers of patients at

uncomfortable with

eat with others.

mealtimes.

others may not eat in

front of other people.

After medications have

PT will not be able to retain

Assess cognitive

improved PTs attention

information while

functioning to determine

span, teach him about

confused and

when teaching can be

nutritious food selection

disoriented.

implemented.

and the food pyramid.

Evaluation
Outcomes
PT is eating all meals and

Revised Outcomes
Interventions
Maintain adequate nutrition. Explore the need to

snacks with other patients.

continue nutritional

He has a healthy appetite

education based on plans

and has been consuming

for PT and his family

at least 3,000 calories a

after discharge.

day. He weighs 158 lb.

PT can identify the foods in

the food pyramid but
states his mother knows
what foods to boy.