NURSING CARE AND

MANAGEMENT OF CLIENT WITH

SCHIZOPHRENIA
By : Haryati Osman
DEFINITION
Schizophrenia is a mental disorder
characterized by a breakdown of thought
processes and by poor emotional
responsiveness.(Wikipedia dictionary)
SYMPTOMS
Positive Symptoms
Delusions
Hallucinations
Disorganized thinking
Agitation
Negative Symptoms
Affective flattening - The person's range of
emotional expression is clearly diminished;
poor eye contract; reduced body language
Alogia - A poverty of speech, such as
brief, empty replies
Avolition - Inability to initiate and persist in
goal-directed activities (such as school or
work)

CAUSES
Genetic
Environment
Substance misuse
Developmental factors
Mechanisms
Psychological
Neurological
PREVENTION
earlier diagnosis and earlier treatment.
taking proactive steps
avoiding illegal drug use,
reducing stress,
getting enough sleep
and starting antipsychotic medications
MANAGEMENT
Psychopharmacology
ECT
Psychosocial therapy
Cognitive Behavior Therapy
Family Education
CASE PRESENTATION

PATIENT WITH

SCHIZOPHRENIA

DEMOGRAPHIC DATA
Miss S
23 years old
Single
Malay
Diagnosis : Schizophrenia
Last Date of Admission : 13 February,
2013
Onset of Mental Illness : 21 years old
FAMILY BACKGROUND
Parent divorced since patient young
First child in the family
Has brother, 19 years old
Stay with family,father, step mother and
brother
Her own mother married again, stay in
Sarawak
EDUCATION AND SOCIAL
BACKGROUND
Study until SPM- grade 3
Further study in University for 6 months
Stopped due to illness
Had a boyfriend - father not agreed
Then stay with mother for 3 years
Stay with uncle for 2 months
MEDICAL HISTORY
History of Gastritis- on follow up HSA



SURGICAL HISTOR
No surgical history
HISTORY OF ADMISSION
1st admission - Hospital Bukit Padang,
Sarawak due to aggressive behavior,
auditory hallucination in 2009.
2nd admission -Hospital Permai-
aggressive, abnormal behavior-July 2010
3rd admission- Hospital Sultanah Aminah-
August 2011-allerged rape, paranoid
toward father "kena bomoh"
4th admission- Hospital Permai-refer by
CPU for job placement.

PHYSICAL EXAMINATION
GC- calm and comfortable.
Height : 150cm
Weight : 60kg
Body Mass Index : 24
Vital signs:
Blood pressure : 114/78 mmHg
Pulse : 90 bpm
Respiration : 22 /min
Temperature : 36.4 C
MENTAL STATE EXAMINATION
General Apperarance calm and
comfortable
Auditory hallucination
No disturbance in thought
Able to maintain eye contact
No disturbance in memory
No disturbance in bahevior
No disturbance in insight




MANAGEMENT
OF
PATIENT
PSYCHOSOCIAL
INTERVENTIONS
Individual Therapy and Group Therapy
Health education
Occupational Therapy
NURSING DIAGNOSIS AND
NURSING INTERVENTIONS
1. Patient loss of focus and concentration
related to hallucinations or delusions.
Goals : Patients experience less hallucinations and
delusions and able to concentrate on reality.

Nursing Interventions:
Do not focus on hallucinations or delusions. Perform
an interrupt to initiate interaction with the patients
hallucinatory one-on-one based on reality.
do not agree with the perception of the client, but the
validation that you believe that the hallucinations are
real to the patient.
Do not argue with the patient about the hallucinations
or delusions.
Respond to the feelings that are
communicated to the patient when he was
having hallucinations or delusions.
Switch and the patient focus on a
structured activity or task-based reality.
Move the patient to a more quiet, less
stimulating.
Wait until the patient does not have
hallucinations or delusions before starting
the counseling session about it.
Explain that hallucinations or delusions are
symptoms of psychiatric disorders.
Help patient to control hallucinations by
focusing on reality and take medication as
prescribed.
If hallucinations persist, help patient ignore it
and continue acting remedy properly despite
a hallucination.
Teach a variety of cognitive strategies and tell
the patient to use self talk ("voices that makes
no sense") and the cessation of the mind ("I
will not think about it").


2. Patient who are suspicious and rude related
to paranoid
Goals : patients will be able to cooperate and communicate
in a good manner with the staff
Nursing Interventions:
Form professional relationships; too friendly to bet the
threat.
Be careful with the touch because it can be considered a
threat.
Give as much control and autonomy to the client within
the therapeutic limits.
Create a sense of trust through brief interactions that
communicate caring and respect.
Describe any treatment, medication and
laboratory tests before the start.
Do not focus or strengthen the suspicion
or delusional ideas.
Identify and provide a response to the
underlying emotional needs of suspicion or
delusional
Intervene when the client shows signs of
increasing anxiety and potentially express
an unconscious behavior.
Be careful to not behave in a way that
could be misinterpreted client.
3. Communication disorder related to social
isolation and withdrawal personality.
Goals : patients will be able to communicate
and able to understand by the staff
Nursing Interventions:
Keep your own communication to keep it
clear and unambiguous.
Maintain consistency of your verbal and
nonverbal communication.
Clarification of any meaning ambiguous or
not clearly related to client communication.

4. Patient show regressive behaviour or unfair
related to low self esteem.
Goals : Patients can live a normal life more
vibrant, competitive and do the daily routine
by himself.
Nursing Interventions:
Do approach, it is strange behaviour (do not
reinforce this behaviour).
Treat the client as an adult, even though the
client regresses.
Monitor the client's diet, and give support and
assistance when necessary.

Assist the client in terms of hygiene and dress
up, only when the client can not do it alone.
Be careful with the touch because it can be
considered a threat
Create a regular schedule of activities of daily
living.
Give a simple choice of two things for clients
who experience ambivalence.
CONCLUSION
Miss S suffering from schizophrenia.
Family support is important in patient
management.
It would require multidisciplinary team to
provide collaborative care to meet Miss S
complex needs.
The aim for management of schizophrenia
is to minimize of the negative effects of
schizophrenia and enhances quality life.
REFERENCES
US Department of Health and Human Services (2001).
The Impact of Mental Illness on Society (NIH Publication
01-4586), National Institutes of Health.

Stefan, M., Travis, M. & Murray, R. M. (2002). An Atlas
of Schizophrenia, Parthenon Publishing.

NARSAD (2003). Understanding Schizophrenia, National
Alliance for Research on Schizophrenia and Depression.


THANK YOU