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A Case Study on
SCHIZOPHRENIA PARANOID
Submitted to:
Aida Bautista RN, MAN
Clinical Instructor
Submitted by:
MENDOZA, STEANIOBEDOZA, EST!ER
ODRADA, E"IZABET!#ERO", MAE
S$N%A, &ARENTAN, 'EANETTE
(A"EROS, 'A)SON(ICENCIO, DIOSSA(I""AN$E(A, &ERSTINE
BSN 3Y2-2DTABLE OF CONTENTS:
1
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"earnin* Ob+ecties.-..........................----3
Introduction..............................----- 4
#atient/s #ro0ile-............................-----6
#1ysical Assessment and MSE....--..................-7
#syc1osocial T1eory and Deelo2ment...................-9
%ordon/s unctional !ealt1 #attern..........-..........-13
Course in t1e 3ard..--........................---15
#syc1ot1era2ies............................--- 20
Anatomy and #1ysiolo*y---...............--........---21
#at1o21ysiolo*y---.......---....................-23
"aboratory...........-----................... 25
Dru* Study...--...........................--27
Nursin* Care #lan.....................------------------------.31
Recommendation.-..---......................------- .34
General Objectives
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T1is case study aims to identi0y and determine t1e *eneral 1ealt1 2roblems and needs
o0 t1e 2atient 4it1 an admittin* dia*nosis o0 #aranoid Sc1i5o21renia- T1is study also
intends to 1el2 us 2romote 1ealt1 and medical understandin* o0 suc1 condition t1rou*1
t1e a22lication o0 t1e nursin* s6ills-
Specific Objectives
A0ter t1e com2letion o0 t1is case study, t1e students 4ill be able to:
De0ine #aranoid Sc1i5o21renia
Enumerate t1e ris6 0actors, di00erent si*ns and sym2toms and to trace t1e
2at1o21ysiolo*y o0 #aranoid Sc1i5o21renia
Identi0y and understand t1e di00erent 2syc1ot1era2ies
To understand t1e role o0 dru* t1era2y in mana*in* t1e client
ormulate a22ro2riate nursin* care 2lan and 2roide nursin* care
Rationale for choosin the case
3e c1ose t1is as our case study to en1ance 6no4led*e and ac7uire more in0ormation
to understand t1e mental disorder better- It 1as been obsered to be t1e most common
2syc1otic diseases accountin* 0or 1i*1 costs in mental 1ealt1 care- It is t1ere0ore
im2ortant 0or us student nurses and ital 0or t1e community to be 6no4led*eable ands6ill0ul in carin* 2atient 4it1 Sc1i5o21renia, its sym2toms and 1o4 best to 1andle
2atients su00erin* 0rom t1e disorder in order to ensure t1at suc1 indiiduals 4ill be lead
to a better and 0ul0illed lies and 4ill become a 0unctional member o0 t1e society-
Scope an! "i#itation$
T1is is a case o0 89 year old 0emale dia*nosed 4it1 #aranoid Sc1i5o21renia- T1e
2atient 4as admitted in National Center 0or Mental !ealt1, Mandaluyon*- Treatment,
laboratory results and ot1er si*ni0icant data are included 0or inter2retations- Reliabilityo0 in0ormation 0rom 2atient is ;
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Schi%ophrenia ca&ses !istorte! and
bi5arre t1ou*1ts, 2erce2tions, emotions,
moements, and be1aior- It cannot be
de0ined as a sin*le illness= rat1er,
sc1i5o21renia is t1ou*1t o0 as a syndrome
or as a disease 2rocess 4it1 many
di00erent arieties and sym2toms, muc1
li6e t1e arieties o0 cancer- or decades,
t1e 2ublic astly misunderstood
sc1i5o21renia, 0earin* it as dan*erous and uncontrollable and causin* 4ild disturbances
and iolent outbursts- Many 2eo2le belieed t1at t1ose 4it1 sc1i5o21renia needed to be
loc6ed a4ay 0rom society and institutionali5ed- T1rou*1 2rolon* and in>de2t1 researc1
Only recently 1as t1e mental 1ealt1 industry come to learn and educate t1e community
at lar*e t1at sc1i5o21renia 1as many di00erent si*n and sym2toms and 2resentations
and is an illness t1at medication can control- Clients 41ose illness is medicallysu2erised and 41ose treatment is maintained o0ten continue to lie and sometimes
4or6 in t1e community 4it1 0amily and outside su22ort-
T1e 4ord ?sc1i5o21renia? comes 0rom t1e %ree6 roots sc1i5o @s2lit and 21rene @mind todescribe t1e 0ra*mented t1in6in* o0 2eo2le 4it1 t1e disorder- T1e sym2toms o0sc1i5o21renia and diided into t4o ma+or cate*ories: 2ositie or 1ard sym2toms, 41ic1include delusions, 1allucinations, and *rossly disor*ani5ed t1in6in*, s2eec1, and be1aiorand ne*atie or so0t sym2toms, 41ic1 include 0lat a00ect, lac6 o0 olition, and social4it1dra4al or discom0ort-
'aranoi! schi%ophrenia, also called sc1i5o21renia, 2aranoid ty2e is a sub>ty2e o0
sc1i5o21renia as de0ined in t1e Dia*nostic and Statistical Manual o0 Mental Disorders,
@DSM>I( is t1e most common ty2e o0 sc1i5o21renia in most 2arts o0 t1e 4orld- T1e
clinical 2icture is dominated by relatiely stable, o0ten 2aranoid, delusions, usually
accom2anied by 1allucinations, 2articularly o0 t1e auditory ariety-
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A00ect is usually less blunted t1an in ot1er arieties o0
sc1i5o21renia, but a minor de*ree o0 incon*ruity is common, as
are mood disturbances is also common 41ic1 are described as
irritability, sudden an*er, 0ear0ulness, and sus2icion-
(a&ses
T1e causes o0 sc1i5o21renia are not 0ully 6no4n- !o4eer, it
a22ears t1at sc1i5o21renia usually results 0rom a com2le interaction bet4een *enetic
and enironmental 0actors-
)pi!e#iolo*
Sc1i5o21renia in Sout1eastern Asia
Country +ber of (ases
East Timor ,
