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slower developmental skills, and was diagnosed as suffering from hyperactivity in early childhood.
Records indicate that the patient experienced a turbulent home life because of ongoing conflicts
between her parents that resulted in separation, and reconciliation. Because of her apparent
developmental disabilities, her parents devoted time to the patient however, the patient did receive
criticism from her father for her behavioral dysfunctions.
As the patient matured, she displayed signs of being socially awkward and isolated from her peers,
and in early adulthood started to display worsening symptoms like talking to herself, and displaying
unusual behavior like stating at the floor for long periods. Her first documented schizophrenia
episode requiring hospitalization occurred shortly after the additional symptoms started to be
displayed. During her examination, the patient displayed signs of unresponsiveness, and waxy
flexibility that allowed her limbs to be easily positioned (Meyer, Chapman, & Weaver, 2009). After
the initial hospitalization, the patient was returned home to facilitate a quicker recovery. that was
short lived because the patient failed to follow the prescribed treatment regimen which, resulted in a
secondary episode shortly after her return to college. Further home-based treatments proved
unsuccessful as the patient slowly declined, resulting in unresponsiveness, and displaying
hebephrenic symptoms like unprovoked giggling, and rocking movements (Meyer, Chapman, &
Weaver, 2009).
The patients second hospitalization and treatments started to show positive results, and she was
taken back to her home environment. She was able to obtain a part-time position at work, and
maintain daily household chores. However, the patient failed to follow the prescribed treatment
regimen. Following the death of her father, and additional stressors resulting from her mothers
added dependency, the patient suffered from a third regression of the illness. Her third hospitalization
resulted from local law officials discovering her walking in a local pond while incoherently
mumbling to herself.
Components of the Schizophrenic Episodes
The primary component of the patients episodes appear to be related to stress as the primary factor.
However, biological factors resulting from her mothers illness and smoking during pregnancy, and a
genetic predisposition related to her grandfather's eccentricity are viable underlying factors resulting
in the patients illness. In addition to the primary stressor, and the underlying genetic and biological
factors, it is possible that the emotions of the patient also contributed to her condition. Further
documentation indicates that interfamilial expressed emotion, and communication deviance are
probably contributors that appear to be operative in the patients case (Meyer, Chapman, & Weaver,
2009). The first of these factors, expressed emotion would be explained by the turbulent relationship,
combined with her mothers over protective nature conflicting with her fathers over critical reactions
to the patients behavioral issues (Meyer, Chapman, & Weaver, 2009). The second of these factors,
communication deviance resulted from the patients inability to focus and maintain normal dialog
with others (Meyer, Chapman, & Weaver, 2009).
Cognitive factors are a viable consideration for this patients case. Meyer, Chapman, and Weaver
(2009) suggest that prodomal pruning theory may be one example of a cognitive factor. Prodomal
pruning theory suggests that the human brain deletes unnecessary synapses to allow the brain to
function properly during the change from adolescence to adulthood (Meyer, Chapman, & Weaver,
2009). Behavior is another factor relating to the patients repeated hospitalization. The patient
displayed behavior deficiencies in regard to compliance to prescribed treatment regimens, and
involvement in situations that could produce high level stressors in her life.
Conclusion
Because illnesses like schizophrenia relate to various and different factors, each person effected by
the illness will show differences in ability to function in a normal environment. The various
classifications of schizophrenia, ability to receive treatments, and the consideration of various
influences and base-line factors help researchers determine what classification a patient falls into. In
this particular case, the patient displays symptoms of catatonic schizophrenia. She is able to function
in environments that do not produce high levels of demand or stress on the individual. However, the
underlying assumptions would indicate that the combination of outlined biological, emotional,
cognitive, and behavioral were in-place, and waiting for the appropriate stressor to trigger her
symptoms.
Nursing Case Study Paranaoid Schizophrenia
1. 1. PARANOID SCHIZOPHRENIANursingcasestudy.blogspot.com
2. 2. TABLE OF CONTENTSChapter 1
. Introduction Theoretical
Framework Personal Data History of present Illness Past Personal
History Family HistoryChapter 2
General appearance Motor
behavior Sensorium and Cognities Perception Attitude and Behavior
Defense Mechanism Affective State Speech Thought Process and
ContentChapter 3 .
