Bethlehem University

Faculty of Nursing and Health Science

Psychiatric Mental Health Nursing

NURS 342

Interpersonal Record (IPR)

Psychiatric Case Study

Prepared by: Amany Abo Hmood

Submitted to: Mr. Hussein Awawdeh

Spring/2021

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Outline:

 Introduction……………………………………………………………………
 Demographics information…………………………………………………….
 Socioeconomic Status …………………………………………………………
 Chief complain and reason for admission……………………………………..
 History of current illness and previous admissions……………………………
 Family history………………………………………………………………….
 Recent losses…………………………………………………………………..
 Past medical and surgical history………………………………………………
 General state of health, sleep & nutrition……………………………………..
 Mental status examination…………………………………………………….
 Differential diagnosis…………………………………………………………
 Nursing care plan……………………………………………………………...
 Management…………………………………………………………………..
 Discharge plan………………………………………………………………...
 References…………………………………………………………………….

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Introduction :

As a student in the nursing faculty of Bethlehem University, and according to our required
psychiatric mental health nursing, everyone must take a case study, and during my training at
Bethlehem Psychiatric Hospital, I chose a case to study, and this was a unique and different
experience that was completely different from what we are used to. I got new information, and also
I think that this type of cases was very interesting and exciting to be studied, and I think that by
studying this case I will have new knowledge about it, and will help me in my career and future.

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 Bethlehem University
Psychiatric Nursing
NURS 342
Interpersonal Record (IPR)

Student Name: Amany Abo Hmood Date: 7\3\2021

I. Demographics/General Information

Patient’s initials: K.A.K Age: 39 Years old Ward: Men's recovery ‫))النقاهة‬
Gender: Male Nationality: Palestinian Religion: Muslim
Place of residence: Yatta- Hebron-Palestine.
Marital status: Married.(The pt is still married but he has been separated from his wife 10
years ago ).
Number of children: Two daughters
Occupation: Unemployed Educational Level: 8th grade.
Psychiatric diagnosis: Paranoid schizophrenia.
Socioeconomic status:

The natural of pt's life seems very difficult, the pt face a lot of problems and
difficulties in his life. K.AK a 39 year male pt from Hebron, he got married when he was
23 years old and live with his wife for 5 years, and has two daughters one is 12 years old,
the other 10 years old , his wife left him since 10 years ago because as the pt said he was
beating her and suspected that she was betraying him, and frequently made problems with
her, so she went to her family's house and said to him "you are mentally ill and I can't live
with you more than that". He is still legally married and refuses to divorce because he hopes
that his wife will return to him. He lives with his mother and daughters in the family house,
his father died years ago, he has 2 married brothers and 5 sister all of them married and he
is the 6th one , and he has a bad relationship with them before the illness and until now, the
patient parents have not any relative relationship and there is no any genetic disease .He
didn’t continue his education after 8th grade, because as the pt said he heat the study and
creating many problems with his schoolmates and because of their difficult and poor living
conditions . After that, he started working in various jobs, and went to work as a worker in
Israel, and at the age of 17 he joined the Palestinian National security for 8 years then he

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 compulsory retirement due his illness and currently he is unemployed and earns a pension of
1,500 nic a month as the pt said.

Alcohol Use No, he don’t drink alcohol (The pt mentioned that he only drank alcohol
once in his life when he was 23 years old).
Tobacco Use Yes, he smokes 2 packs per day
Caffeine Use Yes, he drinks 4 cups of coffee daily.
Substance abuse No .
Informant: Client, Nursing team and the pt's file.

II. Chief Complaint (Patient’s problem or reason for current admission in patient’s own
words) :
As the pt said:" I fought with my older brother when he asked me to go to court and divorce
my wife, and then he tied me up and brought me here as you see me".
A 39 year old male pt was admitted to the hospital on 29\1\2021, he was brought restrained by
his older brother after they fought and beat each other in a very aggressive way , the pt started
beating his brother an after that he asked him to go to court and divorce his wife, as the pt is still
married but separated from his wife ten years ago, and he completely refuses to divorce his wife
because he hopes that she will return to him , and he considered this issue a very sensitive topic
for him, so he could not control himself when his brother talked about it, and he beat his brother
until he arrived restrained to the hospital as his fifth admission.
III. History of Current Illness (previous admissions/include current and previous
symptoms) :
Patient was admitted to the hospital 5 times, his first admission was on 12/9/2008 , he
was brought by his brothers they reported that the signs and symptoms started to appear on
the patient a month ago , he began to carry out hostile behaviors and become more anger and
violence, he beat his friends at work and uttered bad words.

