Anda di halaman 1dari 21

URDANETA CITY, PANGASINAN

COLLEGE OF NURSING
A CASE STUDY ON
SCHIZOPHRENIA
Submitted to:
Ms. Maribel Murillo RN, MAN
Clinical Instructor
Submitted by:
Kristin Abee E. Guarin
SN Batch !"#
I. PATIENT ASSESSMENT DATABASE
A. Personal Data
Name: Mr. MP
Address: Las Pinas, Philippines
Ae: 35
Se!: Male
B"rt#da$: June 5, 1976
B"rt# Pla%e:
C"&"l Stat's: Single
Nat"onal"t$: Filipino
Rel""on: Roman Catholi
Ed'%at"onal Atta"nment! 3
r"
#ear ollege, $S Management
O%%'(at"on: %one
P#$s"%"an: &r. Corte'
Date o) Adm"ss"on: Jul# 1(, )**(
Adm"tt"n D"anos"s: Shi'ophrenia
*os("tal Name: Mother +heresa , -ome that Cares
B. C*IEF COMPLAINT
%., /he "oesn0t ooperate upon inter1ie23
C. *ISTORY OF PRESENT ILLNESS
%.,/he "oesn0t ans2er m# 4uestion a5out his present illness3

D. PAST *EALT* *ISTORY
%., /he "oesn0t reall his past health histor#3
E. FAMILY ASSESSMENT
%ame Relation ,ge Se6 7upation 8"uational ,ttainment
Mr. MP Patient 35 Male %one 3
r"
#ear ollege
Mr. CP Father 79 Male &oesn0t reall &oesn0t reall
Mrs. &P Mother 69 Female &oesn0t reall &oesn0t reall
F. SYSTEM RE+IE,
1. HEALTH PERCEPTION HEALTH MANAGEMENT PATTERN
%ot assess 5eause patient "oesn0t ans2er m# 4uestions a5out health pereption an" health management
2. NUTRITIONAL METABOLIC PATTERN
%.,
3. ELIMINATION PATTERN
Patient usuall# urinates 6 times a "a# an" "e:eates ) times "ail#
4. ACTIVITY- EXERCISE PATTERN
*;Fee"ing * ;&ressing *;<rooming
*;$athing * ;+oileting ====others
Leend:
1- Full Care
>; Re4uires use o: assistane
>>; Re4uires assistane an" super1isions 5# others
>>>; Re4uires assistane or super1isions :rom another an" e4uipments an" "e1ies
>? @ &epen"ent, "oesn0t partiipate
5. COGNITIVE PERCEPTUAL PATTERN
*ear"n: she "oesn0t ha1e an# hearing pro5lems
+"s"on: she0s ha1ing 5lurre" 1ision an" she use rea"ing glass
Sensor$: our patient is responsi1e an" is a5le stimulate" 5# losing her e#es an" instrute" to point 2hat ha1e 5een pointe" on her
sAin. +here is no pro5lem 2ith sense o: taste an" smell.
Learn"n St$les: m# patient "oesn0t ans2er m# 4uestion an" sometimes not ooperati1e
6. SLEEP- REST PATTERN
,or"ing to m# patient he sleeps at 9pm to 6am. -e also state" that sometimes he ha" pro5lems in sleeping.
7. SELF- PERCEPTION AND SELF- CONCEPT PATTERN
%.,
8. ROLE- RELATIONSHIP PATTERN
%.,
9. COPING- STRESS TOLERANCE PATTERN
N-A
10.VALUE- BELIEF PATTER
N-A
G. DE+ELOPMENTAL *ISTORY
T#eor$ Ae Se! Des%r"(t"on
8riAson0s Ps#hosoial +heor# 35 #ears ol" Male
Int"ma%$ &s Isolat"on
Mr. MP "oesn0t ans2er m# 4uestions sometimes an" "oesn0t partiipate to the
ati1ities 5eause he "oesn0t trust me as his nurse.
H. P*YSICAL ASSESSMENT
A. General S'r&e$
1. O&erall a((earan%e and room"n: upon assessment patient is neat an" lean, he mani:este" a goo" grooming.
2. A%t'al #e"#t and .e"#t &s/ "deal 0od$ .e"#t: n.a
3. S$m(toms o) d"stress: he is not ans2ering m# 4uestion mostl# an" he pre:er to 5e alone sometimes
4. Post're and a"t: upon assessment her posture an" gait are 2ell oor"inate".
5. A))e%t and mood: he is not ans2ering m# 4uestion mostl# an" he pre:er to 5e alone sometimes.
B. Re"onal e!am1 't"l"2e IPPA te%#n"3'e
". *a"r: Bpon inspetion, his hair is e1enl# "istri5ute", thiA, its te6ture is silA# an" resilient hair an" there is no presene o: in:estation
/lie3 an" 1aria5le in amount.