Psychopathology Related Literature and Studies Drug StudyChapter 4
. Process Recordings
Prioritized Psychiatric Nursing DiagnosesChapter 5
Psychotherapies
Implemented
3. 3. CHAPTER 1Introduction Paranoid schizophrenia is the most common type
of schizophrenia in most partsof the world. The clinical picture is dominated
by relatively stable, often paranoid,delusions, usually accompanied by
hallucinations, particularly of the auditory variety,and perceptual
disturbances. Disturbances of affect, volition, and speech, and
catatonicsymptoms, are not prominent. With paranoid schizophrenia, your
ability to think and function in daily life maybe better than with other types of
schizophrenia. You may not have as many problemswith memory,
concentration or dulled emotions. Still, paranoid schizophrenia is a
serious,lifelong condition that can lead to many complications, including
suicidal behavior.(http://www.mayoclinic.com/health/paranoidschizophrenia/DS00862) Patients who have paranoid schizophrenia that has
thought disorder may beobvious in acute states, but if so it does not prevent
the typical delusions or hallucinationsfrom being described clearly. Affect is
usually less blunted than in other varieties ofschizophrenia, but a minor
degree of incongruity is common, as are mood disturbancessuch as
irritability, sudden anger, fearfulness, and suspicion. "Negative" symptoms
suchas blunting of affect and impaired volition are often present but do not
dominate theclinical picture. The course of paranoid schizophrenia may be
episodic, with partial or completeremissions, or chronic. In chronic cases, the
19.19. quickly to an acute episode. Some people have very few such attacks in a
lifetime; othershave more. Some people lead relatively normal lives between
episodes. Others find thatthey are very listless. depressed, and unable to
function well. In some, the illness may develop into what is known as chronic
schizophrenia.This is a severe, long-lasting disability characterized by social
withdrawal, lack ofmotivation, depression, and blunted feelings. In addition,
moderate versions of acutesymptoms such as delusions and thought disorder
may be present in the chronic disorder.What are the symptoms of
schizophrenia?Major symptoms of schizophrenia include: Delusions - false
beliefs of persecution, guilt or grandeur or being under outside control.
People with schizophrenia may describe plots against them or of think they
have special powers and gifts. Sometimes they withdraw from people or hide
to avoid imagined persecution. Hallucinations - most commonly involving
hearing voices. Other less common experiences can include seeing, feeling,
tasting or smelling things which to the person are real but which are not
actually there. Thought disorder - where the speech may be difficult to
follow; for example, jumping from one subject to another with no logical
connection. Thoughts and speech may be jumbled and disjointed. The person
may think someone is interfering with their mind.Other symptoms of
schizophrenia include: Loss of drive - where often the ability to engage in
everyday activities such as washing and cooking is lost. This lack of drive,
initiative or motivation is part of the illness and is not laziness. Blunted
expression of emotions -where the ability to express emotion is greatly
reduced and is often accompanied by a lack of response or an inappropriate
response to external events such as happy or sad occasions.
20.20. Social withdrawal - this may be caused by a number of factors including
the fear that someone is going to harm them, or a fear of interacting with
others because of a loss of social skills. Lack of insight or awareness of
other conditions - because some experiences such as delusions and
hallucinations are so real, it is common for people with schizophrenia to be
unaware they are ill. For this and other reasons, such as medication sideeffects, they may refuse to accept treatment which could be essential for
their well-being. Thinking difficulties - a persons concentration, memory,
and ability to plan and organise may be affected, making it more difficult to
reason, communicate, and complete daily tasks.What causes schizophrenia?
