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Mr. G a 49yr old male single patient in Mother Theresa was born on March 12, 1960. He
weight 74 pounds and height of 54. He lived at barrio matalaba samar. He has a Filipino
nationality and his religion is Roman catholic. He is maritime graduate. He was admitted
at mother theresa on August 13, 2011, involuntarily and accompanied by his relatives
especially his sister Arlene. His sister decided to admit Mr. G due to unwanted behavioral
changes like restlessness and Sleeping disturbance. He was diagnosed as undifferentiated
schizophrenia and now his current diagnosis was undifferentiated schizophrenia.
Undifferentiated schizophrenia
is a mental disorder which is part of the family of disorders broadly known as
schizophrenia. There are a number of subcategories of schizophrenia including
paranoid schizophrenia, catatonic schizophrenia, disorganized schizophrenia, residual
schizophrenia,
and schizoaffective
often
defined as a form in which enough symptoms for a diagnosis are present, but the patient
does not fall into the catatonic, disorganized, or paranoid subcategories.
Schizophrenia is characterized by a lack of grounding in reality, known as psychosis.
People in a state of psychosis can experience hallucinations, delusions, and other events
in which they break from reality. Individuals with schizophrenia experience psychosis
and can also develop symptoms such as disorganized speech, lack of interest in social
interactions, a flat affect, inappropriate emotional responses to situations, confusion, and
disorganized thinking.
paranoid schizophrenia,
the
catatonic
state
seen
in
patients
with
Psychopathology
Causes
One of the reasons for the ongoing difficulty in classifying schizophrenic disorders is
incomplete understanding of their causes. It is thought that these disorders are the end
result of a combination of genetic, neurobiological, and environmental causes. A leading
neurobiological hypothesis looks at the connection between the disease and excessive
levels of dopamine, a chemical that transmits signals in the brain (neurotransmitter). The
genetic factor in schizophrenia has been underscored by recent findings that first-degree
biological relatives of schizophrenics are ten times as likely to develop the disorder as are
members of the general population.
Prior to recent findings of abnormalities in the brain structure of schizophrenic patients,
several generations of psychotherapists advanced a number of psychoanalytic and
sociological theories about the origins of schizophrenia. These theories ranged from
hypotheses about the patient's problems with anxiety or aggression to theories about
stress reactions or interactions with disturbed parents.
Symptoms
Patients with a possible diagnosis of schizophrenia are evaluated on the basis of a set or
constellation of symptoms; there is no single symptom that is unique to schizophrenia. In
1959, the German psychiatrist Kurt Schneider proposed a list of so-called first-rank
symptoms, which he regarded as diagnostic of the disorder.
These symptoms include:
delusions
somatic
hallucinations
History
The patient diagnosed as undifferentiated schizophrenia and current undifferentiated
schizophrenia. He has lesions in legs, arms, back of the body and knee. He does not
undergo in any surgery. His medications are only for his mental illness. His previous
medications are Nozinan and haloperidol. His current medications are nozinan,
haloperidol and chlorpromazine.
Related Treatment
Mr. G is now receiving a Haloperidol 1mg tablet, which an typical antipsychotic
medication. It works by changing the effects of chemicals in the brain. It is used to treat
undifferentiated schizophrenia. Haloperidol 10mg/capsule it is used in the treatment of
schizophrenia and is also used in the management of pain, distress, nausea and vomiting
associated with terminal illness. Nozinan 10mg/ capsule it is used in the treatment of
schizophrenia and is also used in the management of pain, distress, nausea and vomiting
associated with terminal illness. Chlorpromazine is used to treat the symptoms of
schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest
in life, and strong or inappropriate emotions) and other psychotic disorders (conditions
that cause difficulty telling the difference between things or ideas that are real and things
or ideas that are not real) and to treat the symptoms of mania (frenzied, abnormally
excited mood) in people who have bipolar disorder (manic depressive disorder; a
condition that causes episodes of mania, episodes of depression, and other abnormal
moods).
the patient must have two (or more) of the following symptoms during a onemonth period: delusions; hallucinations; disorganized speech; disorganized or
catatonic behavior; negative symptoms
Nursing intervention
1. Assess the patient's ability to carry out the activities of daily living, paying special
attention to his nutritional status. Monitor his weight if he isn't eating. If he thinks that
his food is poisoned, allow him to fix his own food when possible, or offer him foods
in closed containers that he can open. If you give liquid medication in a unit-dose
container, allow the patient to open the container.
2. Maintain a safe environment, minimizing stimuli. Administer medication to decrease
symptoms and anxiety. Use physical restraints according to your facility's policy to
ensure the patient's safety and that of others.
3. Adopt an accepting and consistent approach with the patient. Don't avoid or
overwhelm him. Keep in mind that short, repeated contacts are best until trust has
been established.
4. Avoid promoting dependence. Meet the patient's needs, but only do for the patient
what he can't do for himself.