*ead and )a%e: his hea" is roun", smooth sAull ontour, s#mmetri in si'e an" onsistent 2hile her :ae is s#mmetri in :aial
mo1ement.
. E$es: Bpon inspetion o: the lient0s e#es, its e#e5ro2s an" e#elashes are s#mmetriall# aligne", urle" slightl# out2ar" an" hair is
e1enl# "istri5ute".
$. Nose: Bpon inspetion, lient0s nose is s#mmetrial, no "isharges, uni:orm in olor, he 5reaths properl# through the nares.
#. Ears: +hrough inspetion, lient0s ears are s#mmetrialC the aurile is aligne" 2ith the outer anthus o: the e#es an" same 2ith the
olor o: :aial sAin.
%. Mo't# and t#roat: +hrough inspetion, lient0s lips an" 5ual muosa is pinA in olor. %o retration o: gums, 2ith inomplete teeth.
+ongue mo1es :reel#.
&. Ne%4 and l$m(# nodes: +he lient0s neA musles are e4ual in si'e, no enlargement o: no"ules or masses upon palpation. -ea"
mo1ement is oor"inate" an" smooth mo1ement 2ith no "isom:ort.
'. S4"n: $ro2n in olor, 2arm to touh an" e4uall# "istri5ute" 5# hair.
(. Na"ls: :ingernail plate has on1e6 ur1ature an" an angle o: nail plate a5out 16*D, smooth te6ture, :inger nail an" toenail 5e" olor is
pale, 2ith intat epi"ermis.
). T#ora! and l'ns: Chest is s#mmetri, spine 1ertiall# aligne", spinal olumn is straight, right an" le:t shoul"er are at same height.
"!. Breast and a!"lla: not assesse"
"". . A0domen: not assesse"
". E!trem"t"es: there is no presene o: e"ema or a5normal :in"ings
"$. Gen"tals: not assesse"
"#. Re%t'm and an's: not assesse"
"%. Ne'rolo"%al-Cran"al ner&es: not assesse".
INTRODUCTION
Shi'ophrenia is a ps#hoti "isor"er /or a group o: "isor"ers3 marAe" 5# se1erel# impaire" thinAing, emotions, an" 5eha1iors. Shi'ophreni
patients are t#piall# una5le to :ilter sensor# stimuli an" ma# ha1e enhane" pereptions o: soun"s, olors, an" other :eatures o: their en1ironment.
Most shi'ophrenis, i: untreate", gra"uall# 2ith"ra2 :rom interations 2ith other people, an" lose their a5ilit# to taAe are o: personal nee"s an"
grooming.
Cl"n"%al Man")estat"ons
+he s#mptoms o: shi'ophrenia are "i1i"e" into t2o maEor ategories!
A. +he positi1e s#mptoms inlu"e!
"elusions an" its t#pes,
halluinations,
loose assoiations an"
5i'arre or "isorgani'e" 5eha1ior
B. +he negati1e s#mptoms inlu"es!
restrite" emotions,
anhe"onia,
a1olition,
alogia,
atatonia an"
soial 2ith"ra2al.
D"anost"% Test
Clinial "iagnosis is "e1elope" on historial in:ormation an" thorough mental status e6amination.
%o la5orator# :in"ings ha1e 5een i"enti:ie" that are "iagnosti o: shi'ophrenia.
Routine 5atter# o: la5orator# test ma# 5e use:ul in ruling out possi5le organi etiologies, inlu"ing C$C, urinal#sis, li1er :untion tests,
th#roi" :untion test, RPR, ->? test, serum eruloplasmin / rules out an inherite" "isease, 2ilson0s "isease, in 2hih the 5o"# retains
e6essi1e amounts o: opper3, P8+ san, C+ san, an" MR>.
Rating sale assessment!
Sale :or the assessment o: negati1e s#mptoms.
Sale :or the assessment o: positi1e s#mptoms.
$rie: ps#hiatri rating sale
Treatment
, omprehensi1e treatment program an inlu"e!