No single cause has been identified, but several factors are believed to
contribute to theonset of schizophrenia in some people:Genetic factorsA
predisposition to schizophrenia can run in families. In the general population,
only 1per cent of people develop it over their lifetime. If one parent suffers
from schizophrenia,the children have a 10 per cent chance of developing the
condition - and a 90 per centchance of not developing it.Biochemical
factorsCertain biochemical substances in the brain are believed to be
involved in this condition,especially a neurotransmitter called dopamine. One
likely cause of this chemicalimbalance is the persons genetic predisposition
to the illness.Family relationships
21.21. No evidence has been found to support the suggestion that family
relationships cause theillness. However, some people with schizophrenia are
sensitive to any family tensionwhich, for them, may be associated with
Monitor patient for any adverse reaction.DURING: The client may sip small
amount of water Stay with the client for at least 15-30 minutes after giving
the drug Be alert for adverse reaction and drug interaction
24.24. Name of Date Route/ General Indication/ Clients drug ordered/ Dosage/
action/mechanism Purpose response to Date Frequency of of action medicine
with started/ administration actual s/e Date changedGeneric Date Route of
Chemical Effect: This is AdministratioName: Ordered: Administration: May
block given to n of the drug January Per Orem postsynaptic the patient was
notHaloperidol 31, 2009 dopamine with actually Date Dosage and receptors
in brain. chronically observed Started: Frequency: Therapeutic psychotic
January 5mg tab tid Effect: disorder 31, 2009 Decreases who needs psychotic
prolonged Date behaviors. therapy. Ended: ----------- ---------- NURSING
RESPONSIBILITIES: BEFORE: Explain the importance and action of the drugs.
Tell the possible reaction or side effects of the drugs. Monitor patient for
any adverse reaction. DURING: Stay with the client for at least 15-30
minutes after giving the drug Monitor patient for tardive dyskinesia, which
may not appear until months or years later and may disappear spontaneously
or persists for life despite stopping use of drug.
25.25. CHAPTER 5PSYCHOTHERAPIES IMPLEMENTEDPsychotherapy- treatment of
mental disorders and behavioral disturbances using verbaland nonverbal
communication, as opposed to agents such as drugs or electric shock, toalter
maladaptive patterns of coping, relieve emotional disturbance, and
encouragepersonality growth. Also called psychotherapeutics.Individual
Psychotherapy- Through one-on-one conversations, this approach focuses
onthe patients current life and relationships within the family, social, and
work.Group Psychotherapy- Group psychotherapy is a special form of therapy
in which asmall number of people meet together under the guidance of a
professionally trainedtherapist to help themselves and one another. Group
therapy helps people learn aboutthemselves and improve their interpersonal
relationships. It addresses feelings ofisolation, depression or anxiety. And it
helps people make significant changes so theyfeel better about the quality of
their lives.REMOTIVATION THERAPYDefinition: A simple group therapy which
aims to bridge the fantasy- world of thePsychotics to the real world. Is a
technique of simple group therapy, objective in nature,used with a group of
patients in an effort to reach the unwounded areas of eachpatients
personality & to get them back into reality.
26.26. Title of the poem: Ang Bulaklak The short poem describes the importance
of flower in our nature.Goals: To stimulate patients to be fellow explore the
real world. To develop their ability to communicated and share ideas and
experiences with the other people. To develop feelings of acceptance. To
promote group harmony and identification.Role of the nurse: To be a
facilitator in the activity To encourage clients feeling about the topic To
present the reality to the client about the poem.NEWSPAPER
THERAPYDefinition: Newspaper therapy is giving information to the clients
about events and whatis happening outsideNewspaper therapy is cutting
clippings from newspaper and sharing this information tothe clients and
knowing their feelings and ideas about the information given. Providingbasic
information about places/events may motivate the clients to follow the
medicalregimen to be well. The facilitator let the clients to read the topic,
then ask themquestions.Title of the cut news: Boxing The news was all
about boxing competition held in Araneta Coliseum & who wonfor that
competition.