Indonesia F,G,HH
"aos G,;;
Malaysia FG;,88
#1ili22ines HG9,8
Sin*a2ore 8,F8
T1ailand 8,H9
(ietnam HH,8GH
Accordin* to t1e record o0 Ca*ayan (alley Medical Center 2syc1iatry de2artment 0rom
'an- 'uly o0 ;F;, t1ere 4ere 2atients admitted in 0emale 4ard, and amon* t1ose
2atients t1ere 4ere H cases o0 sc1i5o21renia- T1ere are HG9,8 cases o0
sc1i5o21renia in t1e #1ili22ines, 98< are males and t1e rest are 0emales- And 8F
million 2eo2le 4orld4ide su00er 0rom sc1i5o21renia in 41ic1 males 1ae t1e 1i*1est
2ercenta*e- @;F, searc1cure
,p!ates
Researc1 1as 0ound a tentatie bene0it in usin* minocycline@antibiotic to treatsc1i5o21renia- T1e addition o0 minocycline to aty2ical anti2syc1otic dru*s in earlysc1i5o21renia 1ad si*ni0icant e00icacy on ne*atie sym2toms but 1ad a sli*1t e00ect ont1e attention domains o0 2atients 4it1 sc1i5o21renia- t1e mec1anism o0 action o0minocycline 4ould include a00ectin* *lutamate 2at14ays in t1e central nerous system,bloc6in* nitric oide>induced neurotoicity, or in1ibitin* micro*lial actiation in t1e brain,
5
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causin* in0lammation- It may be considered as a ne4 ad+unct treatment 0or ne*atiesym2toms o0 sc1i5o21renia-Nidotherapyor e00orts to c1an*e t1e enironment o0 2eo2le 4it1 sc1i5o21renia toim2roe t1eir ability to 0unction, is also bein* studied= a collaboratie treatment inolin*t1e systematic assessment and modi0ication o0 t1e enironment to minimise t1e im2act
o0 any 0orm o0 mental disorder on t1e indiidual or on societyJ- !o4eer, t1ere is notenou*1 eidence yet to ma6e conclusions about its e00ectieness-
Patients Pr!"e
#atient/s name: Mrs- #
%ender: emale
Date o0 Birt1: 'une ;H, FG89
Admittin* dia*nosis: #aranoid Sc1i5o21renia
Ciil status: Married
A*e: 89 yKo
!os2ital L:;888H8
Educational attainment: %rade
Reli*ion: Cat1olic
Address: Sabon* Tabo6, "ae5ares, Nort1ern Samar
Citi5ens1i2: ili2ino
Birt12lace: Samar
Date o0 admission: December F8, ;F @8:; 2m
(hief (o#plaint$
Accordin* to t1e 2atient: #ina*>6a6aisa1an a6o n* m*a 2ulis, na6amanman sila sa
a6in
-istor* of 'resent llness$
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T1e 2atient came 0rom B*y- Tabo6, Nort1ern Samar 41o 4as 6no4n to be
0re7uently inoled in 0i*1ts 4it1 t1e nei*1bors- S1e 4as a22re1ended by NA#O"COM
last 'uly ;F- S1e 0iled a case a*ainst 2olicemen batterin* 1er and 4as t1en re0erred
to DO! by a teleision 2ro*ram o0 Tul0o and Attorney #ersida Acosta- S1e 4as t1en
re0erred to NCM! to ac7uire a medical certi0icate attestin* t1at s1e is ca2able to stand
trial a*ainst t1e 2olicemen 41o alle*edly abused 1er- S1e came alone and 4as
irritable, 0urious, cursin* and 4as 21ysically iolent 1ence admission in NCM!-
'ast #e!ical histor*$
#atient 1as no 6no4n 1istory o0 !#N, DM, #TB and ot1er medical disease-
No 2reious 1os2ital con0inement-
/a#il* health histor*$
No 6no4n 0amily 1ealt1 1istory o0 !#N, DM, #TB and ot1er medical disease-
*sical )a#ination
PHYSICAL E#A$ %NOIDENTIFIEDPHYSICALABNOR$ALITIES&
HEADnormocephalic, symmetrical facial
-movements, smooth without
masses or depressions and
symmetrical facial movements
NEC' no abnormal
swelling or masses
EYES no discharge and pink
conunctiva
EARS
no lesions or discoloration
NOSE nasal !aring
$OUTH
dry mouth, cracked lips
TEETH "ncomplete
CHEST
e#ual chest e$pansion, clear breath sounds
%
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ABDO$EN
&lat, soft, normoactive, no
tenderness
E#TRE$ITIES full and e#ual
pulses
ental Stat&s )a#
#atient seen and eamined an adult 0emale o0 aera*e 1ei*1t and 4ei*1t- S1e 1as
bro4n s6in 4it1 s1oulder len*t1 blac6 1air- S1e 4as clad in red 1os2ital *o4n, 0airly
*roomed- S1e 1as 0air sustained eye contact- S1e 4as coo2eratie- 3it1 2syc1omotor
a*itation noted- Mood is labile- S2eec1 is s2ontaneous, 1y2er2roductie, audible andclear- #atient denied any 2erce2tual disturbances- S1e denied any 1omicidal and
suicidal t1ou*1ts- S1e still 1as 2ersecutory delusions- S1e became teary eyed 41en
as6ed about 41at 1a22ened at t1e 2olice station in t1e 2roince- Na6amanman an*
m*a 2ulis 2ero 4ala na naman sila- #atient is alert and oriented- S1e 1as 2oor insi*1t
4it1 im2aired +ud*ment and im2ulse control-
+e&roloical )a#
conscious, co1erent, 1y2er2roductie s2eec1, oriented to time and 2lace, able to do sim2le
commands
(ranial +erves
CN I> smell intact
CN II> 2u2ils e7ually round and reactie to li*1t
CN III, I(, (I> intact EOM
CN (> can clenc1 teet1
CN (II> no 0acial asymmetry
CN (III> intact 1earin*
CN I, > uula at t1e midline
CN I> s1ru*s s1oulders
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CN II> ton*ue is midline, no atro21y
's*schosocial heories of evelop#ent
Eri6sonJs sta*es o0 2syc1osocial deelo2ment, as articulated by Eri6 Eri6son, is a
2syc1oanalytic t1eory 41ic1 identi0ies ei*1t sta*es t1rou*1 41ic1 a 1ealt1ily deelo2in*
1uman s1ould 2ass 0rom in0ancy to late adult1ood- In eac1 sta*e, t1e 2erson con0ronts,
and 1o2e0ully masters, ne4 c1allen*es- Eac1 sta*e builds u2on t1e success0ul
com2letion o0 earlier sta*es- T1e c1allen*es o0 sta*es not success0ully com2leted may
be e2ected to rea22ear as 2roblems in t1e 0uture-
LIFE STA(E
INDICATIONS
OF POSITI)E
RESOLUTION
INDICATIONS
OF NE(ATI)E
RESOLUTION
ASSESS$ENT *USTIFICATION
nfanc* birth to 1 12
*ears ol!
