case study schizoprenia

7/30/2019 case study schizoprenia

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Universidad De Manila(Formerly City College of Manila)

COLLEGE OF NURSING

A case study of

Submitted To:

Mrs. Connie Castro RN

Clinical Instructor

Submitted By:

Rachel V. Sorilla

NR42 Group 4


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Schizophrenia is a psychotic disorder characterized by loss of contact with the

environment, by noticeable deterioration in the level of functioning in everyday

life, and by disintegration of personality expressed as order of feeling, thought,

perception and behaviour (MW. 2006). Schizophrenia is usually diagnosed in the

late adolescence or early adulthood. Rarely does it manifest in childhood. The peak

of incidence of onset is 15 to 25 years old for men and 25 to 35 year old for women

(American Psychiatric Association, 2000).

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.

The prevalence of schizophrenia is thought to be about 1% of the

population around the world. Thus, it is more common than diabetes, Alzheimer'sdisease, or multiple sclerosis. Male and female equally affected. Symptoms appear

earlier in males. More than 1/2 of all male schizophrenic patients and 1/3 of all

female patients are first admitted to psychiatric hospitals before 25.The disorder

is considered to be one of the top ten causes of long-term disability worldwide.

There are 697,543 cases of schizophrenia in the Philippines, 75% are males

and the rest are females (2010). And 51 million people worldwide suffer fromschizophrenia in which males have the most number of percent. This statistics

shows that males have the greater risk to develop psychiatric disorder such as

schizophrenia because of their lifestyle and keeping their emotions.


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The DSM-IV-TR(APA, 2000) classified schizophrenia into four types:

Schizophrenia, paranoid type; Schizophrenia, disorganized type; Schizophrenia,

catatonic type; Schizophrenia, undifferentiated type and Schizophrenia, residual

type. The diagnosis is made according to the clients predominant symptoms.

Undifferentiated schizophrenia is characterized by mixed schizophrenic

symptoms (of other types) along with disturbances of thought, affect and behaviour

(Videbeck, 2006). It is 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.

Undifferentiated schizophrenia is a difficult diagnosis to make with any

confidence because it depends on establishing the slowly progressive

development of the characteristic negative symptoms of schizophrenia without

any history of hallucinations, delusions, or other manifestations of an earlier

psychotic episode, and with significant changes in personal behaviour, manifest as

a marked loss of interest, idleness, and social withdrawal.

There are no known single causes. One of the reasons for the ongoing

difficulty in classifying schizophrenic disorders is incomplete understanding of

their causes.


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GENERAL OBJECTIVE:

At the end of the case analysis, I, a fourth year nursing student, will be able

to share the knowledge that I have gained about undifferentiated schizophrenia

acute, the skills required to manage the patient and the attitude that I must obtain to

become an effective and efficient nurse to the patient that I may encounter in the

future.

SPECIFIC OBJECTIVE:

After researching the case analysis. I will specifically:

* Determine the patients psychiatric health history

* Enumerate the different signs and symptoms manifested by the patient

* Determine the factors that cause the disease.

* Trace the psychopathology of the disorder

* Formulate Nursing care Plan utilizing the nursing process

* Know the actions and side effects of the medication prescribed by the

physician and understand why the drugs are given.


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Name:

Age: 39 yrs/old

Birth date: October 7, 1972

Birthplace: Leyte

Address: Manila

Gender: Male

CivilStatus: Single

Nationality: Filipino

Religion: Roman Catholic

EducatonalAttaiment: High School Graduate

Date of Admission: July 22, 2012

Time of Admission: 2:40 PM

Admitting Diagnosis: Undifferentiated Schizophrenia, Disturbed

Final Diagnosis: Undifferentiated Schizophrenia, Paranoid type

:

According to the mother, the client was hostile and showing untoward behaviors. He began to be

assaultive to his mother and father. Tried to burn their house and he would be seen talking and

laughing to self

The client has been showing untoward behaviors for 12 years, it all started when his business

went into bankruptcy. He was unable to sleep and eat. His illness worsen when his live-in partner

leave him.

:

Unknown

(+)Hypertension (+)Diabetes


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A. GENERAL APPEARANCEThe client appears stated with his age of 39 years old, wearing a blue shirt and

short, well groomed. Hes taking a bath everyday with a good daily routine. The clienthas a good posture, gait and coordination. During interaction, he has a good eye to eye

contact. He was well oriented with time, place, date and reality. The client considered the

interview as a normal thing and he was guided accordingly with no harsh or offending

questions thrown to him during the interview. He was cooperative with consistency of

speech and behavior.