,ntips#hoti me"iation
8"uation F support, :or 5oth ill in"i1i"uals an" :amilies
Soial sAills training
Reha5ilitation to impro1e ati1ities o: "ail# li1ing
?oational an" rereational support
Cogniti1e therap#
N'rs"n Inter&ent"ons:
A. Strent#en"n D"))erent"at"on
Pro1i"e patient 2ith honest an" onsistent :ee"5aA in a non threatening manner.
,1oi" hallenging the ontent o: patient0s 5eha1ior
Fous interations on patient0s 5eha1ior.
,"minister "rugs as presri5e" 2hile monitoring an" "oumenting patient0s response to "rug regimen.
Bse simple an" lear language 2hen speaAing 2ith the patient.
86plain all proe"ures, test an" ati1ities to patient 5e:ore starting them
B. Promot"n So%"al"2at"on
8nourage patient to talA a5out :eelings in the onte6t o: a trusting, supporti1e relationship.
,llo2 patient to re1eal "elusions to #ou 2ithout engaging in po2er struggle o1er the ontent or the entire realit# o: the "elusions.
Bse supporti1e, emphati approah to :ous on patient0s :eelings a5out trou5ling e1ents or on:lits.
Pro1i"e opportunities :or soiali'ation an" enourage partiipation in group ati1ities.
$e a2are o: personal spae an" use touh Eu"iiousl#.
-elp patient to i"enti:# 5eha1iors that alienate signi:iant others an" :amil# mem5ers.
C. Ens'r"n Sa)et$
Monitor patient :or 5eha1iors that in"iate inrease" an6iet# an" agitation.
Colla5orate patient to i"enti:# an6ious 5eha1iors as 2ell as auses.
8sta5lish onsistent limits on patients 5eha1ior an" learl# ommuniate these limits to patients, :amil# mem5er, an" health are pro1i"ers.
Seure all potential 2eapons an" artiles :rom patients room an" the unit en1ironment that oul" 5e use" to in:lit inEur#.
&etermine the nee" :or e6ternal ontrol, inlu"ing selusion or restraints. Communiate the "eision to patient an" put plan into ation.
Fre4uentl# monitor the patient 2ithin gui"elines o: :ailit#0s poli# on restriti1e "e1ies an" assess the patients le1el o: agitation.
Ghen patient0s le1el o: agitation 5egins to "erease an" sel: ontrol regaine", esta5lish a 5eha1ioral agreement that i"enti:ies spei:i
5eha1iors that in"iate sel: ontrol against are esalation agitation.
ANATOMY AND P*YSIOLOGY
I/ Str'%t'res
,. +he ne'rolo"% s$stem onsists o: t2o main "i1isions, the entral ner1ous s#stem /C%S3 an" the peripheral ner1ous s#stem /P%S3. +he
autonomi ner1ous s#stem /,%S3 is ompose" o: 5oth entral an" peripheral elements.
1. +he CNS is ompose" o: the 5rain an" spinal or".
). +he PNS is ompose" o: the 1) pairs o: the ranial ner1es an" the 31 pairs o: the spinal ner1es.
3. +he ANS is omprise" o: 1iseral e::erent /motor3 an" the 1iseral a::erent /sensor#3 nulei in the 5rain an" spinal or". >ts peripheral
"i1ision is ma"e up o: 1iseral e::erent an" a::erent ner1e :i5ers as 2ell as autonomi an" sensor# ganglia.
$. +he 0ra"n is o1ere" 5# three mem5ranes.
1. +he d'ra matter is a :i5rous, onneti1e tissue struture
ontaining se1eral 5loo" 1essels.
). +he ara%#no"d mem0rane is a "eliate serous mem5rane.
3. +he ("a matter is a 1asular mem5rane.
C. +he s("nal %ord e6ten"s :rom the me"ulla o5longata to the lo2er
5or"er o: the :irst lum5ar 1erte5rae. >t ontains millions o: ner1e :i5ers,
an" it onsists o: 31 ner1es @ 9 er1ial, 1) thorai, 5 lum5ar, an" 5
saral.
&/ Cere0ros("nal )l'"d 5CSF6 :orms in the lateral 1entriles in the
horoi" ple6us o: the pia matter. >t :lo2s through the :oramen o: Monro
into to the thir" 1entrile, then through the a4ue"ut o: S#l1ius to the
:ourth 1entrile. CSF e6its the :ourth 1entrile 5# the :oramen o:
Magen"ie an" the t2o :oramens o: LusAa. >t then :lo2s into the istema
magna, an" :inall# it irulates to the su5arahnoi" spae o: the spinal
or", 5athing 5oth the 5rain an" the spinal or". Flui" is a5sor5e" 5# the
arahnoi" mem5rane.
