Nursing Care Plan for Schizophrenia
Schizophrenia is a severe, lifelong brain disorder. People who have it may hear voices, see things that aren't there or believe that others are reading or controlling their minds. In men, symptoms usually start in the late teens and early 20s. They include hallucinations, or seeing things, and delusions such as hearing voices. For women, they start in the mid-20s to early 30s. Other symptoms include
- Unusual thoughts or perceptions
- Disorders of movement
- Difficulty speaking and expressing emotion
- Problems with attention, memory and organization
NIH: National Institute of Mental Health
Causes For Schizophrenia
Schizophrenia may result from a combination of genetic, biological, cultural, and psychological factors with genetic and environmental insults most associated. For example, some evidence supports a genetic predisposition to this disorder. Close relatives of schizophrenic patients are up to 50 times more likely to develop schizophrenia; the closer the degree of biological relatedness, the higher the risk.
The most widely accepted biochemical hypothesis holds that schizophrenia results from excessive activity at dopaminergic synapses. Other neurotransmitter alterations may also contribute to schizophrenic symptoms.
Numerous psychological and sociocultural causes, such as disturbed family and interpersonal patterns, also have been proposed as possible causes. Schizophrenia has a higher incidence among lower socioeconomic groups, possibly related to downward social drift or lack of upward socioeconomic mobility, and to high stress levels, possibly induced by poverty, social failure, illness, and inadequate social resources. Gestational and birth complications, such as Rh factor incompatibility, prenatal exposure to influenza during the second trimester, and prenatal nutritional deficiencies, have been associated.
Assessment Nursing Care Plans For Schizophrenia
Schizophrenia is associated with a wide variety of abnormal behaviors; therefore, assessment findings vary greatly, depending on both the type and phase of the illness. The individual may exhibit a decreased emotional expression, impaired concentration, and decreased social functioning, loss of function, or anhedonia. Individuals with these particular symptoms (present in one-third of the schizophrenic population) are associated with poor response to drug treatment and poor outcome.
Although behaviors and functional deficiencies can vary widely among patients and even in the same patient at different times, watch for the following characteristic signs and symptoms during the assessment interview:
- ambivalence coexisting strong positive and negative feelings, leading to emotional conflict
- clang associations words that rhyme or sound alike used in an illogical, nonsensical manner; for instance, It's the rain, train, pain.
- concrete thinking inability to form or understand abstract thoughts
- delusions false ideas or beliefs accepted as real by the patient. Delusions of grandeur, persecution, and reference (distorted belief regarding the relation between events and one's self; for example, a belief that television programs address the patient on a personal level) are common in schizophrenia. Also common are feelings of being controlled, somatic illness, and depersonalization.
- echolalia meaningless repetition of words or phrases
- echopraxia involuntary repetition of movements observed in others
- flight of ideas rapid succession of incomplete and poorly connected ideas
- hallucinations false sensory perceptions with no basis in reality. Usually visual or auditory, hallucinations may also be olfactory (smell), gustatory (taste), or tactile (touch).
- illusions—false sensory perceptions with some basis in reality; for example, a car backfiring might be mistaken for a gunshot.
- loose associations not connected or related by logic or rationality
- magical thinking belief that thoughts or wishes can control other people or events
- neologisms bizarre words that have meaning only for the patient
- poor interpersonal relationships
- regression return to an earlier developmental stage
- thought blocking sudden interruption in the patient's train of thought
- withdrawal disinterest in objects, people, or surroundings
- word salad illogical word groupings; for example, She had a star, barn, plant. It's the extreme form of loose associations.
Diagnoses Nursing Care Plans For Schizophrenia
- Bathing or hygiene self-care deficit
- Disabled family coping
- Disturbed body image
- Disturbed personal identity
- Disturbed sensory perception (auditory, visual, kinesthetic)
- Disturbed sleep pattern
- Disturbed thought processes
- Dressing or grooming self-care deficit
- Imbalanced nutrition: Less than body requirements
- Impaired home maintenance
- Impaired social interaction
- Impaired verbal communication
- Ineffective coping
- Ineffective role performance
- Risk for injury
- Risk for other-directed violence
- Risk for self-directed violence
- Social isolation
Interventions Nursing Care Plans For Schizophrenia
- 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.
- 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.
- 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.
- Avoid promoting dependence. Meet the patient's needs, but only do for the patient what he can't do for himself.
- Reward positive behavior to help the patient improve his level of functioning.
- 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.
- If the patient is hallucinating, explore the content of the hallucinations. If he has auditory hallucinations, determine if they're command hallucinations that place the patient or others at risk. Tell the patient you don't hear the voices but you know they're real to him. Avoid arguing about the hallucinations; if possible, change the subject.
- Don't tease or joke with the patient. Choose words and phrases that are unambiguous and clearly understood. For instance, a patient who's told, That procedure will be done on the floor, may become frightened, thinking he is being told to lie down on the floor.
- Don't touch the patient without telling him first exactly what you're going to do. For example, clearly explain to him, I'm going to put this cuff on your arm so I can take your blood pressure. If necessary, postpone procedures that require physical contact with facility personnel until the patient is less suspicious or agitated.
- Remember, institutionalization may produce new symptoms and handicaps in the patient that aren't part of his diagnosed illness, so evaluate symptoms carefully.
- Mobilize community resources to provide a support system for the patient and reduce his vulnerability to stress. Ongoing support is essential to his mastery of social skills.
- Encourage compliance with the medication regimen to prevent relapse. Also monitor the patient carefully for adverse effects of drug therapy, including drug-induced parkinsonism, acute dystonia, akathisia, tardive dyskinesia, and malignant neuroleptic syndrome. Make sure you document and report such effects promptly.