B. GENERAL BEHAVIOR AND ACTIVITYThe client sometimes lethargic and catatonic stupor during interactions. There are

also times that he was restless where he cant remain still. He has also knee tremors

which were involuntary, purposeless rhythmic movements.

C. ORIENTATIONThe client was well oriented on date, time, place and reality. He can relate to past

experiences and able to organized ideas and thoughts related to his present condition. He

know and aware that he was at the National Center for Mental Health.

D. AFFECT AND MOODThe client show appropriate affect with regards to a certain situation. But

sometimes, he suddenly change in expression of mood and this makes hard to identifywhether he was on stated condition and willing to cooperate and interested with the

interaction. Sometimes, there was an alteration of the affective state of the client which

was inappropriate and contrary to his feelings and emotions.

E. THOUGHT PROCESS AND CONTENTEven the client was at the center, he has a normal and logical thought process.

What he uttered was meaningful and with sense. He didnt use confabulation nor

circumstantial. He can easily catch up what the interviewee mean and answer relevant to

the questions.

F. MEMORY, PRESENT AND REMOTEThe client good memory but sometimes he had lapses. He can recall and

remember his past experiences and important events and people in his life. What were

discussed in the previous days were recalled which were integrated on the present

scenario on the interaction.


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G. JUDGMENTThe condition of the client only started when he was on his early adulthood.

Therefore, it doesnt mean that he cannot make decisions on its own. He can formulate

and think of other alternatives which later beneficial for solving his own problems.

H. INSIGHTThe client was knowledgeable and aware of his condition that he was at the

national center for mental health. He knows the state of his illness being manageable and

how was the progression with regards to his rehabilitation and in response to medication

regimen and psychotherapies. He was able to respond of what was going on and can

comprehend appropriately.

I. INTELLECTHe has a good sense of reasoning but it was limited. He was able to pinpoint and

defend his answers but if asked for the main reason why he was at the center, he cant

answer directly.

J. COPING MECHANISMSThe client has good pattern in handling stressors that arises in his life. Since he

was able to formulate ideas and alternatives in order to divert his attention his problems,

he just did his responsibilities at the center and just enjoyed the therapies.

K.DEFENSE MECHANISM

In the case of my client, he used denial as a defense mechanism. In the reason

why he was at the center, he elaborated that he only wanted to rest because she was

already tired and exhausted, but in fact, hes been hostile and doing unacceptable manner.


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Color Yellow

Transparency Slightly Turbid

Specific Gravity 1.010

Ph AcidicProtein Negative

Sugar Negative

WBC 0-2 /hpf

RBC 0-2 /hpf

Epithelial cells moderate

Mucus treads few

Amorphorous Urates moderate

Part examined: Chest

Tentative Diagnosis: Kochs

Chest

There are few small nodular densities on the (R) supraclavicular area

The rest of the lungs are clear

The heart ,diaphragm and cestophrenic sinuses are normal. Impression:

Impression

PTB, minimal (R)activity undetermined

A. Anatomy and Physiology


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Structure and function of the nervous system

I.Structures

A. The neurologic system consists of two main divisions, the central nervous system (CNS)

and the peripheral nervous system (PNS). The autonomic nervous system (ANS) is

composed of both central and peripheral elements.

1. The CNS is composed of the brain and spinal cord.

2. The PNS is composed of the 12 pairs of the cranial nerves and the 31 pairs of the

spinal nerves.

3. The ANS is comprised of visceral efferent (motor) and the visceral afferent (sensory)

nuclei in the brain and spinal cord. Its peripheral division is made up of visceral

efferent and afferent nerve fibers as well as autonomic and sensory ganglia.

B. The brain is covered by three membranes.

1. The dura matter is a fibrous, connective tissue structure containing several blood

vessels.

2. The arachnoid membrane is a delicate serous membrane.

3. The pia matter is a vascular membrane.

C. The spinal cord extends from the medulla oblongata to the lower border of the first

lumbar vertebrae. It contains millions of nerve fibers, and it consists of 31 nerves 8cervical, 12 thoracic, 5 lumbar, and 5 sacral.

