John, 33 years old has been admitted to the hospital; for the third time with diagnosis of Schizophrenia.

John had been taking Haloperidol

(Haldol) but stop taking it 2 weeks ago, telling his case manager it was and "the poison that is making me sick". yesterday John was
brought to the hospital after neighbors called the police because he had been up all-night yelling loudly in his apartment. Neighbors
reported him saying, " I can't do it. They don't deserve to die!". And similar statements.
John appears guarded and suspicious and has very little to say to anyone. His hair is matted, he has a strong body odor, and he is dressed
in several layers of heavy clothing even though the temperature is warm. So far, John has been refusing any offers of food and fluids. When
the nurse approached John with a dose of Haloperidol, he said " do you want me to die?"

DISCUSSION: ANSWER THE FOLLOWING QUESTIONS.

 Discuss your understanding of Schizophrenia spectrum
Answer:

Schizophrenia is a difficult condition that is often misunderstood and difficult to assess. This disorder is assessed through Diagnostic
and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 and individual should possess the three symptoms for it to rule out as
schizophrenia. Schizophrenia is a serious mental disorder in which people interpret reality abnormally. The symptoms are hallucinations,
delusions, cognitive symptoms (disorganized processing of thoughts), and negative symptoms (isolation). I understand that this disorder
needs a thorough observation because this syndrome or disease possess verities of symptoms that are similar to other mental disorder. I
believe that the observation for the symptoms lasts for a month and it progress up until 6 months for it to confirm that it is schizophrenia.

 Describe various theories of etiology of schizophrenia

Answer:

Schizophrenia's exact causes are unclear. According to research, a person's risk of developing the disorder is increased by a
combination of physical, genetic, psychological, and environmental factors. A stressful or emotional life event can cause a psychotic
episode in some people who are predisposed to schizophrenia. However, why some people show symptoms and others do not is
unknown.
Genetics
 Schizophrenia tends to run in families, but no single gene is thought to be responsible. It's more likely that different combinations
of genes make people more vulnerable to the condition. However, having these genes does not necessarily mean you'll develop
schizophrenia. Evidence that the disorder is partly inherited comes from studies of twins. Identical twins share the same genes.
Brain development
Studies of people with schizophrenia have shown there are subtle differences in the structure of their brains. These changes are
not seen in everyone with schizophrenia and can occur in people who do not have a mental illness. But they suggest schizophrenia may
partly be a disorder of the brain.
Neurotransmitters

Research suggests schizophrenia may be caused by a change in the level of 2 neurotransmitters: dopamine and serotonin. Some studies
indicate an imbalance between the 2 may be the basis of the problem. Others have found a change in the body's sensitivity to the
neurotransmitters is part of the cause of schizophrenia.
Pregnancy and birth complications

Research has shown people who develop schizophrenia are more likely to have experienced complications before and during their birth,
such as:
 a low birthweight
 premature labor
 a lack of oxygen (asphyxia) during birth
It may be that these things have a subtle effect on brain development.

 Identify 3 priority problems of John

Answer:
The 3 main priority problems for John are first is being delusional. We can see that he is delusional by his statement "the poison that
is making me sick" referring on taking his medication in which it is his very firm/fixed belief that Haloperidol (Haldol) is a poison for him.
The second one is hallucination and we can see it in his statement, " I can't do it. They don't deserve to die!" as if he has someone talking
to. And the last one is negative symptoms in which he withdrawn himself from the society and we can see it because he didn’t take care
of himself by being suspicious and has very little to say to anyone. His hair is matted, he has a strong body odor, and he is dressed in
several layers of heavy clothing even though the temperature is warm.
  Make a nursing care plan of John based from the problem identified.

Assessment Diagnosis Background Planning Nursing Intervention Rationale Evaluation

Knowledge
Subjective Data: Disrupted Hallucinations.  Expresses  Acknowledge  Stating to the client After effective
"I can't do it. Sensory Theseusually thoughts and that the voices that you do not sense nursing
They Perception involve seeing or feelings in a and sightings or perceive the voices intervention,
may be hearing things coherent and are real to the and sightings will help the goals are
don't deserve to related to that don't exist. logical client but clearly the client become met.
die!" as Altered Yet for the person manner state that you do uncertain of the
evidenced by the sensory with  Reports not hear or see validity of what he/she
patient. perception schizophrenia, lesser them. sees or hears.
usually they have the full episodes of  Exploring the
Objective Data: evidenced by force and impact hallucination  Look into how hallucinations with the
(+) Talking, of a normal s the client will help
hallucination murmurin or experience.  Maintains hallucinations him/her gain a sense
g laughing to Hallucinations can social are experienced of being empowered,
self. be in any of the relationship by the client. thus
senses, but improving the
hearing voices is chances of the client
the most being able to manage
common his/her hallucinations.
hallucination.  This will decrease the
 Whenever potential for anxiety
possible, which can trigger
decrease hallucinations.
environmental Decreased stimuli will
stimuli. help the client calm
down.
 The client’s thought
 Make process might be
conversations disorganized. A basic
simple, basic and reality-based
and reality- conversation will help
based. Avoid the client to focus.
bombarding the
client with
 multiple ideas.
Instead, help the
client to focus on
one idea at a  Being engaged in
time. reality-based activity
 Involve the client provides a healthy
in reality-based diversion and
activities such as prevents the client
drawing or from acting out
listening to his/her hallucinations.
music.  There are instances
when clients can learn
 Stay with the to push away or
client when disregard the voices
he/she starts to when they are given
hallucinate. repeated instructions.
Guide him/her to
tell the “voices”
to go away.
Repeat this often
and in a tone that
is matter-of- fact.  Clients usually obey
hallucinatory
 If voices commandseven those
predispose a involving killing self or
client to self- others. The proper
harm or harming
others, take the intervention will help
necessary save lives.
environmental
precautions. Be
sure to follow the
given protocol
on this.
 This will prevent the
client’s level of
anxiety from
 Intervene with escalating, thereby
medication (as keeping the patient
needed) or one from being out of
on one seclusion control.
when
appropriate. Be
sure to follow the
protocol.

