Nursing Care Plan (NCP) for Schizophrenia

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Outline

Pathophysiology

Schizophrenia is a serious mental disorder that affects how a person thinks, feels and behaves. Patients often have difficulty distinguishing between reality and imagination and have difficulty communicating with others. Schizophrenia tends to run in families, but most frequently appears to be related to an imbalance of neurotransmitters (dopamine, glutamate and serotonin) that change the way the brain reacts to stimuli.  Patients are not normally violent, but may react defensively to even the most well-intended gestures or stimuli.

Etiology

 

Diagnostic Criteria:

  The patient must have experienced at least two of the following symptoms, one of which must be a positive symptom.

  • Positive symptoms
    • Delusions
    • Hallucinations
    • Disorganized speech
    • Disorganized (or catatonic) behavior
  • Negative symptoms
    • Flat affect
    • Decrease in emotional range
    • Loss of interest in activities
    • Reduced speaking

Symptoms must be present for at least 6 months with at least one month of active symptoms. Symptoms are not related to substance use/abuse or any other medical condition.

Desired Outcome

Patient will communicate effectively. Patient will demonstrate reality-based thought processes. Patient will demonstrate ability to distinguish between reality and hallucinations.

Schizophrenia Nursing Care Plan

Subjective Data:

  • Hallucinations
  • Feeling of being watched (paranoia)
  • Change in personality
  • Inability to sleep
  • Inability to concentrate
  • Feelings of  indifference

Objective Data:

  • Awkward body positioning
  • Decreased or impaired speech
  • Decline in academic or work performance
  • Inappropriate behavior
  • Extreme preoccupation with religion or the occult
  • Flat affect
  • Unprovoked outbursts or uninhibited actions
  • Tense, anxious or erratic movements
  • Wandering

Nursing Interventions and Rationales

  • Obtain history and assess patient for hostile or self-destructive behaviors

 

Determine risk of harm to patient or others and what precautions may be required. Stress response often triggers hallucinations.

 

  • Provide encouragement in a non-judgemental, compassionate way, understanding that symptoms are real to patient

 

Develop trust between patient and nurse to improve effectiveness of interventions and cooperation.

 

  • Encourage patient to communicate (verbal, drawing, written) how hallucinations make them feel

 

Helps understand and anticipate behaviors and help identify stressors such as fear or helplessness. Reduce anxiety.

 

  • Ask if hallucinations are instructing them to harm themselves or others. Provide safety for patient and others per facility protocol if needed.

 

Patients may be inclined to obey commands given by hallucinations that instruct them to harm themselves or others. Notify security or police if necessary.

Follow your facility’s specific protocol regarding supervision, restraint, and documentation.

 

  • Provide redirection for inappropriate behaviors, maintain boundaries and guidelines.

 

Avoids need for intervention and exacerbated behaviors. Redirecting patient helps remove the focus from the current perceived threat to a more positive activity.  

Boundaries and guidelines should be held consistently among caregivers to prevent splitting (turning one caregiver against another).

 

  • Encourage reality-based activities (music, art, playing cards, etc.)

 

Help redirect patient to acceptable activities and behaviors and reduce the risk of hallucinatory distractions.

 

  • Explain all procedures slowly and carefully before beginning

 

Reduces paranoia and encourages cooperation. Patients are less likely to feel “tricked” if they understand what is happening to them. Even taking a blood pressure can be frightening if not fully explained first.

 

  • Avoid using large gestures or touching the patient except when necessary

 

Patient’s distortion of reality may interpret the touch or gesture as an aggressive or threatening action.

 

  • Gently reorient patient as necessary

 

Reorienting patient helps them differentiate between reality and hallucination.

 

  • Avoid arguing with a patient regarding delusions or hallucinations

 

If reorienting is initially ineffective, avoid persistent attempts or arguing as it can agitate the patient or cause feelings of isolation.

Never confirm a delusion or hallucination (“I see Jesus, too!”) – this can exacerbate agitation or confusion.