II/ F'n%t"on
A/ CNS
1. Bra"n
T#e %ere0r'm is the enter :or onsiousness, thought, memor#, sensor# input, an" motor ati1it#C it onsists o: t2o hemispheres /le:t an"
right3 an" :our lo5es, eah 2ith spei:i :untions.
+he :rontal lo5e ontrols 1oluntar# musle mo1ements an" ontains motor areas, inlu"ing the area :or speehC it also ontains the enters :or
personalit#, 5eha1ioral, autonomi an" intelletual :untions an" those :or emotional an" ar"ia responses.
+he temporal lo5e is the enter :or taste, hearing an" smell, an" in the 5rain0s "ominant hemisphere, the enter :or interpreting spoAen
language.
+he parietal lo5e oor"inates an" interprets sensor# in:ormation :rom the opposite si"e o: the 5o"#.
+he oipital lo5e interprets 1isual stimuli.
+he t#alam's :urther organi'es ere5ral :untion 5# transmitting impulses to an" :rom the ere5rum. >t also is responsi5le :or primiti1e
emotional responses, suh as :ear, an" :or "istinguishing 5et2een pleasant an" unpleasant stimuli.
L#ing 5eneath the thalamus, the #$(ot#alam's is an automati enter that regulates 5loo" pressure, temperature, li5i"o, appetite, 5reathing,
sleeping patterns, an" peripheral ner1e "isharges assoiate" 2ith ertain 5eha1ior an" emotional e6pression. >t also helps ontrol pituitar# seretion
an" stress reations.
+he ere5ellum or hin"5rain, ontrols smooth musle mo1ements, oor"inates sensor# impulses 2ith musle ati1it#, an" maintains musle
tone an" e4uili5rium.
+he 5rain stem, 2hih inlu"es the mesenephalon, pons, an" me"ulla o5longata, rela#s ner1e impulses 5et2een the 5rain an" spinal or".
7/ T#e s("nal %ord :orms a t2o;2a# on"utor path2a# 5et2een the 5rain stem an" the P%S. >t is also the re:le6 enter :or motor ati1ities that "o
not in1ol1e 5rain ontrol.
B/ T#e PNS onnets the C%S to remote 5o"# regions an" on"uts signals to an" :rom these areas an" the spinal or".
C/ T#e ANS regulates 5o"# :untions suh as "igestion, respiration, an" ar"io1asular :untion. Super1ise" hie:l# 5# the h#pothalamus, the ,%S
ontains t2o "i1isions.
1. +he s$m(at#et"% ner&o's s$stem ser1es as an emergen# prepare"ness s#stem, the H:light;:or;:ightI response. S#mpatheti impulses
inrease greatl# 2hen the 5o"# is un"er ph#sial or emotional stress ausing 5ronhiole "ilation, "ilation o: the heart an" 1oluntar# musle 5loo"
1essels, stronger an" :aster heart ontrations, peripheral 5loo" 1essel onstrition, "erease" peristalsis, an" inrease" perspiration. S#mpatheti
stimuli are me"iate" 5# norepinephrine.
). +he (aras$m(at#et"% ner&o's s$stem is the "ominant ontroller :or most 1iseral e::etors :or most o: the time. Paras#mpatheti
impulses are me"iate" 5# aet#lholine.
PAT*OP*YSIOLOGY
Distur!"#$ i" "$ur%tr!"s&itt$r
s'st$&
Br!i" ($)$*%+&$"t ,r%& #%"#$+ti%" t% $!r*'
!(u*t-%%(
A"!t%&i# !"( ,u"#ti%"!* (isru+ti%" i" "$ur!* #%""$#ti)it' !"(
#%&&u"i#!ti%"
I&+!ir$( !i*it' t%
+$r#$i)$
I&+!ir&$"t i" %"$ %r &%r$ s$#%"(-%r($r
#%."iti)$ +r%#$ss
I&+!ir&$"t i" ! ,u"(!&$"t!* #%."iti)$
+r%#$ss
*redis+osin,
-actor
Str$ss
/%0 s%#i%$#%"%&i#s
LABORATORY RESULT
Ele%trol$tes
Result %ormal ?alues Signi:iane
So"ium 136 135;1(5 Githin normal range
Potassium 3.99 3.5;5.* Githin normal range
Ur"nal$s"s
RESULTS SIGNIFICANCE RESULTS SIGNIFICANCE
Color!
