Davao Medical School Foundation. Inc.

Medical School Drive, Bajada, Davao City

College of Nursing

In partial fulfillment of the requirements in

NCM 105 RLE

A term paper on

SCHIZOPHRENIA

SUBMITTED TO:

Ms. Gremma W. Baratas RN, MAN

Clinical Instructor

SUBMITTED BY:
Yasierah K.Agalin St.N
BSN 3 Student

DATE: February 21, 2017

Definition

a long-term mental disorder of a type involving a breakdown in the relation between thought,
emotion, and behavior, leading to faulty perception, inappropriate actions and feelings,
withdrawal from reality and personal relationships into fantasy and delusion, and a sense of
mental fragmentation.

Medical Management
Heres how schizophrenia is medically managed:
Drug Therapy: Schizophrenia is mainly treated by antipsychotics (neuroleptic) drugs.
o These prevent relapse of acute symptoms.
o Psychotic symptoms must be present 12 to 24 months before patients receive
their first medical treatment.
o Examples of these drugs include the typical or conventional typical
antipsychotic chlorpromazine (Thorazine) and the atypical
Electroconvulsive Therapy: Rarely used but is for patients with acute schizophrenia
and those who cant tolerate or dont respond to medication. It is effective in reducing
depressive and catatonic symptoms of schizophrenia.
Other treatments include compliance promotion programs, psychosocial treatment and
rehabilitation, vocational counseling, supportive psychotherapy, and appropriate use of
community resources.

Nursing Management

Here are the nursing responsibilities for taking care of patients with schizophrenia:
Nursing Assessment
Recognize schizophrenia. Note characteristic signs and symptoms of schizophrenia
(e.g., speech abnormalities, thought distortions, poor social interactions).
Establish trust and rapport. Dont tease or joke with patients. Expect that patient is going
to put you through rigorous testing periods. Introduce yourself and explain your purpose.
Maximize level of functioning. Assess patients ability to carry out activities of daily living
(ADLs).
Assess positive symptoms. Assess for command hallucinations; explore answers.
Assess if the client has fragmented, poorly organized, well-organized, systematized, or
extensive system of beliefs that are not supported by reality. Assess for pervasive
suspiciousness about everyone and their actions (e.g., vigilant, blames others for
consequences of own behavior, argumentative, threatening).
Assess negative symptoms. Assess for the negative symptoms of schizophrenia (as
mentioned above).
Assess medical history. Assess if the client is on medications, what these are, and
adherence to therapy.
Assess support system. Determine whether the family is well informed about the
disease. Does the family understand the need for medication adherence?
Nursing Diagnoses
Impaired Physical Mobility related to depressive mood state and reluctance to initiate
movement.
Impaired Social Interaction related to problems in thought patterns and speech.
Decreased Cardiac Output related to orthostatic hypotensive drug effects.
Risk for Suicide related to impulsiveness and marked changes in behavior.
 Risk for Injury related to hallucinations and delusions.
Risk for Imbalanced Nutrition: less than body requirements related to self-neglect and
refusal for self-care.
Planning and Goals
Main Article: 6 Schizophrenia Nursing Care Plans
Reduce severity of psychotic symptoms
Prevent recurrence of acute episodes
Meet patients physical and psychosocial needs
Help patient gain optimum level of functioning
Increase clients compliance to treatment and nursing plan
Nursing Interventions
Establish trust and rapport. Dont touch client without telling him first what you are going
to do. Use an accepting, consistent approach; short, repeated contacts are best until
trust has been established. Language should be clear and unambiguous. Maintain a
sense of hope for possible improvement, and convey this to the patient.
Maximize level of functioning. Avoid promoting dependence by doing only what the
patient cant do for himself. Reward positive behavior and work with him to increase
his personal sense of responsibility in improving functioning.
Promote social skills. Provide support in assisting him to learn social skills.
Ensure safety. Maintain a safe environment with minimal stimulation.
Ensure adequate nutrition. Monitor patients nutritional status and if the patient thinks his
food is poisoned, let him fix his own food if possible or offer him foods in closed
containers that he can open. Institute suicide and/or homicide precautions as
appropriate.
Keep it real. Engage patient in reality-oriented activities that involve human contact (e.g.,
workshops, inpatient social skills training). Clarify private language, autistic inventions, or
neologisms.
Deal with hallucinations by presenting reality. Explore the content of hallucinations. Avoid
arguing about the hallucinations. Tell them you do not see, hear, smell, or feel it but
explain that you know that these hallucinations are real to him.
Promote compliance and monitor drug therapy. Administer prescribed drugs and
encourage the patient to comply. Ensure that patient is really taking the drug. Observe
for manifestations that warrant hypersensitivity reactions and toxicity.
Encourage family involvement. Involve family in patient treatment and teach members to
recognize impending relapse (e.g. nervousness, insomnia, decreased ability to
concentrate). Suggest ways how families can manage symptoms.
Evaluation
Evaluate effectiveness of drug therapy (absence of acute episodes and psychotic
symptoms).
Evaluate compliance to health instructions (taking medications on time, showing
independence in activities, involvement of family).
Level of patients functioning (ability to engage in social interactions).

REFLECTION

The article was mainly schizophrenia, a psychotic disorder characterized by distortions of reality
and disturbances of thought and language and withdrawal from social contact, the article
explained about the causes and the different signs and symptoms of this condition as well as
the medical management which mostly consists of antipsychotic drugs, I learnt about the
progression of the disease and it's common signs and symptoms, I read about the different
theories about the etiology and risk factors of this disease as well as the related disorders.

In my extensive research, I scrolled through many articles about this disorder researching the
possible cause of this condition, testing possible theories about it being genetically related or
has something to do with some environmental factors, I came across articles that introduced a
new therapy or drug for this condition, I could appreciate the importance of research in providing
us with new technology and medical discoveries that can help us better manage this disorder,
thanks to those updates, medical professionals can have a better ideal in how to treat this
condition.

As a student nurse, this reading was very significant for me as it supplemented the information I
read in the book about this condition, the reading gave extra and more recent information
regarding this disorder that I highly appreciated as such knowledge will be quite helpful to me
when I encounter or handle a patient with this condition, knowing the disease process of the
patient is an important responsibility of a nurse as it helps us better in managing the client's
condition, recognizing the signs that are normally present in such a condition and therefore,
meeting the needs of that client and knowing when to refer the client when he or she presents
with certain dangerous signs, aside from that, a knowledge of psychopharmacology is important
as this condition involves mostly the use of drug therapy, specifically antipsychotic drugs, those
drugs are known to cause serious adverse effects in case of toxicity and it always remains the
nurse's responsibility to prevent such incident and report promptly if ever a case of drug

The article made me think about how much I can do to help them and how should I handle a
patient with this condition if ever I was assigned to one, the knowledge I am reading and
learning about today, will not be helpful only in my psychiatric exposure but also in the future
when I encounter similar cases, the ability to practice your knowledge in the actual area helps
retain knowledge more and makes it easier to recall in the future.