D.Cerebrospinal fluid (CSF) forms in the lateral ventricles in the choroid plexus of the pia

matter. It flows through the foramen of Monro into to the third ventricle, then through the

aqueduct of Sylvius to the fourth ventricle. CSF exits the fourth ventricle by the foramen

of Magendie and the two foramens of Luska. It then flows into the cistema magna, and

finally it circulates to the subarachnoid space of the spinal cord, bathing both the brain

and the spinal cord. Fluid is absorbed by the arachnoid membrane.
http://nursingcrib.com/anatomy-and-physiology/cranial-nerves/http://nursingcrib.com/anatomy-and-physiology/cerebrospinal-fluid/http://nursingcrib.com/anatomy-and-physiology/cerebrospinal-fluid/http://nursingcrib.com/anatomy-and-physiology/cerebrospinal-fluid/http://nursingcrib.com/anatomy-and-physiology/cranial-nerves/


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II.Function

A. CNS

1. Brain

a The cerebrum is the center for consciousness, thought, memory, sensory input, and

motor activity; it consists oftwo hemispheres (left and right) and four lobes,

each with specific functions.

i The frontal lobe controls voluntary muscle movements and contains motorareas, including the area for speech; it also contains the centers for

personality, behavioral, autonomic and intellectual functions and those for

emotional and cardiac responses.
http://cdn.nursingcrib.com/wp-content/uploads/anatomy-brain.jpg?9d7bd4


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ii The temporal lobe is the center for taste, hearing and smell, and in the brains

dominant hemisphere, the center for interpreting spoken language.

iii The parietal lobe coordinates and interprets sensory information from the

opposite side of the body.

iv The occipital lobe interprets visual stimuli.

b The thalamus further organizes cerebral function by transmitting impulses to and

from the cerebrum. It also is responsible for primitive emotional responses, such

as fear, and for distinguishing between pleasant and unpleasant stimuli.

c Lying beneath the thalamus, the hypothalamus is an automatic center that regulates

blood pressure, temperature, libido, appetite, breathing, sleeping patterns, and

peripheral nerve discharges associated with certain behavior and emotional

expression. It also helps control pituitary secretion and stress reactions.

d The cerebellum or hindbrain, controls smooth muscle movements, coordinates

sensory impulses with muscle activity, and maintains muscle tone and

equilibrium.
http://cdn.nursingcrib.com/wp-content/uploads/cerebralhemispheresfunctions.jpg?9d7bd4


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e The brain stem, which includes the mesencephalon, pons, and medulla oblongata,

relays nerve impulses between the brain and spinal cord.

2. The spinal cord forms a two-way conductor pathway between the brain stem and thePNS. It is also the reflex center for motor activities that do not involve brain control.

B. The PNS connects the CNS to remote body regions and conducts signals to and from

these areas and the spinal cord.

C. The ANS regulates body functions such as digestion, respiration, and cardiovascular

function. Supervised chiefly by the hypothalamus, the ANS contains two divisions.

1. The sympathetic nervous system serves as an emergency preparedness system, the

flight-for-fight response. Sympathetic impulses increase greatly when the body is

under physical or emotional stress causing bronchiole dilation, dilation of the heartand voluntary muscle blood vessels, stronger and faster heart contractions, peripheral

blood vessel constriction, decreased peristalsis, and increased perspiration.

Sympathetic stimuli are mediated by norepinephrine.

2. The parasympathetic nervous system is the dominant controller for most visceral

effectors for most of the time. Parasympathetic impulses are mediated by

acetylcholine.

III. Differences in nervous system response. The nervous system is one of the first systems to

form in utero, but one of the last systems to develop during childhood.

A. Accuracy and completeness of the neurologic assessment is limited by the childs

development.

B. The childs brain constantly undergoes organization in function and myelinization.

Therefore, the full impact of insult may not be immediately apparent and may take years

to manifest.
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C. The peripheral nerves are not fully myelinated at birth. As myelinization progresses, so

does the childs fine motor control and coordination.

D. Early signs ofincreased intracranial pressure (ICP) may not be apparent in infants because

open sutures and fontanelles compensate to a limited extent.

E. The development of handedness before 1 year of age may signify a neurologic lesion.

F. Several primitive reflexes are present at birth, disappearing by 1 year of age. Absence,

persistence, or asymmetry of reflexes may indicate pathology.

G. The spinal cord ends at 13 in the neonate, instead of L1-L2 where it terminates in the

adult. This affects the site of lumbar puncture.

H. Children have 65 to 140 ml of CSF compared to 90 to 150 ml in the adult.
http://nursingcrib.com/pathophysiology/increased-intracranial-pressure/http://nursingcrib.com/pathophysiology/increased-intracranial-pressure/


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GENERIC/

BRAND

NAME

CLASSIFICATION MECHANISM

OF

ACTION

CONTRAIN-

DICATION

SIDE &

ADVERSE

EFFECT

Nursing Implication

Chlorpromazine Antipsychotic A piperidone

phenothiazine

that may block

post synaptic

dopamine

receptors in the

brain.