Jello2 Githin normal range
Sugar!
negati1e
Githin normal range
+ransparen#! Spei:i gra1it#!
/%%s$"$ss %, !i*it' i"
t-i"1i".
S2S34 D$*usi%" !"(
-!**u#i"!ti%"
Dis%r.!"i5$( t-%u.-t
#%",usi%"
S%#i!* is%*!ti%"
Clear Githin normal range 1.*1* Githin normal range
Reation! Mirosopi!
PusleuAo#tes!
,l5umin!
,i"i ,l5umin Githin normal range 8r#thro#tes!
Roentroenolo"%al re(ort
F"nd"ns:
+here are ha'# in:iAtrates at 5oth suprahilar area heart is not enlarge" "iaphragm an" suli are intat
Im(ress"on
Suprahilar pneumonitis, 5ilateral AohKs etiolog# not rule" out
DRUG STUDY
Gener"% Name: -aloperi"ol
Brand Name: -al"ol
Dr' Class")"%at"on: ,ntips#hoti
Dosae: )*mg 1.( ta5 7&
Ind"%at"on: Management o: mani:estations o: ps#hoti "isor"ers
Me%#an"sm o) A%t"on Ad&erse E))e%ts Contra"nd"%at"ons S"de E))e%ts N'rs"n Cons"derat"ons
,nti;ps#hotis 5loA
posts#napti "opamine
reeptors in the 5rain,
"epress the R,S,
inlu"ing those parts o:
the 5rain in1ol1e" 2ith
2aAe:ulness an" emesis.
?ertigo, hea"ahe
%asal ongestion
Pol#uria
Cere5ral e"ema
+remor
,ta6ia
7rthostati
h#potension
Car"iomegal#
S>,&-
8osinophilia
Leuopenia
Jaun"ie
Brtiaria
Coma
Se1ere C%S
"epression
$one marro2
"epression
$loo" "#srasia
Cirulator# ollapse
Su5ortial 5rain
"amage
Cere5ral
arterioslerosis
Coronar# "isease
Se1ere h#potension
or h#pertension
&ro2siness
$lurring o: 1ision
&r# mouth
%ausea an" 1omiting
+ah#ar"ia,
5ra"#ar"ia
insomnia
Pro1i"e sa:et# to the patient
Maintain :lui" intaAe an" use
preautions against heatstroAe or
heat 2eather
Monitor eletrol#tes le1el
Monitor ?ital Signs ontinuousl#
Pro1i"e rest an" om:ort
Monitor C$C, $B%, Creatinine
<ra"uall# 2ith"ra2 "rug 2hen
patient has 5een on maintenane
therap#
Gener"% Name: &iphenh#"ramine h#"rohlori"e
Brand Name: $ena"r#l
Dr' Class")"%at"on: ,ntiparAinsonian
Dosae: 5*mg ap -S
Ind"%at"on: ParAinsonism /inlu"ing "rug in"ue" parAinsonism an" e6trap#rami"al reations3, in the el"erl# intolerant o: more potent "rugs, :or
mil"er :orms o: "isor"er
Me%#an"sm o) A%t"on Ad&erse E))e%ts Contra"nd"%at"ons S"de E))e%ts N'rs"n Cons"derat"ons
Competiti1el# 5loAs the
e::ets o: histamine at
h1 reeptor sites, has
atropine;liAe, anti;
pruriti an" se"ati1e
e::ets
Fatigue
Con:usion
$lurre" 1ision
-ea"ahe
&iplopia
+remors
Palpitations
$ra"#ar"ia
&iarrhea
Constipation
Brinar# :re4uen#
,nore6ia
&#suria
rash
+hir" trimester o:
pregnan#
Latation
Used %a't"o'sl$
."t#:
%arro2 angle
glauoma
,sthmati attaA
$la""er neA
o5strution
Pregnan#
Stenosing pepti
uler
S#mptomati
prostati
h#pertroph#
&ro2siness
Se"ation
&i''iness
&istur5e"
oor"ination
%ausea an" 1omiting
Pro1i"e sa:et# to the patient
,ssist patient in am5ulation
Maintain :lui" intaAe an" use
preautions against heatstroAe or
heat 2eather
Monitor eletrol#tes le1el
,"minister these "rugs 2ith :oo"