(entral as$ r&st vs
istr&st
Centers on t1e in0ant/s
basic needs bein* met
by t1e 2arents- T1e
in0ant de2ends on t1e
2arents, es2ecially t1e
mot1er, 0or 0ood,
(earning
how to
trust others
)istrust,
withdrawal,
enstrangemen
t
)istrust *er mother did not
breastfeed her+
he was taken
care of by her
grandmother for ayear while her
mother worked+
(ola ko ang nag-
palaki sa akin+
)adalas ako iwan
ng nanay ko kasi
.
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sustenance and com0ort-
I0 t1e 2arents e2ose t1e
c1ild to 4armt1 and
de2endable a00ection,
t1e in0ant/s ie4 o0 t1e
4orld 4ill be one o0 trust-But i0 t1e care*iers are
ne*lect0ul, t1e in0ant
instead learns t1at t1e
4orld is un2redictable
and unsa0e 2lace-
nagtrabaho siya+/
)arl* chil!hoo! 1 8 3
*ears ol!
(entral as$
:&tono#* vs Sha#e
an! o&bt
I0 care*iers encoura*e
sel0>su00icient be1aior,
c1ild deelo2s a sense
o0 autonomy> a sense o0
bein* able to 1andle
t1in*s on t1eir o4n- But
i0 care*iers demand too
muc1 too soon, re0use tolet c1ildren 2er0orm
tas6s o0 41ic1 t1ey are
ca2able= t1ey may
instead deelo2 s1ame
and doubt about t1eir
ability to 1andle t1in*s-
elf-co
ntrol
without loss
of self
esteem0
ability to
cooperate
and
e$press
oneself
Bo4el control:
F P years old
Daytime
bladder
control:
P years old
ompulsive
self-discipline
or
compliance0
willfulness and
deance
utonomy he client was
potty trained when
she was 2 years
old+
"ate (hil!hoo! 36
*ears ol!
(entral tas$ nitiative
vs G&ilt
T1e c1ild learns to ta6e
initiatie and *et ready
0or leaders1i2 and *oal
ac1ieement roles-
(earning
degree of
assertivene
ss and
purposein!uence
the
environmen
t 0 begins to
evaluate
ones own
ver
restriction of
own desired
activity
7uilt he client did not
engage much in
childhood play+ *er
mother did not
allow her to playoutside and
compelled her to
go shing with his
father on a regular
basis to earn a
living+
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behavior
9i ako
pinapayagan mag-
laro sa labas,
nagagalit nanay
ko+ :inapasamaako mangisda
kasama ang tatay
ko kasi doon kami
kumikita+/
School :e 712 *ears
ol!
(entral as$ n!&str*
vs nferiorit*
C1ildren are ea*er to
learn and accom2lis1
more com2le s6ills=
readin*, 4ritin*, tellin*
time-
9eveloping
sense of
competenc
e and
perseveran
ce
ense of
being
mediocre0
withdrawal
from peers
and school
"nferiority 9isplayed poor
performance in
school due to
absences+ he
withdraws herself
with her
classmates+ he
only has a few
friends due to lack
of interaction with
them+ he dropped
out of school in 4th
grade due to
nancial reasons+
!indi a6o
masyadon*na6a6a2aso6 sa
es6u4ela 6asi 6a2os
at nan*in*isda 6ami
n* tatay 6o at
tumutulon* din ma*>
tinda sa 2alen*6e-:!olescence 1221
*ears ol!
(entral as$ !entit*
vs Role (onf&sion
Concerned 4it1 1o4
t1ey a22ear to ot1ers-
T1e sense o0 central
identity a22ears t1rou*1
seual, emotional,
Sense o0 sel0
and 2lans to
actuali5e
one/s abilities
eelin*s o0
con0usion,
2ressure,
1esitancy
Role
Con0usion
At t1e a*e o0 F, 1er
mot1er 1ad arran*ed
marria*e 0or 1er to be
ec1an*ed 0or a co4-
%usto 6asi n* nanay
6o n* mala6in* ba6a-
Na*lalaro 2a n*a a6o
noon nun* sinundo
a6o sa ba1ay n*
ma*ulan* n*
ma*i*in* asa4a 6o-
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educational, et1nic,
cultural and ocational
discoery-
$na a6on* na*>
6aana6 nun* FH 2a
lan* a6o at sunod
sunod na yun*
dala4a 6o 2an*
ana6, isan* taon 2alan* an* 2a*itan
)arl* :!<hoo!
2135 *ears ol!
(entral as$ nti#ac*
;s solation
ormin* adult, loin*
relations1i2s and
meanin*0ul attac1ments
to ot1ers-
Intimate
relations1i2
4it1 anot1er
2erson and
1as a sense
o0
commitment
to 4or6 and
relations1i2s
Aoidance o0
relations1i2,
career or
li0estyle
commitments
Isolation !er s2ouse 4or6ed
abroad in Dubai 0or
years as a
construction 4or6er-
S1e stayed at 1ome
and too6 care o0 1er
c1ildren and 1ad a
small sari>sari store-
S1e 1ad a rou*1
relations1i2 4it1 1er
inla4s re*ardin*
0inancial matters-
Mata*al 6amin* na*>
6a4alay n* asa4a
6o, 6asi na*traba1o
siya sa Dubai-
!inu1ut1utan sya n*
biyenan 6o at
2ina6ulam 2a a6o n*m*a 6ama* ana6 n*
asa4a 6o 2ara
ma6u1a nila m*a
ana6 6o- Itinali at
*ina2os- Nun*
nalaman n*
ma*ulan* 6o 6inu1a
nila a6o- Na*>1i4alay
na rin 6ami n* asa4a
6o 2a*>6au4i niya
6asi natata6ot a6o sa
2amilya niya ba6a
*a4an nila a6o ulit n*
masama-
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i!!le :!<hoo! 35
65 *ears ol!