Pt having unrealistic feeling of jealousy delusions about his wife so he and beat his
wife, suspecting that she would kill him and that she was betraying ‫ ))تقوم بخيانته‬him, and he
began to have visual hallucination in the form of a jinn that entered his wife's body and beat
her to get the jinn out of her body according to the pt and the medical record.

And as a history of the first admissions the patient told me that he seemed to feel
strange and do strange behaviors and became very nervous, it was after he went through a

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 very bad event in his life when he saw his friends who were killed in the mortuary. And as
the patient said: "It is the most difficult thing that a person may see in his life".

After this difficult day, and in order to forget this painful event , he and his friends drank
alcohol excessively, and when he woke up the next day he felt that he had changed and
became strange ,anger and did a lot of problems, irritable moods, anxiety in his sleep, and
involved himself in his room and became unable to work.. And when he was watching
pictures of his dead friends on television he used to break the television so that he would
constantly break the television and go to buy a new one and break it again. and he believes
that those on television are watching him and imitating his movements and will kill him as
they killed his friends.

The patient has several admission for a variety of reasons, including

Date Reasons
violence behavior , visual hallucination, jealousy delusions, persecutory
12\9\2008 delusions.
The patient's condition worsened after his separation from his wife nearly a
2\5\2011 year ago and he was dismissed from his job in the National Security due to
absenteeism from work and inefficiency in carrying weapons. On that day, he
beat his brother, tore his clothes, and bitten him with his teeth, and imposes a
curfew(‫ ) منع التجول‬in the neighborhood.
The patient was re-admitted while he was in a poor health condition
13\5\2012 represented by his feeling of fear and anxiety, that he was persecuted and had
family problems.

His last admission was on 29\1\2021, he was brought to the hospital restrained by his
brother without a referral note, as mentioned in the file, the patient brother said he was not
doing well for months and he was irritable, aggressive verbally and physically, he hit his
mother and daughters, and in the day of admitting he hit his brother when he came to talk to
him about lawsuit from his divorced.
And as the patient said that he has not taken his medication for a month since this event, he
suffers from poor sleep, became violent with his mother and daughters, became isolated and
returned to see visual hallucination.

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  NOTE: There is another missed admission that I could not find in the patient's file,
and the patient also did not remember it.

IV. Family History (Mental Disorders, type and treatment if known)

The pt has 2 brothers and 5 sisters with free psychiatric history and he has a bad
relationship with them and there is continues problem between them. His father died when
he was 19 years old, his mother is 72 years old, The pt said that his mother told him that
there is a female woman from her relative that complain of a mental disorder, and his
cousin has autism. The patient mentioned that his father was imprisoned for five years and
his mother worked as a seamstress support the family during this period ( ‫ )تعيل العائلة‬. I asked
the patient if his mother told him about his period of pregnancy, he said yes, she told him
that his pregnancy was easy and he was born by normal vaginal delivery, full term.
The patient also said that the relationship between his parents was not good and they had a
lot of problems and family instability, this means that the pt didn't live in an integrated
family full of love & kindness.

V. Recent Losses/Stressors as Reported/Predisposing & Precipitating Factors

During the interview, when I asked the patient about important events or losses that he
had suffered during his life and he can't forget it, he took a deep breath and the first thing
that he told me that when he was 12 years old something happened to him that changed his
life, and when I asked him to tell me what the event was he said :" I could not tell you that
it was a painful event for me and I do not want to remember it now". But when I looked at
the patient’s medical file, it became clear to me that when the patient was 12 years old, he
was sexually assaulted by a shepherd when he was going to collect grass. Therefore, I
believe that this event is the most important event in the patient's life as the predisposing
factor.
The biggest loss in the patient’s life was as he said when he lost his father, the patient
was affected by the loss of his father very much, that the patient was very attached to his
father and spoiled for him ‫ ))مدلل‬and after losing him, he became very distressed and nervous
The patient also told me that his father had been a prisoner for five years, and he was born
when his father was very old, so he always accompanied him with him sits and listens to the
conversations of the elderly, this is evidence that the patient did not live his childhood
properly, so instead of spending his time playing and having fun with his peers, he spent it
listening to elderly conversations.