i: <> upset our
Monitor ?ital Signs ontinuousl#
Pro1i"e rest an" om:ort
Monitor C$C, $B%, Creatinine
<ra"uall# 2ith"ra2 "rug 2hen
patient has 5een on maintenane
therap#
Gener"% Name: Fluo6etine h#"rohlori"e
Brand Name: Pro'a
Dr' Class")"%at"on: SSR> /Seleti1e Serotonin ReuptaAe >nhi5itor3
Dosae: initiall# )*mg."a# ta5
Ind"%at"on: treatment o: "epressionC most e::eti1e in patients 2ith maEor "epressi1e "isor"er
Me%#an"sm o) A%t"on Ad&erse E))e%ts Contra"nd"%at"ons S"de E))e%ts N'rs"n Cons"derat"ons
,ts as an
anti"epressant 5#
inhi5iting C%S neuronal
uptaAe o: serotoninC
5loAs uptaAe o:
serotonin 2ith little
e::et on norepinephrine
,gitation
Se"ation
Sei'ure
,5normal gait
Palpitations
Flatulene
C#stitis
>mpotene
alopeia
h#persensiti1it# to
:luo6etine an"
pregnan#
&i''iness
-ea"e"nes
%er1ousness
S2eating an" "r#
mouth
%ausea an" 1omiting
&iarrhea
onstipation
5ra"#ar"ia
Pro1i"e sa:et# to the patient
+eah patient a5out rela6ation
tehni4ue
>nrease :lui" intaAe
Maintain :lui" intaAe an" use
preautions against heatstroAe or
heat 2eather
Monitor eletrol#tes le1el
8at :oo"s high in :i5er
Monitor ?ital Signs ontinuousl#
Pro1i"e rest an" om:ort
Gener"% Name: Fluphena'ine "eanoate
Brand Name: Mo"eate
Dr' Class")"%at"on: ,ntips#hoti
Dosae: initial "ose, 1).5 @ )5mg >M
Ind"%at"on: Management o: 5eha1ioral ompliation in patients 2ith mental retar"ation
Me%#an"sm o) A%t"on Ad&erse E))e%ts Contra"nd"%at"ons S"de E))e%ts N'rs"n Cons"derat"ons
,nti;ps#hotis 5loA
"opamine reeptors in
the 5rain, "epress the
R,S, inlu"ing those
parts o: the 5rain
in1ol1e" 2ith
2aAe:ulness an" emesis.
?ertigo, hea"ahe
%asal ongestion
Pol#uria
Cere5ral e"ema
+remor
,ta6ia
7rthostati
h#potension
Car"iomegal#
S>,&-
8osinophilia
Leuopenia
Jaun"ie
Brtiaria
Coma
Se1ere C%S
"epression
$one marro2
"epression
$loo" "#srasia
Cirulator# ollapse
Su5ortial 5rain
"amage
Cere5ral
arterioslerosis
Coronar# "isease
Se1ere h#potension
or h#pertension
&ro2siness
$lurring o: 1ision
&r# mouth
%ausea an" 1omiting
+ah#ar"ia,
5ra"#ar"ia
insomnia
Pro1i"e sa:et# to the patient
Maintain :lui" intaAe an" use
preautions against heatstroAe or
heat 2eather
Monitor eletrol#tes le1el
Monitor ?ital Signs ontinuousl#
Pro1i"e rest an" om:ort
Monitor C$C, $B%, Creatinine
<ra"uall# 2ith"ra2 "rug 2hen
patient has 5een on maintenane
therap#
Gener"% Name: Clo'apine
Brand Name: Lipro
Dr' Class")"%at"on: ,ntips#hoti
Dosae: 1**mg M ta5 )6.2eeA -S
Ind"%at"on: Management o: se1erel# ill shi'ophrenis 2ho are unresponsi1e to stan"ar" ps#hoti "rug
Me%#an"sm o) A%t"on Ad&erse E))e%ts Contra"nd"%at"ons S"de E))e%ts N'rs"n Cons"derat"ons
,nti;ps#hotis 5loA
"opamine reeptors in
the 5rain, "epress the
R,S, inlu"ing those
parts o: the 5rain
in1ol1e" 2ith
2aAe:ulness an" emesis.