(entral as$
Generativit* vsStanation
Contributin* to society
and 1el2in* to *uide
0uture *enerations-
31en a 2erson ma6es a
contribution durin* t1is
2eriod, 2er1a2s by
raisin* a 0amily or
4or6in* to4ard t1e
betterment o0 society> a
sense o0 2roductiity and
accom2lis1ment-
3or6in*
to4ards t1e
betterment o0
society=
bein*
2roductie
"ac6 o0
2roductiity, not
1el2in* society
to moe 0or4ard
%eneratiity S1e 4or6ed as a
1ouse serant 0or F;
years and saed u2
1er earnin*s- S1e
t1en started a small
u6ay>u6ay businessbac6 in t1e 2roince
41ic1 4as doin* 4ell
0or years until s1e
4as a22re1ended by
2olicemen and 4as
detained and
subse7uent
admission at NCM!-
"umu4as a6o n*
Manila at namasu6an
n* sam2un* taon-
Na6a2a* i2on at
umu4i n* 2robinsya
u2an* ma*>um2isa
n* u6ay u6ay-
Mala6as an* benta
n* m*a 2aninda 6o-
#a*6ata2os n*
tatlon* taon bi*la nalan* a6on* 1inuli n*
m*a 2ulis at 6inulon*
na 4alan*
6ada1ilanan-
GORO+
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'ROR O :SSO+ ,'O+ )=:+:O+
-):"- ')R()'O+ :+
:+:G))+
No re*ular c1ec6 u2
4it1 t1e doctor
%oes to Albularyo
41en sic6
Ta6es otc dru*s 0ormild 0eer and colds
and use o0 1erbal
medicines
3illin* to listen to
1ealt1 teac1in*s
Com2liance 4it1
medication re*imen
Accordin* to 2atientMaluso* naman a6o
6aya lan* na* iisi2 a6o
6un* 6elan a6o
ma6a6alabas-
+,RO+:"):>O"( Eats a day @t1ere
are times t1at s1e
s6i22ed meals
because o0 1er 4or6
Drin6s 8>H *lasses o0
4ater eeryday
%ood a22etite
is1 and e*etables
Eats a day meal
Drin6s >8 *lasses o0
4ater eeryday
)"+:O+ $rinates 8>H times
daily 4it1out any 2ain
or di00iculty
Normal daily bo4el
moement in t1e
mornin*
(oids yello4 turbid
colored urine at least
> times a day
De0ecates 0ormed
stool once eery t4o
days
:(;?)=)R(S)
Could 2er0orm AD" 3or6s almost
eeryday
Stays in t1e cornerinside t1e 4ard
Aoid social interaction
4it1 ot1ers(OG+;)')R()',:" Could do sim2le
calculations
Intact memory and 1as
*ood 0und o0
6no4led*e
Res2onds
a22ro2riately to
21ysical and erbalstimuli
#atient denied suicide
and 1omicidal t1ou*1t
Denied any 2erce2tual
disturbances
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S"))'R)S Normal 8>H 1ours o0
slee2 daily and no
na2s durin* t1e day
Aera*e o0 8 1ours o0
slee2 daily
re7uent a4a6enin*s
due to noises and
di00iculty o0 *oin* bac6
to slee2
S)"/')R()'O+S)"/ (O+()'
Sees 1ersel0 4it1 *ood
2ersonality
Describes 1ersel0 as
Masaya1in a6o tao at
matulun*in noon*
ara4
Accordin* to 2atient
Matanda at ma1ina na
a6o Diyos nalan*
na6a6aalam sa bu1ay
6o
RO")R)":O+S-' Married but se2arated
0or almost ; years
3it1 c1ildren@1as not
seen t1em since ;;8
No contact 4it1 1er
0amily
!as not seen 1er
c1ildren since ;;8
Absent o0 su22ort
system
S)=,:"?
R)'RO,(;)
Not seually actie Se2arated 4it1
1usband 0or ; years
Not seually actie
(O'+GSR)SS
O")R:+()
Does not drin6 alco1ol
Does not smo6e
&ee2s 2roblem to
1ersel0
Social isolation
#reoccu2ation 4it1
un+usti0ied doubts
about trust4ort1inesso0 0riends
;:",)>)")/ Roman Cat1olic
Attends Sunday mass
No restrictions in any
treatments brou*1t by
reli*ion
15
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COURSE IN THE +ARD
:? 1 arch 3 2015 Nurse/s Notes:;;am F:;; noon
Assisted in administration o0 medications @Ris2eridone m*
BID, multiitamins F tab OD, bi2eriden m* #RN,
Receied 2atient in clean 1os2ital *o4n, 0airly *roomed, and
4earin* sli22ers
Brou*1t client out 0rom t1e 4ard to t1e actiity area
E2lained roles as a student nurse
Conducted nurse 2atient interaction: Orientation 21ase
%at1ered 2ertinent data about t1e client
Discussed duration and limitations o0 t1e relations1i2
are de0ined
Discussed nurse and 2atient interaction 0rom eac1ot1er
Ra22ort is built by demonstratin* acce2tance and
non>+ud*mental attitude
Establis1ed trust
As6ed client about t1e 2ositie bene0its o0 re*ular eercise
acilitated dance eercise @S2a*1etti
Stated Na6a6abu1ay n* du*o
%ames conducted@21ysical and mental *ames
Re0used to 2artici2ate @s1o4ed discom0ort and 4as
uncommunicatie 4it1 team members
Sered snac6 and drin6 @re0used to eat
%ame 2ri5es *ien
Assisted 4it1 1y*iene care
Assisted 2atient bac6 to 4ard
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:? 2 arch 4 2015 Nurse/s Notes
:;;am F:;;noon
Assisted in administration o0 medications @Ris2eridone m*
BID, multiitamins F tab OD, bi2eriden m* #RN,
Receied 2atient in clean 1os2ital *o4n, 0airly *roomed, and
4earin* sli22ers
Brou*1t client out 0rom t1e 4ard to t1e actiity area
As6ed client about t1e 2ositie bene0its o0 re*ular eercise
acilitated dance eercise @S2a*1etti
Stated Na6a6a2a*2ala6as
%ames conducted @21ysical and mental *ames
#artici2ation and coo2eration noted
Music and art t1era2y 2roided
As6ed to e2lain 1er dra4in* @3rote Na6a6alun*6ot an*
6anta and dre4 a small 0lo4er
Sered snac6 and drin6
A4arded *ame 2ri5es
Assisted 4it1 1y*iene care
Conducted nurse 2atient interaction: Orientation 21ase
%at1ered 2ertinent data about t1e client
Discussed duration and limitations o0 t1e relations1i2
are de0ined
Discussed nurse and 2atient interaction 0rom eac1
ot1er
Ra22ort is built by demonstratin* acce2tance and
non>+ud*mental attitude
Establis1ed trust
Assisted 2atient bac6 to 4ard
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:? 3 arch 9 2015 Nurse/s Notes:;;am F:;;noon
