nursing interventions in schizophrenia

7/28/2019 Nursing Interventions in Schizophrenia

1/24

Nursing Interventions in

Schizophrenia


2/24

Self-Assessment: Working

with Schizophrenic Clients

Peer group supervision

Client's intense emotions produce

similar emotions in the nurse

Willingness for nurse to discuss feelings and behaviors with

supervisors decreases defensive behaviors

Team approach to decrease staff burnout

Periodic reassessments of

Treatment outcomes

Client's strengths and weaknesses


3/24

Assessment of the

Client

Safety of client and others

Medical history and recent medical workup

Positive, negative, cognitive, and moodsymptoms

Current medications and compliance to

treatment Family response/support system


4/24

Potential Nursing

Diagnoses

Risk for self-directed or other-directed

violence

Disturbed sensory perception

Disturbed thought processes

Impaired verbal communication

Ineffective coping

Compromised or disabled family coping


5/24

Outcome Criteria Acute phase

Client safety and medical stabilization

Maintenance phase Adherence to medical regimen

Understanding schizophrenia

Participation of client and family in psychoeducational activities

Stabilization phase

Target negative symptoms

Anxiety control

Relapse prevention


6/24

Planning of

Appropriate Interventions

Acute phase

Possible hospitalization Ensure client safety

Provide symptom stabilization

Maintenance and stabilization phases

Psychosocial education

Relapse prevention skills


7/24

Interventions: Basic Level

Acute phase

Administer antipsychotic medication asprescribed

Observe client behavior closely Set limits on inappropriate behavior

Do not touch without warning

Offer foods that are not easilycontaminated

Supportive counseling

Milieu management

Family psychoeducation


8/24

Interventions: Basic LevelContinued

Maintenance and stabilization phases

Health teaching

Health promotion and maintenance


9/24

Milieu Therapy

Safety

Potential for physical violence due tohallucinations or delusions

Priority is least restrictive safety technique

Verbal de-escalation

Medications

Seclusion or restraints

Activities

Provide support and structure

Encourage development of social skillsand friendships


10/24

Counseling:Communication Guidelines Hallucinations

Hearing voices most common

Approach client in nonthreatening andnonjudgmental manner

Assess if messages are suicidal or homicidal

Initiate safety measures if needed

Client anxious, fearful, lonely, brain not processingstimuli accurately

Focus on the clients feelings and present reality


11/24

Communication Guidelines

continued

Delusions

Be open, honest, matter-of-fact, and calm

Have client describe delusion Avoid arguing about content

Focus on feelings

Present reasonable doubt Validate part of delusion that is real


12/24

Communication Guidelines

continued

Associative looseness

Do not pretend that you understand

Place difficulty of understanding on yourself Look for reoccurring topics and themes

Emphasize what is going on in the client's

environment Involve client in simple, reality-based

activities

Reinforce clear communication of needs,

feelings, and thoughts


13/24

Client Teaching

Coping Techniques for

Schizophrenia

Distraction

Interaction

Activity

Social action

Physical action


14/24

Client and Family Teaching Learn all you can about the illness.

Develop a relapse prevention plan.

Avoid alcohol and drugs. Learn ways to address fears and losses.

Learn new ways of coping.

Comply with treatment.

Maintain communication with supportivepeople.

Stay healthy by managing illness, sleep, anddiet.


15/24

CLIENT AND FAMILY TEACHING Teach about schizophrenia and available

mental health agencies for support at thelocal and national level (NAMI AND NIMH).

Develop a relapse prevention plan.

Teach about medication and treatmentcompliance.

Teach to avoid alcohol or drugs. Teach to keep in touch with supportive

people.

Teach to keep healthy stay in balance.


16/24

Loose Association

Definition - thinking haphazard, illogical,

and confused. Connections in thought

are interrupted. Example:I cant go to the zoo, no

money, Oh... I have a hat, these

members make no sense, manWhatsthe problem?

Back
http://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Loose_Assoc.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Loose_Assoc.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Loose_Assoc.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Loose_Assoc.mov


17/24

Neologism

Definition: Words a personmakes up that have meaning

only for that person, it is oftenpart of a delusional system.

Example:I am afraid to go tothe hospital because the norksare looking for me.

Back
http://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Neologism.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Neologism.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Neologism.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Neologism.mov


18/24

Clang Association

Definition: The meaningless

rhyming of words, often in a

forceful manner.

Example:Rain, pain, bang,

clang. Back
http://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Clang_Assoc.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Clang_Assoc.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Clang_Assoc.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Clang_Assoc.mov


19/24

Echolalia

Definition - mimicking or imitating

the speech of another person.

Example:The nurse says to the

patient, Tell me your name. The

patient responds, Tell me your

name, tell me your name.Back
http://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Ecolalia.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Ecolalia.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Ecolalia.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Ecolalia.mov


20/24

Word Salad

Definition: Mixture of words andphrases that have no meaning.

Example:I am fineapplepieno salefurniturestoretake it slowcellardoor

Back
http://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Word_Salad.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Word_Salad.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Word_Salad.movhttp://localhost/var/www/apps/conversion/tmp/scratch_2//UTTYLER/COMMON/NURSING/MStanley/Word_Salad.mov


21/24

BE FAMILIAR WITH:

thought broadcasting - the

belief that ones thoughts can

be heard by others

Back


22/24

Thought Insertion

thought insertion - the belief

that thoughts from other people

are being inserted into ones

mind

BACK


23/24

BE FAMILIAR WITH:

thought withdrawal - the belief

that thoughts have been

removed from ones mind by an

outside agency.

Back


24/24

Delusions of Being

Controlled

Delusions of being controlled

belief that ones body or mind is

controlled by an outside agency

BACK

nursing interventions in schizophrenia

Documents