+remor
&istur5e" sleep
Se"ation
S2eating
&r# mouth
Brtiaria
Rash
leuAopenia
Se1ere C%S
"epression
-istor# o: sei'ure
<ranulo#topenia
M#eloproli:erati1e
"isor"ers
&ro2siness
Se"ation
&i''iness
-ea"ahe
%ausea an" 1omiting
Constipation
Fe1er
+ah#ar"ia
h#potension
Pro1i"e sa:et# to the patient
Maintain :lui" intaAe
Monitor eletrol#tes le1el
8at :oo" rih in :i5er
+epi" sponge 5ath
Monitor ?ital Signs ontinuousl#
Pro1i"e rest an" om:ort
Monitor C$C, $B%, Creatinine
<ra"uall# 2ith"ra2 "rug 2hen
patient has 5een on maintenane
therap#
Gener"% Name: $iperi"en
Brand Name: ,Aineton
Dr' Class")"%at"on: ,ntiparAinson
Dosae: )mg."a# N ta5
Ind"%at"on: ,"Eunt in the therap# o: parAinsonism
Me%#an"sm o) A%t"on Ad&erse E))e%ts Contra"nd"%at"ons S"de E))e%ts N'rs"n Cons"derat"ons
,ntiholinergi ati1it#
in the C%S that is
5elie1e" to help
normali'e the
h#pothesi'e" im5alane
o: holinergi an"
"opaminergi
neutransmission in the
5asal ganglia in the 5rain
o: a parAinsonism
patient.
Memor# loss
,gitation
&epression
&ro2siness
+ah#ar"ia
Palpitations
-#potension
Rash
Brtiaria
2eaAness
<lauoma
P#lori or "uo"enal
o5strution
Stenosing pepti
uler
,halasia
Prostati
h#pertroph#
M#asthenia gra1is
&isorientation
Con:usion
$lurre" 1ision
&i''iness
Light;hea"e"nes
%er1ousness
&r# mouth
%ausea an" 1omiting
&iarrhea
onstipation
5ra"#ar"ia
Pro1i"e sa:et# to the patient
7rient patient a5out time, plae,
e1ent or things aroun" her.
+eah patient a5out rela6ation
tehni4ue
Maintain :lui" intaAe an" use
preautions against heatstroAe or
heat 2eather
Monitor eletrol#tes le1el
8at :oo"s high in :i5er
Monitor ?ital Signs ontinuousl#
Pro1i"e rest an" om:ort
Monitor C$C, $B%, Creatinine
<ra"uall# 2ith"ra2 "rug 2hen
patient has 5een on maintenane
therap#
LIST OF IDENTIFIED PROBLEMS ACCORDING TO PRIORITY
1. &istur5e" thought proesses relate" to ina5ilit# to trust e1i"ene" 5# "elusional thinAing.
2. Soial >solation relate" to alteration in mental status
3. Situational lo2 sel:;esteem relate" to ogniti1e impairment
NURSING CARE PLAN
Assessment N'rs"n D"anos"s Plann"n Inter&ent"ons Rat"onale E&al'at"on
S'08e%t"&e:
O08e%t"&e:
Oina5ilit# to trust
OlaA o: interest
&istur5e" thought
proesses relate" to
ina5ilit# to trust
e1i"ene" 5#
"elusional thinAing.
,:ter 1;) "a#s o:
ren"ering nursing
inter1entions, the
patient 2ill 5e a5le
to "e1elop trusting
relationship 2ith
nurse
$e sinere an" honest 2hen
ommuniating 2ith the
lient. ,1oi" 1ague or
e1asi1e remarAs.
$e onsistent in setting
e6petations, en:oring rules,
an" so :orth.
&o not maAe promises that
#ou annot Aeep.
8nourage the lient to talA
2ith #ou, 5ut "o not pr# :or
in:ormation.
86plain proe"ures, an" tr# t
o 5e sure the lient
un"erstan"s the proe"ures
5e:ore arr#ing them out.
>nitiall#, "o not argue 2ith
the lient or tr# to on1ine
the lient that the "elusions
are :alse or unreal.
&elusional lients are
e6tremel# sensiti1e a5out
others an" an reogni'e
insinerit#. 81asi1e
omments or hesitation
rein:ores mistrust or
"elusions.
Clear, onsistent limits
pro1i"e a seure struture
:or the lient.
$roAen promises rein:ore
the lient0s
mistrust o: others.
Pro5ing inreases the
lient0s suspiion an"
inter:eres 2ith the
therapeuti relationship.
Ghen the lient has :ull
Ano2le"ge o: proe"ures, he
or she is less liAel# to :eel
triAe" 5# the sta::.