Assisted in administration o0 medications @Ris2eridone m*
BID, multiitamins F tab OD, bi2eriden m* #RN,
Receied 2atient in clean 1os2ital *o4n, 0airly *roomed, and
4earin* sli22ers
Brou*1t client out 0rom t1e 4ard to t1e actiity areaAs6ed client about t1e 2ositie bene0its o0 re*ular eercise
acilitated dance eercise @S2a*1etti
%ames conducted
#artici2ation and coo2eration noted
Remotiation t1era2y 2roided
Stimulated social s6ills and interest in t1eir enironment
As6ed to e2lain 1er dra4in* @3rote Na6a6alun*6ot an*6anta and dre4 a small 0lo4er
Sered snac6 and drin6
A4arded *ame 2ri5es
Assisted 4it1 1y*iene care
Conducted nurse 2atient interaction: 3or6in* #1ase
Maintained relations1i2 and trust
Encoura*ed client in sel0>disclosure
#romoted a 2ositie sel0>conce2t
Ealuated and rede0ined *oals as a22ro2riate
Assisted 2atient bac6 to 4ard
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:? 4 arch 10 2015 Nurse/s Notes:;;am F:;; noon
Assisted in administration o0 medications @Ris2eridone m*
BID, multiitamins F tab OD, bi2eriden m* #RN
Receied 2atient in clean 1os2ital *o4n, 0airly *roomed, and
4earin* sli22ers
Brou*1t client out 0rom t1e 4ard to t1e actiity area
As6ed client about t1e 2ositie bene0its o0 re*ular eercise
acilitated dance eercise @S2a*1etti
Stated Na6a6a2a*2ala6as
%ames conducted
#artici2ation and coo2eration noted
Bibliot1era2y 2roided
Stimulated 2atient to e2lore t1e real 4orld
As6ed to re0lect on 41at 4as read
Sered snac6 and drin6
A4arded *ame 2ri5es
Assisted 4it1 1y*iene care
Conducted nurse 2atient interaction: 3or6in* #1ase
Maintained relations1i2 and trust
Encoura*ed client in sel0>disclosure
#romoted a 2ositie sel0>conce2t
Ealuated and rede0ined *oals as a22ro2riate
Assisted 2atient bac6 to 4ard
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:? 5 arch 11 2015 Nurse/s Notes:;; F:;; noon
Assisted in administration o0 medications @Ris2eridone m*
BID, multiitamins F tab OD, bi2eriden m* #RN
Receied 2atient in clean 1os2ital *o4n, 0airly *roomed, and
4earin* sli22ers
Brou*1t client out 0rom t1e 4ard to t1e actiity areaAs6ed client about t1e 2ositie bene0its o0 re*ular eercise
acilitated dance eercise @S2a*1etti
Stated Na6a6a2a*2ala6as
%ames conducted
#artici2ation and coo2eration noted
Bibliot1era2y 2roided
Stimulated 2atient to e2lore t1e real 4orld
As6ed to re0lect on 41at 4as read
Sered snac6 and drin6
A4arded *ame 2ri5es
Assisted 4it1 1y*iene care:
Conducted nurse 2atient interaction: Termination #1ase
Assessed client emotional stability
Tal6ed about 2ro*ress o0 t1e relations1i2
Assisted 2atient bac6 to 4ard
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PSYCHOTHERAPIES
:ctivit* Goals St&!ent+&rse (lient
:erobics an! )ercise
>To 2romote 21ysical and
mental 1ealt1
>To let client dance actiely
acilitated S2a*1etti mornin*
eercise dance
Coordinated moements and
stated Na6a6abu1ay n*
du*o
Recreational herap*
>To 1el2 t1e client ac1iee a
balance o0 4or6 and 2lay in
1er li0e
>To 1el2 client sociali5e 4it1
ot1ers
>En1ance memory>Encoura*e 2artici2ation and
coo2eration
acilitated arious indiidual
and team *ames- #roided
re4ards 0or t1e 4inners and as
4ell as consolation 2ri5es-
Durin* t1e 0irst day s1e
s1o4ed discom0ort
interactin* and 4as
uncommunicatie 4it1 team
members- T1e 0ollo4in* day
s1e 2artici2ated and 4as
more coo2eratie-
/oo! an! +&trition
>To 2roide t1e necessary
nutritional needs o0 t1e client
#roided *o, *ro4, and *lo4
li*1t meals
Dis2layed *ood a22etite-
Re#otivation herap*
>To stimulate communication,
ocational, and social s6ills
and interest in t1eir
enironment
acilitated t1e readin* and
ob+ectie e2lanation o0 a
2oem entitled, An* *ulay
S1e 2roided ariety o0
di00erent eam2les o0
e*etables and t1eir di00erent
uses-
>ibliotherap*
>Deelo2 ability to re0lect on
41at 4as read
>To stimulate 2atients to be
0ello4 and e2lore t1e real
4orld
acilitated t1e readin* and
re0lection on a s1ort story
called, N* Da1il Sa #era
Attentie= 41en as6ed about
41at s1e learned, s1e
stated, N* da1il sa 2era sila
ay na*1ira2
&sic an! :rts herap*
>To enable t1e client identi0y
and 4or6 on resolin* issues
Instructed to dra4 usin*
crayons 41ile listenin* to a
slo4 son* T1ousand )ears in
t1e bac6*round
3rote Na6a6alun*6ot an*
6anta and dre4 a small
0lo4er-
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t1rou*1 music and arts
>To e2ress ideas and 0eelin*s
>To 1el2 client e2ress 1er
t1ou*1ts
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ANATO$Y AND PHYSIOLO(Y
The brain is one of the most complex and magnificent organs in the human body. Ourbrain gives us awareness of ourselves and of our environment, processing a constant
stream of sensory data. It controls our muscle movements, the secretions of ourglands, and even our breathing and internal temperature. Every creative thought,
feeling, and plan is developed by our brain. The brains neurons record the memory ofevery event in our lives.The brain controls thoughts, memory and speech, arm and legmovements, and the function of many organs within the body. It also determines howpeople respond to stressful situations (i.e. writing of an exam, loss of a ob, birth of a child,
illness, etc.! by regulating heart and breathing rates. The brain is an organi"ed structure,divided into many components that serve specific and important functions.