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 The pt also said the other, most difficult event of his life was when he saw his friends
who were killed in the mortuary.

The patient also mentioned that he was not ready to marry because he was not ready to
take responsibility, and he married while he was not satisfied with that, and the reason for
that was to fulfill his mother’s desire because there was one of their relatives who told them
that their son was sick with a disease in which he died early, so they wanted to marry him,
so I think that this is another great stress in a patient’s life.
‫)) احد أقاربهم اخبرهم بان ابنهم مصاب بمريض ال يعيش فيه فترة طويلة لذلك ارادو أن يتزوج‬
The loss of his job, as well as his wife, was also one of the difficult events stressors and
losses that affected his life and his mental health.
The loss of his father, his friends, his job and his wife, I think that these event the
precipitating factors led to the emergence of his illness, because after each of these events,
the patient suffered a health setback .
VI. Medical and Surgical History

The pt has free medical and surgical history. No disability or any congenital deformity.
No allergy from medications or food.

VII. General state of health, sleep & nutrition:

In general, the patient appears to be in good health, does not suffer from any chronic
diseases, eats normal food that does not follow any diet, he doesn't prefer special food so
much ,he eat what is available in the house, he drink coffee and tea so much, he complain
from vomiting sometime (may be side effect of the psychiatric drags), the patient told me
that before entering the hospital when he was cut off from treatment, he was not sleeping
well and has poor appetite, but at the present time he sleeps early enough hours with a sleep
pattern of 6-8 hr's a day and wakes up at four Am , and eats 3 meals a day and his appetite is
good.
VIII. Mental Status Exam (MSE)
A. Appearance
The pt is 39 years old, he looks quiet, cooperative with health team -during the
interview- and not active with other patients as I noticed, him appearance suitable to his age,
his weight fits with his height, and has good appetite, when he entered the hospital and took
the medication, he slept enough and woke up early every day at 4 Am, Pt looks clean, usual
dressing, dresses appropriately to the season, speech with normal tone, poor eye to eye

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 contact, has normal posture, he has a normal facial expression fits with the kind of topic,
between laughter and anger. He has no tattoos or marks.

B. Speech
Patient speech was coherent , congruent during the interview, his speech had an adequate
quantity, normal rate with audible voice.
C. Motor Activity
Patient was calm during the interview, Sometimes as I observed him, he wasn’t talking with
other and prefer stay alone for example after he eat he sit alone , then he smoke a cigarette . He
does not have any abnormal movements such as tremors, tics and unusual gestures.
D. Interaction during Interview
The patient looked interested when I ask him about the interview he was happy and welcome
the topic ha said: "Welcome, there is no problem, I want to talk to someone " and he starts
laughing, he sits comfortably and relaxed during the interview, he was cooperative and
answered the questions that I asked him the in an appropriate way and long answer, he has poor
eye contact, most of the time he was talking while looking at the ground and he is friendly with
the team but opposite with family.
E. Mood (patient’s subjective way of explaining emotion/feelings)
The pt has mood that appropriate with his affect. His mood during the interview was good, I
asked him about his mood when he entered the hospital he answered that he felt fearful and
anger and said:" At first, I was sad and I did not want to go back to the hospital because I am
convinced that I am not sick. My brother is the patient, and he is the one who should be here,
not me". Today his mood is good and he says he is happy.
F. Affect (patient’s display of emotion/feelings)
Patient affect is congruent with mood when we asked about his relation with Popular proverbs
he laugh and said :” ‫ "يعني عالقتي متيحة بعرف شوية أمثال وصار يعطينا أمثال ويضحك‬, he can express his
feelings and emotions according to what he really feels, and so his affect. in interview was
appropriate with what we said .
G. Perceptions
Hallucinations : Patient has visual hallucinations that he said:" Many times I see a shadow in
the form of a large falcon". ‫)) خيال على شكل صقر كبير‬. Pt hasn’t tactile, gustatory or olfactory
hallucinations.
Illusions: patient has no illusions , no any depersonalization or derealization .