Logial argument "oes not
"ispel "elusional i"eas an"
an inter:ere 2ith the
"e1elopment o: trust
,:ter ) "a#s o:
ren"ering nursing
inter1entions, the
patient 2as
"e1elop trusting
relationship 2ith
nurse
Assessment N'rs"n D"anos"s Plann"n Inter&ent"ons Rat"onale E&al'at"on
S'08e%t"&e:
O08e%t"&e:
Ounommuniati1e
OseeAs to 5e alone
O proEets hostilit#
Osa"."ull a::et
Soial >solation relate"
to alteration in mental
status
,:ter 1;) "a#s o:
ren"ering nursing
inter1entions, lient
2ill i"enti:# :eelings
o: isolation
Oesta5lish a
therapeuti
relationship 5# 5eing
emotionall# present
an" authenti
Oo5ser1e :or 5arriers
to soial interation
Opro1i"e positi1e
rein:orement 2hen
the lient seeAs out
others
O"isuss auses o:
perei1e" or atual
isolation
O5eing emotionall#
present an" authenti
:osters gro2th in
relationships an"
"erease isolation
Oa"e4uate in:ormation
shoul" 5e gathere" so
appropriate
inter1entions an 5e
planne"
Osoial support
ontri5utes to positi1e
2ell 5eing
Othe in"i1i"ual0s
e6periene o: illnessC
the irumstanes o:
e1er#"a# li1ing that
in:luene a 4ualit# o:
li:e
,:ter 1;) "a#s o:
ren"ering nursing
inter1entions, lient
2ill i"enti:# :eelings
o: isolation
Assessment N'rs"n
D"anos"s
Plann"n Inter&ent"ons Rat"onale E&al'at"on
S'08e%t"&e:
O08e%t"&e:
O laAing e#e
ontat
Olittle interest in
ati1ities
OlaA o: soial
interation
Situational lo2
sel:;esteem
relate" to
ogniti1e
impairment
,:ter );3 hours o:
ren"ering nursing
inter1entions, the
patient 2ill
1er5ali'e
un"erstan"ing o:
things that
preipitate urrent
situation an"
"emonstrate
5eha1iors that
sho2 positi1e sel:;
esteem.
8nourage lient to e6press
honest :eelings in relation to
loss o: prior le1el o:
:untioning
Re1ise metho"s :or assisting
lient to e6press :eelings
properl#.
8nourage lient0s attempts to
ommuniate. >: 1er5ali'ations
are not un"erstan"a5le, e6press
to lient 2hat #ou thinA he
inten"e" to sa#. >t is neessar#
to reorient lient :re4uentl#.
8nourage reminisene an"
"isussion o: li:e re1ie2
8nourage to partiipate in
ati1ities
7::er support an" empath#
Client ma# 5e :i6e" in anger
stage o: grie1ing proess,
2hih is turne" in2ar" on
the sel:, resulting in
"iminishe" sel:;esteem.
+o e6plore the :eelings o:
the lient there5# allo2ing
him to aAno2le"ge his
o2n strength an" 2eaAness
+he a5ilit# to ommuniate
e::eti1el# 2ith others ma#
enhane sel:;esteem
-elp lient resume
progression through the
grie: proess assoiate"
2ith "isappointing li:e
e1ents an" inrease sel:;
esteem
Positi1e :ee"5aA :rom
group mem5ers 2ill
inrease sel:;esteem
Fous on aomplishments
to li:t sel:;esteem
,:ter 3 hours o:
ren"ering nursing
inter1entions, the
patient 2as
1er5ali'e"
un"erstan"ing o:
things that
preipitate urrent
situation an"
"emonstrate"
5eha1iors that sho2
positi1e sel:;esteem.
DISC*ARGE PLAN
Med"%at"on:
>nstrut patient to ontinue taAing her me"iations
&o not stop a5ruptl# taAing the me"iations
Report an# ompliations or se1ere e::ets o: "rugs to #our health are pro1i"er
E!er%"se:
8nourage patient to ha1e regular e6erise e1en he is at their home.
Treatment:
>nstrut patient to ontinue taAing her me"iations.
Cl"n"%al Follo.1'(:
>nstrut patient to ha1e her :ollo2;up heA; up a:ter one 2eeA.
D"et:
,"1ise the patient to eat green lea:# 1egeta5les, rih in iron an" 1itamin C
Daner s"ns:
>nstrut patient to seeA me"ial a"1ie to ph#siian i: she e6periening "isom:ort an" ompliations