 

  • Teach patient coping skills to help manage hallucinations or delusions
    • Exercise
    • Singing / listening to music
    • Writing
    • Drawing
    • Talking with someone they trust

 

Help patient learn how to cope with and manage symptoms to improve daily functioning and behaviors.

 

  • As symptoms improve, allow patient to make small decisions such as what to eat, wear or choice of activities

 

Allows patient to feel that they have more control of themself and their care. Promotes independence.

 

  • Administer medication appropriately

 

Routine medications may be given to help improve symptoms.

  • Atypical antipsychotics

IM medications may be given PRN for acute exacerbations.

  • Diphenhydramine
  • Haloperidol
  • Lorazepam

Writing a Nursing Care Plan (NCP) for Schizophrenia

A Nursing Care Plan (NCP) for Schizophrenia starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey guys, in this care plan, we will explore schizophrenia. In this schizophrenia care plan, we’re going to talk about the desired outcome, the subjective and objective data, along with the nursing interventions and rationales for each. 

 

So our medical diagnosis is schizophrenia. Schizophrenia is a mental disorder that affects the brain, and is going to affect how the patient thinks, how they feel and how they behave. Schizophrenia is thought to involve the imbalance of neurotransmitters like dopamine, glutamate, and serotonin in the brain that change the way the brain reacts to stimuli, so the exact cause is unknown, but it’s thought to be a combination of genetic, psychological, and environmental factors. The disease is thought to be triggered by an extremely stressful life event. Our desired outcome is that the patient will be able to communicate effectively and demonstrate reality based processes. The patient will be able to demonstrate the ability to distinguish between reality and hallucinations. 

 

Now, let’s take a look at our care plan. So, subjective data that your patient may experience that has schizophrenia includes hallucinations, paranoia, and a change in personality due to the imbalances in the brain. So, these in turn cause the patient to have difficulty sleeping and concentrating, which may create feelings of indifference. 

 

Objective data that you might notice in your patient with schizophrenia include inappropriate behavior, a flat affect, unprovoked outbursts. This is all due to the disruptive brain chemicals that are here in her brain. You may notice tense, anxious or erratic movements due to paranoia and hallucinations, so the patient will likely have a decline in academic or work performance, especially when they’re having these schizophrenia episodes. 

 

Now let’s look at our nursing interventions. So you will obtain a history and assess the patient for hostile or self-destructive behaviors. Doing so is going to help determine if the patient is at risk for harming themselves or others. That way, the most appropriate precautions can be taken,  especially according to the protocol of your organization. You want to provide non-judgemental compassion, encouragement, and just reorient them gently. You want to develop trust between you and the patient. It’s hard for them to trust people. They’re feeling paranoid. They’re feeling like they can’t trust anybody, so just be there for them. Listen, and just try to help them maintain a touch with reality. You definitely want to make sure that you encourage communication about the patient’s experience and their feelings. Listen to them. This is the biggest thing I can tell you to do. Listen, help them to reduce their anxiety and encourage them to have a sense of control. You should redirect inappropriate behaviors and maintain boundaries. Do not let them walk all over you because they will try.

 

You want to prevent escalation of behaviors and avoid manipulation in these patients. Make sure that you explain any procedure slowly and carefully. You want to reduce their paranoia. Remember they’re already paranoid. They already don’t might not trust you or the organization that they’re in right now, so you want to help them to reduce their paranoia. You want to encourage cooperation, avoid arguing, and never confirm delusions ever, ever, ever. Do not just go along with something, just to make things easier. This patient has a lot going on in their head. Let’s not make it any worse than it already is. Let’s try to reorient them. 

 

Okay, we want to reduce agitation. We want to reduce their confusion. They need therapeutic communication to keep their mind on the right path. Administer medications as ordered, such as anti-psychotics to help reduce those symptoms. 

 

We love you guys. Now, go out and be your best self today and as always, happy nursing!

 

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