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H. Thought Process
The pt's thought is clear, understandable and logical, Pt has no thought disorder, there’s no
flight of ideas, word salad, neologism, loose association, tangential or circumstantial.

I. Thought Content
Delusions: The patient has persecution thoughts delusions, I noticed this when the patient said
that he feels that people on television are tracking him and watching him. He also said he felt
everyone was stalking him.
The pt has jealousy delusions, the patient has delusional thoughts about his wife's infidelity
without any concrete evidence. "I suspect my wife was cheating on me while she was going to
work, so I was watching her," the patient said, clearly.
The pt also has grandiose delusions, I noticed that when I asked the patient about his religious
aspect, and within the conversation, he mentioned to me that sometimes and not always he feels
like he was a prophet.
J. Risk Assessment
Suicidal ideation: The patient does not have any suicide attempt, but he said that every day he
thinks about suicide, either by throwing himself from a high place or suddenly appearing in
front of a speeding car. He said that what prevents him from that is that he does not want to
suffer if he doesn't die.
Homicidal ideation: In the last disagreement between the patient and his brother before
admission, the patient tried to strangle ‫ ))خنق‬his brother, but his relatives intervened to keep him
away from him, and this is not the first time that the patient tries to harm his brother. When I
asked the patient if he had thought about killing someone, he replied, "Yes, that he wants to get
rid of his brother, because he is the reason for his hospitalization.
K. Judgment (patient’s judgment based on hypothetical situations)
The patient has a good ability of judgment, I asked him: if you see a big fire what would you
do? he answered: "I will call the help, ask the nurses &other pt to turn off this fire, and if there’s
a fire extinguisher, I will use it". so he has the ability to evaluate the situations and makes
solutions for the problems.

L. Insight (patient’s understanding of the illness/treatment)

The patient has no insight; he does not understand that he is hospitalized because of his
mental illness and he said again:" I am not a psychopath, my brother is the patient".
M. Cognition

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 Level of consciousness :

Patient, alert and he was fully conscious during the interview. He was able to provide
personal details.

Orientation (time, place & persons):

The pt is oriented to himself, time, place and persons, when I asked him about the place,
day, date and why he is in the hospital he answered me well, so he is fully oriented.

Memory (remote, recent, immediate):

The pt has a good remote memory because of when I asked him about events from his
childhood when he was five years old and he mentioned events with their details and
how he used to go with his father and listen to the conversations of the elderly He has a
good recent memory because of when I asked him what did you have on breakfast in
the morning and said:" Cheese, tea and bread". Also the pt has good immediate
memory because At the beginning of the interview, I introduced myself and my name,
and after a quarter of an hour I asked him what was my name and he answered me
correctly and said " your name is Amany".

Abstract thought:

I said for him "any door come from it wind Close it "what does this proverb means
for you?, he answered me that we should keep away from the problems to rest our
mind. The pt is logical in his answer & has a good ability to abstract.

Concentration ,attention and calculation:

The patient was concentrated during the interview and gives me clear answers for my
questions, but with poor eye to eye contact .He had the ability to resolve the calculation
question when I ask him with serial of 3 I ask 30 – 3 he said “ 27" and I ask 27-3 he said
"24' and he was not distracted .

IX. Differential Diagnosis/Impression (Psychiatric Dx./Mental Disorders).

As manifested by the MSE findings about Schizophrenia, my patient has paranoid
schizophrenia, and he has a positive symptoms like visual hallucinations, persecutory
,grandiose and jealousy delusion as I explained before, and he has no negative symptoms.

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 Schizophrenia

Schizophrenia refers to a group of severe, disabling psychiatric disorders marked by withdrawal

from reality, illogical thinking, possible delusions and hallucinations, and emotional, behavioral, or
intellectual disturbance.

 Like many diseases, schizophrenia is linked to various factors.

1. Precise cause is unknown.

2. Genetic factors. 

3. Biochemical factors. Involves dopamine (focus of most studies), serotonin, norepinephrine,

and epinephrine. Excessive dopamine activity is linked to hallucinations, agitation, and
delusion. High norepinephrine is linked to positive symptoms of schizophrenia.