27.27. Goals: To give information to the clients on what is happening outside
and to give latest news today. To encouraged emotions and reactions about
the newsRole of the Nurse: To introduce topics that will encourage clients
participation/cooperation To assess level of intelligence of the clients To
encourage the clients to express/verbalize feelings/ideas regarding to the
topicPLAY THERAPYDefinition: A form of psychotherapy used to help them
express or act out theirexperiences, feelings, and problems by playing with
dolls, toys, and other play material.Name of the Play: Ball
catchingProcedure:The clients are instructed to catch the ball with their
respective partners.Goals: To establish rapport since it is the first
recreational activity of the client To encourage release/ express clients
emotions To let the client learn on how to cooperate To let the client play
freely and activelyRole of the Nurse: To be the facilitator of the game To
let and encourage the clients to participate on the play
28.28. DANCE THERAPYDefinition Dance is the most fundamental of the arts,
involving direct expression throughthe body. Dance /movement therapy
effects changes in feelings, cognition, physicalfunctioning, and behavior.Title
of the dance song: Cha-Cha-Cha Facilitators are in the front, dancing different
steps, in able for the client to followeasily the facilitators.Goals: To encourage
release/ express clients emotions To let the client learn on how to dance in
simple steps To let the client dance freely and activelyRole of the Nurse:
To be the facilitator of the game To let and encourage the clients to
participate on the danceSONG THERAPYDefinition: A kind of recreational
therapy under the music category, which connects uswith our creativity,
innate wisdom and our vast inner resources for growth and well-being. It has
a soothing and pleasing effect and provides for emotion and release.Title of
the song: Tag-ulanProcedure:
29.29. Using the visual aids that has the written lyrics, the patients read it
first. The nurse sings the song with the use of guitars. Nurses, together
with the patients, sing the song. Lastly, let the patients sing to the tune of
guitars.Goals: Develop patients ability to read and reflect. Develop
patients listening skill. To encourage them to participate and cooperate.
Patients will learn to express emotions and feelings.Role of the Nurse:
Explain the procedure to the patients. To be a good facilitator. To be an
active participant too. To promote trust.ART THERAPYDefinition: is the use
of art materials for self-expression and reflection.Name: House-TreePersonProcedure: Patients are provided with crayons and 3 pieces of paper
as drawing materials. They are then asked to draw a house, afterwards a
tree, and lastly, a person on each of the papers with the use of crayons.
Series of questions constitute the post drawing interrogations.
30.30. During post drawing phase, paients are given opportunity to define,
describe, and interpret the objects drawn.Goals: To obtain data concerning
patients progress. To aid in the establishment of rapport between the nurse
and the patient. Help the patients gain insight through interpretations.
Measure patients self perception and attitudes.Role of Nurses: Explain the
procedure of the activity. Provide the means of the therapy (crayons,
papers). Interrogate patients during post drawing phase. Assessing and
interpreting answers based on Bucks HTP interpretation. Develop a deeper
nurse-patient relationship through building of trust.OCCUPATIONAL
THERAPYDefinition: Any activity, mental or physical, prescribed and guided to
aid an individualsrecovery from diseases or injury. This activity excludes
competition and pressure. Thereis opportunity for creativeness and produce
something tangible out of patients ownthinking and imagination. Self
confidence and personal achievements are alsoexperienced.Title: Designing
Picture FrameProcedure: Designing Picture Frame Nurses play a great role in
making this therapy successful. Nurses give picture frame.
31.31. Different shapes of cut cartolina & different styles of stickers are also
given along with the glue. Patients are asked to design their picture frame
wherever they like.Goals: Expose patients hidden abilities in designing and
pasting. Increase patients self confidence. Assess patients motor and
intellectual functioning.Role of Nurses: To select the most useful activity.
To facilitate the activity successfully. To assist the patients. To promote
positive personality growth
32.32. BIBLIOGRAPHYVidebeck, Psychiatric Mental Health Nursing, Third
EditionShives, Isaacs, Basic Concepts of Psychiatric-Mental Health
NursingRebraca et. al., Psychiatric Mental Health Nursing, 5th EditionNurses
Dictionary, Second Edition7th Edition Nursing Diagnosis Handbook: A Guide
to Planning Care by Betty J Auckley and GailB.
Ladwighttp://www.answers.com/topic/psychosishttp://www.emedicine.com/me
d/byname/brief-psychoticdisorder.htmhttp://www.hawaii.edu/hivandaids/Philippines_Mental_Health_Cou
ntry_Profile.pdfhttp://en.wikipedia.org/wiki/Psychotic_disorder