5. Reward positive behavior to help the patient improve his level of functioning.
6. Engage the patient in reality-oriented activities that involve human contact: inpatient
social skills training groups, outpatient day care, and sheltered workshops. Provide
reality-based explanations for distorted body images or hypochondriacal complaints.
Clarify private language, autistic inventions, or neologisms, explaining to the patient
that what he says isn't understood by others. If necessary, set limits on inappropriate
behavior.
Evaluation
The client was able to maintain reality orientation. He is oriented to time when asked
what day it is. The patient was demonstrate behaviors that show positive self esteem as
evidenced by inability to have an eye contact.
Recommendation
He is advised to take part in complying with the treatment; the medication and
therapeutic regimen designed for his rehabilitation. He should realize the importance of
complying with his medication and the benefits this practice would bring to the
improvement of his well-being. Even if nursing students find it difficult to establish
therapeutic relationships with mentally-ill patients because of the relatively short time
spent in the clinical area, still we have to render amounts of effort, time and trust to our
patients; and improve our therapeutic technique in caring for our patients; that we may
play a part in the rehabilitation of our mentally-ill patients.
Diagnosis
Self care deficit bathing/ hygiene related to lack of motivation. The patient has an
impaired ability to provide self care requisites due to environmental and psychological
factors.
Planning
After 2 hours of nusing care, the client will be able to
a) Verbalize self care need
b) Demonstrate techniques to meet self care needs
Interventions
1. Establish rapport.
R: to gain clients trust and facilitate a good working relationship.
2. Identify reason for difficulty in self-care.
R: underlying cause affects choice of interventions/ strategies.
3. Determine hygienic needs and provide assistance as needed with activities like
care of nails and brushing teeth.
R: basic hygienic needs may be forgotten.
4. Discuss on importance of hygiene.
R: makes client aware of how hygiene is vital in caring for oneself.
5. Orient client to different equipment for self-care like various toiletries.
R: increases the clients awareness of different materials for self-care.
6. Let the patient enumerate his ideas on the importance of hygiene.
R: Encourages the patient to understand the need for hygiene.
7. Discuss the possible negative implications of not taking a bath such as infections
and odor.
R: Broadens the patients idea about the problem and encourages him to meet the
need.
8. Encourage client to perform self-care to the maximum of ability as defined by the
client. Do not rush client.
R: promotes independence and sense of control, may decrease feelings of
helplessness.
9. Allot plenty of time to perform tasks.
R: cognitive impairment may interfere with ability to manage even simple activities.
10. Assist with dressing neatly or provide colorful clothes.
R: Enhances esteem and convey aliveness.
Evaluation
GOAL PARTIALLY MET
After 2 hours of nursing care, the client was able to:
T: 36.5C
P: 54
R: 12
BP: 110/ 80
Diagnosis
Disturbed Sleep Pattern related to hyperactivity
Planning
After 8 Hours, Patient will be able to report feeling rested and show improvement in sleep/rest
pattern.
Intervention
INDEPENDENT
1. Assess past patterns of sleep in normal environment: amount, bedtime rituals, depth,
length, positions, aids, and interfering agents.
2. Document nursing or caregiver observations of sleeping and wakeful behaviors.
Record number of sleep hours. Note physical (e.g., noise, pain or discomfort, urinary
frequency) and/or psychological (e.g., fear, anxiety) circumstances that interrupt
sleep.
3. Instruct patient to follow as consistent a daily schedule for retiring and arising as
possible.
4. Avoid including in the meal alcohol or caffeine as well as heavy meal
5. Increase daytime physical activities as indicated.
6. Recommend an environment conducive to sleep or rest (e.g., quiet, comfortable
temperature, ventilation, darkness, closed door).
COLLABORATIVE
Administer sedatives as ordered.
Evaluation
After 8 hours of Nursing Interventions, the patient was able to show improvement in
his sleeping pattern.
Localized erythema
Disruption of the skin
Diagnosis
Impaired skin integrity related to inflammatory response secondary to infection.
Planning
Following a 3-day nursing intervention, the client will be able to display improvement in
wound healing as evidenced by:
Intact skin or minimized presence of wound.
Absence of redness or erythema.
Absence of purulent discharge.
Absence of itchiness.
Intervention
Assessed skin. Noted color, turgor, and sensation. Described and measured wounds
and observed changes.
Demonstrated good skin hygiene, e.g., wash thoroughly and pat dry carefully.
Instructed family to maintain clean, dry clothes, preferably cotton fabric (any Tshirt).
Emphasized importance of adequate nutrition and fluid intake.
Evaluation
At the end of the 3-day nursing intervention, the client was able to display improvement
in wound healing as evidenced by:
Minimized presence of wounds.
Several wounds have dried up.
Minimized erythema.
Minimized purulent discharge.
(Continue cleaning the wound with disinfectant)
Presence of itchiness (Continue instructing client to avoid scratching the wound)