4. Other factors include structural brain abnormalities enlarged ventricles), developmental (faulty

neuronal connections), and other possible causes (maternal influenza during second trimester of
pregnancy, epilepsy of the temporal lobe, head injury).

 Signs and symptoms

1. Positive symptoms are associated with temporal lobe abnormalities.

2. Negative symptoms are associated with frontal cortex and ventricular abnormalities.

 Schizophrenia usually progresses through three distinct phases

1. Prodromal Phase.

2. Active Phase

3. Residual Phase

 Subtypes of schizophrenia:

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1. Paranoid

 Characterized by persecutory or grandiose delusional thought content and delusional

jealousy.

 Stress may worsen patient symptoms.

 Experience
frequent auditory
hallucinations but lack
symptoms of other subtypes
like incoherence, loose
associations, and affect
problems.

 Tend to be less severely disabled than other schizophrenics and are more responsive to
treatments.

2. Disorganized

3. Catatonic

4. Undifferentiated

5. Residual

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 X. Nursing Care Plan (3-4 Nursing diagnosis and interventions) :

Nursing Diagnosis(1): Risk for suicide related to impulsiveness and marked changes in

behavior, evidence by the presence of suicidal thoughts.

Interventions Rationale
 Render close patient supervision by Suicide may be an impulsive act with little or
sustaining observation or awareness of no warning. Close supervision is a must.
the patient at all times.
Removing potentially harmful objects
 Provide a safe environment.
prevents the patient from acting or
Weapons and pills should be
sudden self-destructive impulses.
removed by friends, relatives, or the
nurse. It is helpful for the patient to talk about

suicidal thoughts and intentions to harm

 Present opportunities for the patient to
express thoughts, and feelings in a themselves. Expressing their thoughts and
nonjudgmental environment. feelings may lessen their intensity. Also, they

need to see that staff are open to

discussion.
 Stay with the patient more often.
This approach provides the patient with a

sense of security and strengthens self-

worth.

 Help the patient with problem-solving

in a constructive manner. Patients can get to identify situational,

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 interpersonal, or emotional triggers and

learn to assess a problem and implement

problem-solving measures before reacting.

 Contact family members, arrange

for individual and/ or family crisis
counseling. Activate links to self- Reestablishes social ties. Diminishes a sense of
help groups. isolation, and provides contact from individuals
who care about the suicidal person.

 Educate the patient cognitive-

behavioral self-management responses Patient learns to identify negative thoughts
to suicidal thoughts. and develops positive approaches and

positive thinking.

Nursing Diagnosis(2): Impaired social interaction related to impaired thought perceptions and
content by visual hallucinations, persecutory ,grandiose and jealousy delusion, evidenced by that
he unable to make eye contact,  and spends time alone by self.

Interventions Rationale
 Assess if the medication has reached Many of the positive symptoms of
therapeutic levels. schizophrenia (hallucinations, delusions,

racing thoughts) will subside with

medications, which will facilitate

interactions.
 Keep client in an environment as free
of stimuli (loud noises, crowding) as
Client might respond to noises and crowding
possible.
with agitation, anxiety, and increased

inability to concentrate on outside events.

 Avoid touching the client.
Touch by an unknown person can be
misinterpreted as a sexual or threatening
gesture. This particularly true for a paranoid
 Structure times each day to include

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 planned times for brief interactions and client.
activities with the client on one-on-one
basis. Helps client to develop a sense of safety in a

non-threatening environment.
 Teach client to remove himself briefly
when feeling agitated and work on Teach client skills in dealing with anxiety and
some anxiety relief exercise (e.g., increasing a sense of control.
meditations, rhythmic exercise, deep
breathing exercise).

Nursing Diagnosis(3): Disturbed sensory perception related to altered sensory perception,

evidenced by visual hallucinations.

Interventions Rationale
 Accept the fact that the voices are real Validating that your reality does not include
to the client, but explain that you do voices can help client cast “doubt” on the
not hear the voices. Refer to the voices
validity of his or her voices.
as “your voices” or “voices that you
hear”.
Exploring the hallucinations and sharing the

 Explore how the hallucinations are experience can help give the person a sense
experienced by the client. of power that he or she might be able to

manage the hallucinatory voices.