T1e cerebral 1emis21eres o0 t1e brain are diided into 2airs o0 lobes as 0ollo4s:
rontal t1e lar*est lobe, located in t1e 0ront o0 t1e brain- T1e ma+or 0unctions o0 t1is
lobe are concentration, abstract tho&ht, infor#ation storae or #e#or*, and
#otor f&nction- It contains Broca/s area 41ic1 is located in t1e le0t 1emis21ere and is
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critical 0or #otor control of speech- T1e 0rontal lobe is also res2onsible in lar*e 2art
0or a personle0t orientation-
Tem2oral located in0erior to t1e 0rontal and 2arietal lobes, t1is lobe contains t1e
auditory rece2tie areas and 2lays a role in memory o0 sound and understandin* >
Occi2ital located 2osterior to t1e 2arietal lobe, t1is lobe is res2onsible 0or isual
inter2retation and memory-
+e&rotrans#itters$
Do2amine> Plays important roles inmotor control,motivation,arousal, cognition, andreward.
Serotonin> Res2onsible 0or maintainin* mood balance, 0ood inta6e control, slee2 and
4a6e0ulness and tem2erature re*ulation
%lutamate> Ma+or mediator o0 ecitatory si*nals in t1e central nerous system and is inoled in
most as2ects o0 normal brain 0unction includin* co*nition, memory and learnin*-
http://en.wikipedia.org/wiki/Motor_controlhttp://en.wikipedia.org/wiki/Motivationhttp://en.wikipedia.org/wiki/Arousalhttp://en.wikipedia.org/wiki/Reward_systemhttp://en.wikipedia.org/wiki/Motor_controlhttp://en.wikipedia.org/wiki/Motivationhttp://en.wikipedia.org/wiki/Arousalhttp://en.wikipedia.org/wiki/Reward_system -
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'S?(-O':-O"OG?
Eti",
ocial &actors"ndividual "nterpersonal
-eparation
fromchildren;spou
se
-health
-ge 5%
-elease of hormone adrenaline, noradrenaline,
cortisol
daptive energy is drained out
9ecrease blood supply in the
brain
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&rontal lobe hypometabolism
difficulty
concentrating
hostile
suspiciousness
:ersecutory delusion
ctions of?
-dopamine
- serotonin
-glutamate
)alfunction of
transmission in
electrical impulses
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LABORATORY RESULT
He.at",
He.at", Res/"t Nr.a" )a"/es
RBC
+BC
He.,"0in
He.at1rit
Diferential Count
Ne/tri"
L.1te
$n1te
Esini"
P"ate"et C/nt
RD+
Red Cell Indices
$C)
$CH
$CHC
4+'
6+6
125
8+3'
8+68
8+25
8+85
8+82
333
8+13
''
2.+2
332
4+6 @ 1812 ;(
5+18 @ 18. ;(
128-168 g;(
8+ 36 -8+42
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inalysis
(rss E4a.inatin $i1rs1i1 !n5in,s
C"r: Ye""6
Transaren1: T/r0i5
Se1i!1 ,ra7it: 892
H: A1i5i1
Prtein: Psiti7e%;;&
S/,ar: ne,ati7e
+BC: 2< -2=
RBC: 3->
Eite"ia" 1e""s: $5erate
$/1/s Trea5s: Fe6
A.r/s /rates: $5erate
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DRU( STUDY
r& +a#e r& (lass r&
Rationale
:ction Si!e )ffects +&rsin (onsi!eration
%eneric
Name:
Risperi!one
Brand Name:
Risper!al
m* BID
Aty2ical
Anti2syc1o
tics
is used to
treat certain
mentalKmood
disorders
@suc1 as
sc1i5o21renia, bi2olar
disorder,
irritability
associated
4it1 autistic
disorder-
T1is
medication
can 1el2 you
to t1in6
clearly and
ta6e 2art in
eeryday li0e-
Bloc6s
do2amine
rece2tors in
t1e brain-
@non obsered
>4ei*1t *ain
>dro4siness
>di55iness
>droolin*
>nausea
>muscles2asms
>tremors
>insomnia
>E2lain t1e im2ortance and action o0 t1e dru*
> Monitor 2atient 0or tardie dys6inesia, 41ic1 may occur a0te
2rolon*ed use- It may not a22ear until mont1s or years later
and may disa22ear s2ontaneously or 2ersist 0or li0e, des2ite
sto22in* dru*-
http://www.webmd.com/mental-health/mood-disordershttp://www.webmd.com/mental-health/mood-disordershttp://www.webmd.com/schizophrenia/default.htmhttp://www.webmd.com/schizophrenia/default.htmhttp://www.webmd.com/bipolar-disorder/default.htmhttp://www.webmd.com/bipolar-disorder/default.htmhttp://www.webmd.com/mental-health/mood-disordershttp://www.webmd.com/mental-health/mood-disordershttp://www.webmd.com/schizophrenia/default.htmhttp://www.webmd.com/schizophrenia/default.htmhttp://www.webmd.com/bipolar-disorder/default.htmhttp://www.webmd.com/bipolar-disorder/default.htm -
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%eneric
Name:
biperi!en
Brand Name:
:ineton
m* #RN
Antic1oline
r*ic
#reent E#S
secondary to
neurole2tic
dru* t1era2y
side e00ects
be0ore t1ey
actually
occur-
Synt1etic
antic1oliner*ic
dru*, bloc6s
c1oliner*ic
res2onses in t1e
CNS
Dry mout1
>dry mout1
>blurred
ision
>dro4siness
>urinary
retention
>2ostural
1y2otension
>consti2ation
>a*itation
>Adise 2atient to increase 0luid inta6e to aoid dry mout1 an
consti2ation
r& +a#e r& (lass r&
Rationale
:ction Si!e )ffects +&rsin (onsi!eration
%eneric
Name:
#<ivita#ins
F tab OD
Multiitamin
s and
minerals
>used to
2roide
itamins t1at
are not ta6en
in t1rou*1
t1e diet
>also used to
treat itamin
de0iciencies
#romotes
normal
bioc1emical
reactions,
stren*t1ens
t1e immune