Hypersensitivity to

drug and those with

Parkinsonism, coma

or CNS depression

CNS: severe extra

pyramidal

reactions,

dyskinesia,

dizziness,

drowsiness

CV: tachycardia

GI: nausea

constipation, dry

mouth

-Monitor blood pressure

regularly.

- Watch for orthostatic

hypotension

-Monitor for tardice

dyskinesia

-Watch for signs and

symptoms of neurolyptic

malignant syndrome

-Advise client not to chew

extended release capsule

before swallowing

DOSAGE INDICATION THERAPEUTIC

EFFECTS

PRECAUTION

100 mg capsule

once a day

Psychotic Disorders Exerts

antipsychoticeffects to the

client

Use cautiously in

elderly clients, thosewith history of

seizures, CV

disorders and

respiratory disorders


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GENERIC/

BRAND

NAME

CLASSIFICATION MECHANISM

OF

ACTION

CONTRAIN-

DICATION

SIDE &

ADVERSE

EFFECT

Nursing Implication

Haloperidol/

Haldol

Antipsychotic A butyrophenone

that probablyexerts

antipsychotic

effects by

blocking post

synaptic

dopamine

receptors in the

brain.

Hypersensitivity to

drug and those withParkinsonism, coma

or CNS depression

CNS: severe

extra pyramidalreactions,

dyskinesia,

seizures,

lethargy

CV:

hypotension,

tachycardia

GI: anorexia,

constipation, dry

mouth

- Monitor patient for

tardive dyskinesia whichmay occur after prolong

use.

- Watch for signs and

symptoms of extra

pyramidal effects

- Tell client to relieve dry

mouth with sugarless

candy

DOSAGE INDICATION THERAPEUTIC

EFFECTS

PRECAUTION

5 mg tablet

once a day

Psychotic Disorders Exerts

antipsychotic

effects to the

client

Use cautiously in

elderly clients, those

with history of

seizures, CV disorders

and those using

lithium.


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ASSESSMENT BACKGROUND

KNOWLEDGE

PATIENTS

PROBLEM

OBJECTIVE OF

INTERVENTIONS

NURSING ACTIONS AND

RATIONALE

SUBJECTIVE:

>Malungkot dito

kapag walangstudent nurse.

OBJECTIVE:

>sadness

> poor eye

contact at times

>absent of

significant others

>isolates self in

room most of the

time

Aloneness

experienced by the

individual areperceived as

imposed by others

and as a negative or

threatening state.

Social Isolation

related to sadness,

poor eye contactat times, absent of

significant others

and isolation of

self in room most

of the time.

After nursing

interventions, the

client will be able toengage self in all

social activities

actively and

verbalize willingness

to social interactions.

>Provide therapeutic Environment

_To gain clients trust

> Provide a positive reinforcement when

client makes moves towards others.

_It encourages continuation of efforts.

>Promote participation in activities.

_This facilitates socialization

>Engage other client to interact with the

client

_this promotes social skills in a safe

setting.

>Help the client seek out clients to

socialize with who have similar interest._Shared common interest promote more

enjoyable socialization which may be

repeated.

>Praise the client for attempts to seek out

others for activities and interactions

_Praises promotes repeated positive social

behavior.


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Medication

Instruct the family of the client to strictly follow the doctors prescribed medication

. Medication education should also be documented, along with instructions about

dosage, times and any special instructions such as the need to take the drugs

with food or milk

Instruct the family of the client importance of compliance to medication as

discontinuing antipsychotic medications is a frequent cause of relapse and

rehospitalization.

Exercise

Instruct the family of the client to continue the light exercise and avoid thestrenuous activity because to prevent seizure

Treatment

Strictly follow Physicians treatment order.

Health teaching

Inform the family of the patient to always orient the patient to time, place, date

and current events

Inform the family of the patient to use therapeutic communication while talking tothe patient

Inform the family of the patient to do different therapeutic activity like

occupational, remotivational, movie analysis and health teaching.

Inform the family of the client that good communication is a big contributing factor

for the recovery of the patient.

Out-patient follow up

Inform the family of the client that the appointment or follow up with the

psychiatrist is very much needed for the patient with schizophrenia to promote

continues recovery

Advise the family of the client to go back to hospital If they observe any

unnecessary action of the patient aside from the one explained by the

psychiatrist.


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case study schizoprenia

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