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 Helps both nurse and client identify

situations and times that might be most

 Help client to identify times that the
anxiety-producing and threatening to the
hallucinations are most prevalent and
frightening. client.

The client can sometimes learn to push

 Stay with clients when they are starting
to hallucinate, and direct them to tell voices aside when given repeated
the “voices they hear” to go away. instructions. especially within the framework
Repeat often in a matter-of-fact
of a trusting relationship.
manner.

Intervene before anxiety begins to escalate.

 Intervene with one-on-one, seclusion,
If the client is already out of control, use
or PRN medication (As ordered) when
chemical or physical restraints following unit
appropriate.
protocols.

Nursing Diagnosis(4): Disturbed thought contact related to overwhelming stressful life

events, evidence by persecutory ,grandiose and jealousy delusion .

Interventions Rationale
 Attempt to understand the significance Important clues to underlying fears and
of these beliefs to the client at the time issues can be found in the client’s seemingly
of their presentation.
illogical fantasies

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  Identify feelings related to When people believe that they are
delusions. For example: understood, anxiety might lessen.
 If client believes someone is
going to harm him/her, client is
experiencing fear.

 If client believes someone or

something is controlling his/her
thoughts, client is experiencing
helplessness.

When thinking is focused on reality-based

 Interact with clients on the basis of
things in the environment. Try to activities, the client is free of delusional
distract client from their delusions by
thinking during that time. Helps focus
engaging in reality-based activities (e.g.,
card games, simple arts and crafts attention externally.
projects etc).

Arguing will only increase client’s defensive

 Initially do not argue with the client’s
beliefs or try to convince the client that position, thereby reinforcing false beliefs.
the delusions are false and unreal. This will result in the client feeling even

more isolated and misunderstood.

Another Nursing Dx:

(5):Defensive Coping
(6):Interrupted Family Process

Management :

 Pharmacotherapy

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 # TRADE NAME GENERIC DOSE ROUT
NAME

1. RISPERDAL Resperidone 2MG 2*2 P.O

2. LARGACTIL Chlorpromazine 100 MG1*1 P.O

(CPZ)

3. ARTANE Trihexyphenidyl 2MG 1*3 P.O

(HCl)

RISPERDAL

Class: A typical antipsychotic medication(second generation).

Action: Blocking dopamine and neurotransmission in the brain by blocking D2 receptors.

Uses: Treating positive and negative symptoms of schizophrenia, bipolar disorder.

Side effect: Drowsiness, dizziness, lightheadedness, drooling, nausea, weight gain.

Nursing implications:
 Monitor diabetics for loss of glycemic control.
 Reassess patients periodically and maintain on the lowest effective drug dose.

 Monitor closely neurologic status of older adults.

 Monitor cardiovascular status closely; assess for orthostatic hypotension, especially during
initial dosage titration.

 Monitor closely those at risk for seizures.

 Assess degree of cognitive and motor impairment, and assess for environmental hazards.

LARGACTIL

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Class: Typical antipsychotic medication(first generation).

Action: Blocking dopamine transmission in the brain by blocking D2 receptors.

Uses: Use to treat severe depression or behavioral disturbances, treating positive symptoms such as
persecutory delusion.

Side effect: Extra pyramidal such as Akathisia, parkinsonism, dystonic reactions, nervousness,
blank facial expression, dizziness, agitation.

Nursing implications:
 Establish baseline BP (in standing and recumbent positions), and pulse, before initiating
treatment.
 Lab tests: Periodic CBC with differential, liver function tests, urinalysis, and blood glucose.

 Monitor cardiac status with baseline ECG in patients with preexisting cardiovascular
disease.

 Be alert for signs of narcoleptic malignant syndrome. Report immediately.

 Monitor I&O ratio and pattern: Urinary retention due to mental depression and
compromised renal function may occur.

 Monitor diabetics or prediabetics on long-term, high-dose therapy for reduced glucose

tolerance and loss of diabetes control.

 Ocular examinations, and EEG (in patients >50 y) are recommended before and periodically
during prolonged therapy.