system,
su22orts
normal *ro4t1
and
deelo2ment
and 1el2s
@non obsered
>stomac1
u2set
>1eadac1e
>un2leasant
Aoid ta6in* more t1an one itaminKmineral 2roduct at t1e
same time unless your doctor tells you to- Ta6in* similar
itamin 2roducts to*et1er can result in a itamin oerdose-
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2reent *ro4t1
retardation in
c1ildren and
youn* adult
taste in t1e
mout1
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ASSESS$ENT DIA(NOSIS PLANNIN( INTER)ENTIONS RATIONALE E)ALUATIS&bjective$
#ina*>6a6aisa1an a6o
n* m*a tao- Tatlon*
beses na a6on* 1inuli n*
m*a 2ulis at 6inulon*-
3ala a6on* *ina4an*
masama, minaltrato nila
a6o at lina*ay sa
bartolina as erbali5ed
by t1e client-
Objective$
>1y2eri*ilance
>sus2iciousness
>easily distracted
>a22re1ensie @uneasy
>al4ays on *uard
>socially 4it1dra4n
Disturbed t1ou*1t
2rocess: 2ersecutory
delusion related to
im2aired co*nitie
0unction secondary to
mental illness as
mani0ested by delusional
t1in6in* and
1y2eri*ilance-
S1ort term:
3it1in F day o0 nursin*
interentions, t1e client
4ill conerse about
concrete 1a22enin*s in
t1e enironment 0or at
least F8 minutes or more
durin* nurse 2atient
interaction-
"on* term:
3it1in 4ee6s o0
nursin* interentions,
t1e client 4ill be able to
demonstrate t1at t1e
disturbed t1ou*1ts are
less intense and less
0re7uent
Aoided lau*1in*,
41is2erin*, or tal6in*
7uietly 41ere client can
see but not1ear 41at is bein* said
Bein* sincere 41en
communicatin*- Aoided
a*ue or easie remar6s
Encoura*ed to 2artici2ate
in 4ard actiities and
tau*1t client co2in* s6ills
t1at minimi5e 4orryin*
t1ou*1ts- @tal6in* to
someone, sin*in*, readin*
Consistent in settin*
e2ectations, en0orcin*
rules
Reco*ni5ed t1e client/s
delusions as t1e client/s
2erce2tion o0 t1e
enironment
Did not ar*ue 4it1 t1e
client or try to conince t1e
client t1at t1e delusions are0alse or unreal
Interacted 4it1 t1e client on
t1e basis o0 real t1in*s= did
not d4ell on t1e delusional
t1ou*1ts
Reco*ni5ed and su22ort
client/s accom2lis1ments
@2ro+ects com2leted,
interactions initiated
S1o4ed em2at1y
re*ardin* client/s 0eelin*s=
Sus2icious clients o0ten
beliee ot1ers are tal6in*
about t1em, and
secretie be1aiors
rein0orce t1e 2aranoid
0eelin*s
Easie comments or
1esitation rein0orces
mistrust or delusions-
31en t1in6in* is 0ocused
on reality based
actiities, 1el2s 0ocus
attention eternally and
not on t1e delusions
Clear, consistent limits
2roide a secure
structure 0or t1e client
Reco*ni5in* t1e client/s
2erce2tions can 1el2
understand t1e 0eelin*s
s1e/s e2eriencin*
"o*ical ar*ument does
not dis2el delusional
ideas and can inter0ere
4it1 t1e deelo2ment o0
trust
Interactin* about reality
is 1ealt1y 0or t1e 2atient
Reco*ni5in* t1e client/s
accom2lis1ments can
increase client/s sel0
conce2t and trust on
ot1ers
Em2at1y coneys carin*,
S1ort term:
A0ter F day o
nursin*
interentions
*oal 4as met
T1e client
conersed ab
concrete
1a22enin*s i
t1e enironm
0or at least F8
minutes durin
nurse 2atient
interaction-
"on* term:
A0ter 4ee6s
nursin*
interentions
*oal 4as 2art
met- T1e clie
demonstrated
disturbed
t1ou*1ts are
intense and
0re7uent as
eidenced by
>Delusions 4
not obsered
durin* actiiti
>#artici2ated
more on *rou
actiities
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DA) F
reassured o0 2resence and
acce2tance
Collaboratie: Assisted in
t1e administration o0
Ris2eridone m* @BID
interest and acce2tance
o0 t1e client-
Bloc6s do2aminer*ic
rece2tor sites t1ere0ore
decreasin* delusional
t1ou*1ts o0 t1e client-
ASSESS$ENT DIA(NOSIS PLANNIN( INTER)ENTIONS RATIONALE E)ALUATION
S&bjective$
Ayo6o ma6i1alubilo
sa iba, 2a6iramdam 6o
6asi sasa6tan at
lolo6o1in lan* nila 6o-
as erbali5ed by t1e
2atient-
Objective$
> Social 3it1dra4al
> #re0ers to be alone
> Reluctance to
inole in *rou2
actiities
> #oor eye contact
durin* interaction> $ncommunicatie
4it1 ot1ers
> #re>occu2ation 4it1
o4n t1ou*1ts
> Sense o0 discom0ort
4it1 ot1ers-
Social Isolation
related to disturbed
t1ou*1t 2rocess as
mani0ested by eident
discom0ort in social
situation
S1ort Term:
3it1in 1ours o0
nursin* interentions,
t1e 2atient 4ill
understand causes
and tec1ni7ues to
correct isolation-
"on* Term:
3it1in 4ee6s o0
nursin* interentions,
t1e 2atient 4ill
2artici2ate 4illin*ly in
t1era2eutic actiities
and inole sel0 in
social interaction-
Deelo2 a t1era2eutic
nurse>2atientrelations1i2 t1rou*1
0re7uent brie0
contacts and an
acce2tin* attitude-
Encoura*e 2atient to
e2ress 0eelin*s and
2erce2tions o0
2roblems-
Assess 2atient/s use
o0 co2in* s6ills and
de0ense mec1anisms-
S1o4 unconditional
2ositie re*ard-
#roide 2ositie
rein0orcement 0or
2atient/s oluntary
Acce2tance and
coneyanceen1ances 0eelin*s o0
sel0>4ort1 and
0acilitates trust-
!el2s identi0y and
clari0y reasons 0or
di00iculties in
interactin* 4it1 ot1er
2eo2le-