ARTANE

Class: Anticholinergic drugs.

Action: Synthetic tertiary amine Anticholinergic agent similar to atropine. Thought to act by blocking
excess of acetylcholine at certain cerebral synaptic sites. Relaxes smooth muscle by direct effect and by
atropine like blocking action on the parasympathetic nervous system.

Uses: Symptomatic treatment of all forms of parkinsonism (arteriosclerotic, idiopathic, post

encephalitic). Also to prevent or control drug-induced extra pyramidal disorders.

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Side effect: Disorientation , hallucination , tachycardia , rash , dry mouth , constipation , urinary
retention ,Sedation .

Nursing implications:
 Be aware that incidence and severity of adverse effects are usually dose related and may be
minimized by dosage reduction
 Monitor vital signs.
 In patients with severe rigidity, tremors may appear to be accentuated during therapy as rigidity
diminishes.

 Monitor daily I&O if patient develops urinary hesitancy or retention. Voiding before taking
drug may relieve problem.

 Check for abdominal distention and bowel sounds if constipation is a problem.

 Monitor intraocular pressure at regular intervals.

 Provide close follow-up care. Tolerance may develop, necessitating dosage adjustment or use of
combination therapy.

 Electroconvulsive Therapy (ECT)

Pt has no (ECT ) therapy.

 Psychotherapy (explain about one recommended psychotherapy model)

Psychotherapy, or "talk" therapy, is an important part of treatment for schizophrenia .

During therapy, pt can discuss feelings, thoughts, and behaviors that cause pts problems. Talk
therapy can help people understand and hopefully master any problems that hurt their ability to
function well in their life and career. It also helps pts stay on their medication. It can help pts
maintain a positive self-image.

The types of psychotherapy used to treat schizophrenia include:

 Individual psychotherapy : During sessions, a therapist or psychiatrist can teach the person
how to deal with their thoughts and behaviors. They’ll learn more about their illness and its
effects, as well as how to tell the difference between what’s real and what’s not. It also can help
them manage everyday life.

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 Cognitive behavior therapy (CBT): This can help the person change their thinking and
behavior. A therapist will show them ways to deal with voices and hallucinations. With a
combination of CBT sessions and medication, they can eventually tell what triggers their
psychotic episodes (times when hallucinations or delusions flare up) and how to reduce or stop
them.

 Cognitive enhancement therapy (CET): This type of therapy is also called cognitive
remediation. It teaches people how to better recognize social cues, or triggers, and improve their
attention, memory, and ability to organize their thoughts. It combines computer-based brain
training and group sessions.

 Social recovery therapy :This treatment puts the focus on helping the person set and achieve
goals and building a sense of optimism and positive beliefs about themselves and others.

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XI. Discharge Plan (METHOD).

M: Teach the patient about medication commitment.

1. Take your medication on time

2. Do not drink your medication with grapefruit juice, alcohol or caffeine.

Drink it with lots of water in order to minimize the side effects.

E: Provide exercises:

1. Do the morning physical exercises to begin your day active.

2. Do some group physical exercises to increase your social interactions.

T: teaching:

1. Teach the patient about his disease and the adverse effects that may affect him.

2. Encourage the patient to talk more about herself and her problems in order to find
solutions to let her feel more comfortable.

H: Hygiene:

1. Teach the patient about the importance of self-care and self-hygiene( take a shower every
morning it will make you feel clean and comfortable, brush your teeth).

O: Outcome:

1. Evaluate the status of the patient

2. Compliance to his medication

D: Diet:

1. Teach him the importance of eating healthy in order not to gain more weight.

2. Do not take your medication with alcohol, grapefruit juice or caffeine.

3. Increase your intake of fibers to prevent constipation, increase your water uptake.

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References:

1. From the patient nursing team.

2. Patient’s medical record.

3. My observation

4. Scott, J. (1995). Psychotherapy for schizophrenia . The British Journal of

Psychiatry, 167(5), 458-472.

5. Psychiatric Slides NURS342

6. DSM5 pdf. :Romito, Kathleen(2018).Care instruction of schizophrenia .Myhealth Alberta.

Available from<
https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?
hwid=tw12395> accessed in 1-11-2019.

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