De0ense
mec1anisms used to
2rotect t1e indiidual
t1at may contribute
to 0eelin*s o0
isolation-
T1is coneys a belie0
in t1e 2atient as a
4ort1 41ile social
bein*-
#ositie
rein0orcement
S1ort Term:
A0ter 1ours o
nursin*
interentions,
t1e 2atient 4as
able to
understand
causes and
tec1ni7ues t1a
corrects isolati
as eidenced b
absence o0
discom0ort in
social situation
"on* Term:A0ter 4ee6s
nursin*
interentions,
t1e 2atient 4as
able to
2artici2ate
4illin*ly in
t1era2eutic
actiities and
inoled sel0 in
social
interaction-
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DA) F
interactions 4it1
ot1ers-
Encoura*e t1e
2atient in reality>
oriented actiities t1at
inoled 1uman
contact 4it1 1er co>
2atient-
en1ances sel0>
esteem and it
encoura*es
re2etition o0 desirable
be1aiors-
To minimi5e stimuli
t1at 4ill tri**er
sym2toms o0 t1e
condition-
ASSESS$ENT DIA(NOSIS PLANNIN( INTER)ENTIONS RATIONALE E)ALUATIONSub+ectie:
$u2a6an na 6ita
dyan e1Q #or6et
matanda na a6o
2ina*6a6aisa1an niyo
a6oQ as erbali5ed by
t1e 2atient in
res2onse to anot1er
clientJs statement-
Ob+ectie:
DA)
Ris6 0or iolence:
directed to ot1ers
related to disturbed
t1ou*1t 2rocess and
ra*e reactions to
t1reatenin* situation
as deliered by
2atient-
S1ort:
3it1in ; minutes o0
2er0ormin* nursin*
interentions, t1e
2atient 4ill learn to
assess situation
realistically be0ore
ta6in* action
"on* term:
3it1in 4ee6s o0
2er0ormin* nursin*
interentions, t1e
2atient 4ill
F- Deelo2 strate*ies
to control im2ulse-
- Re0rain 0rom
1urtin* ot1ers-
Maintained lo4 leel o0
stimuli in client/s
enironment-
>Assisted in identi0yin*
situation and stimuli t1at
initiated an*ry outburst and
t1e means o0 dealin* 4it1
stimuli, suc1 as 4al6in*
a4ay or ta6in* dee2
breat1s
>#roided sa0eenironment by remoin*
all dan*erous ob+ects 0rom
clients/ enironment-
Remained calm and stated
limits on ina22ro2riate
be1aior in a 0irm manner-
Obsered clients be1aior
0re7uently-
As6ed directly i0 client is
t1in6in* o0 actin* on
t1ou*1ts or 0eelin*s-
Reie4ed 4it1 client t1e
0actors @0eelin*s and
eents t1at 2reci2itate
iolent be1aior-
Discussed im2act o0
be1aior on ot1ers and
conse7uences o0 action-
Aniety leel rises in a
stimulatin* enironment
t1us increases iolent
be1aior
#roides in0ormation
needed 0or 2roblem
solin*- T1e client can
t1en identi0y alternatie
res2onses-
Remoal o0 dan*erousob+ects 2reents client
in an a*itated,
con0used state 0rom
usin* t1em to 1arm
ot1ers-
To assist in controllin*
be1aior-
Close obseration is
im2ortant , because
a22ro2riate
interentions can be
2roided immediately
To determine iolent
intent-
To 2roide o22ortunity
0or client to understand
reason and tec1ni7ues
to 2reent iolent
be1aior-
To assist client to
acce2t res2onsibility 0or
im2ulsie be1aior-
S1ort term: A0ter
; minutes o0
nursin*
interentions,
*oal 4as met-
T1e client learned
to assess
situation
realistically be0ore
ta6in* action as
eidenced by
>"eain* t1e
stimulus and
com2osed 1ersel0
>T1en e2lained
1er 0eelin*s in a
noncon0rontin*
manner
"on*term:
A0ter 4ee6s o0
2er0ormin*
nursin*
interentions, t1e
2atient 1asdeelo2ed
strate*ies to
control im2ulse
and re0rained
0rom 1urtin*
ot1ers-
-
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RECO$$ENDATIONS
Medications:
Em21asi5e t1e im2ortance o0 ta6in* medications re*ularly and reli*iously
E2lain t1e indication and side e00ects o0 t1e dru* @lac6 o0 6no4led*e may result
to noncom2liace o0 t1e dru*
Em21asi5e non>com2liance to dru*s results to rela2se
In0orm client to secure disability card 0rom t1e local *oernment and 2resent cardat t1e 21armacy to aail discounted or 0ree medications 41en disc1ar*ed
Enironment:
#roide a sa0e and secure enironment-
Enironmental sanitation is needed to 2roide a 1ealt1y mind and body
reat#ent$
amily t1era2y @su22ort *rou2 aailable 0or 0amilies relaties 41erein t1ey *at1er
once a mont1 to 1el2 t1em deal 4it1 liin* 4it1 a 0amily member 4it1 mentalillness
Encoura*ed to as6 7uestions @2re2aration o0 disc1ar*e
-ealth eachin$
!ae ade7uate slee2 and eercise eeryday
Aoid alco1ol- Alco1ol interacts 4it1 medicine used to treat sc1i5o21renia-
Continue 2artici2atin* in t1era2eutic actiities
#romote sel0>care, 2ersonal 1y*iene and actiities o0 daily liin*,
Instruct t1e 0amily members to monitor t1e client/s 2erce2tion in reality-
O&tpatient$
ollo4>u2 c1ec6 u2s
-
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Return i0 2roblems 4it1 slee2 and eatin* 2attern 4ill be obsered and 1ae
7uestions or concerns about condition o0 care-
iet an! +&trition$
31ole>*rain carbo1ydrates, antioidants @0ruits and niacin- C1ic6en, 2eanuts,
salmon, and tur6ey are ric1 sources o0 Niacin, 41ic1 1el2s conert 0ood intoener*y, 1el2in* essential 0atty>acid metabolism o0 t1e brain-
Reduce inta6e o0 su*ar, re0ined carbo1ydrates, ca00eine and stimulant dru*s
Eat lo4 *lycemic load diet