 Guide the client in  This will help the

identifying client lessen his/her
activities that anxiety, while also
help reduce helping the nurse to
his/her anxiety. build rapport with the
client.
 Assessment Diagnosis Background Planning Nursing Intervention Rationale Evaluation
Knowledge
Subjective Data: Disturbed Delusions are  Patient will  Attempt to  Important clues to After effective
"the poison that thought extremely refrain from understand the underlying fears and nursing
is making me process related common in acting on significance of issues can be found in intervention,
sick" as to schizophrenia, delusional these beliefs to the client’s the goals are
evidenced by the chemical occurring in more thinking. the client at the seemingly illogical met.
patient. alteration than 90% of  Patient time of their fantasies.
usually those who have will develop presentation.
Objective Data: evidenced by the disorder. trust  Recognizes the
(+) delusion delusions. Often, these in at least client’s delusions  Recognizing the
delusions involve one staff as the client’s client’s perception can
illogical or bizarre member perception of the help you understand
ideas or within 1 environment. the feelings he or she
fantasies, such as: week.  Identify feelings is experiencing.
Delusions of  Patient will related to  When people believe
persecution – be free from delusions. For that they are
Belief that others, delusions or example: understood, anxiety
often a vague demonstrate -If client believes might lessen.
“they,” are out to the ability to someone is going to
get you. function harm him/her, client is
without experiencing fear.
responding -If client believes
to persistent someone or something is
delusional controlling
thoughts. his/her thoughts,
client is
experiencing
helplessness.
 Explain the  When the client has
procedures and full knowledge of
try to be sure the procedures, he or she
client is less likely to feel
understands the tricked by the staff.
procedures
before carrying
them out.
 Interact with
clients on the  When thinking is
basis of things in focused on reality-
the environment. based activities, the
Try to distract client is free of
client from their delusional thinking
delusions by during that time. Helps
engaging in focus attention
reality-based externally.
activities (e.g.,
card games,
simple arts and
crafts projects
etc).
 Do not touch the
client; use  Suspicious clients might
gestures misinterpret touch as
carefully. either aggressive or
sexual in nature and
might interpret it as
threatening gesture.
People who are
psychotic need a lot of
personal space.
 Initially do not  Arguing will only
argue with the increase client’s
client’s beliefs or defensive position,
try to convince thereby reinforcing
the client that false beliefs. This will
the delusions are result in the client
false and unreal. feeling even more
isolated and
misunderstood.
 Show empathy  The client’s delusion can
regarding the be distressing.
 client’s feelings; Empathy conveys your
reassure the caring, interest and
client of your acceptance of the
presence and client.
acceptance.
 Utilize safety  During acute phase,
measures to client’s delusional
protect clients or thinking might dictate
others, if the to them that they
client believe might have to hurt
they need to others or self in order
protect to be safe. External
themselves controls might be
against a needed.
specific person.
Precautions are
needed.
 Assessment Diagnosis Background Planning Nursing Intervention Rationale Evaluation
Knowledge
Subjective Data: Negative Impaired social  Uses  Identify with  Identification of the After effective
John appears symptoms abilities in appropriate client symptoms symptoms of anxiety nursing
guarded and related to schizophrenia- skills to he/she will help decrease intervention,
suspicious and impaired social spectrum initiate and experiences agitation and the goals are
has very little to interaction disorders and maintain when he/she aggression of the met.
say to anyone. evidenced by autism are interaction begins to feel client.
inability to thought to be with others anxious around
Objective Data: make eye partly attributable  Improved others.
His hair is contact, to specific social  Avoid touching  This
matted, he has a inability to aspects of interaction the client.
strong body begin or symptomatology, with family particularly applies to
odor, and he is respond to such as negative and friends a paranoid client.
dressed social symptoms (blunt  Expresses Touch,
in several conversations, affect, social being especially by an
layers of heavy inappropriate withdrawal, comfortable unknown person, can
clothing emotional anhedonia) and in certain be misinterpreted as
even though the response and disturbances of structured sexual or viewed as
temperature is prefers to be several domains group  Minimize stimuli threatening by the
warm. alone. of cognitive activities (avoid loud client.
function. noises or  Noise and a huge crowd
crowding) as might result in
much as the client feeling
possible. agitated and anxious.
 Structure
activities based
on the client’s  The client might be
pace and disinterested in
abilities. activities that he/she
finds overwhelming.
This will then lead to
 Structure times an increased sense of
that include failure.
planned  This will help the
client develop a sense
brief interactions of safety in a non-
and threatening
 activities with the environment.
client on a one-
on-one basis.  Many symptoms of
 Check if the schizophrenia subside
medications with medications. This,
have reached in turn, helps facilitate
therapeutic interactions.
levels.  The client has the
 If the client is freedom to choose
extremely his/her level of
paranoid, interaction. However,
solitary or one- encouraging him/her
on-one activities to concentrate can
are appropriate. help minimize
Said activities distressing paranoid
must require a thoughts or
degree of hallucinations.
concentration.  This will help the
client develop the
 Encourage the fundamental skills in
client to use socializing.
coping skills
particularly
conversational
and assertiveness
abilities.  Recognition and
 Remember to appreciation
give praise or encourage the client to
recognition for sustain and
positive steps the increase specific
client takes in social behavior.
increasing social
skills.  This type of training
 Involve the client helps the client to
in social skills adapt and function in
the society thereby
training. increasing his/her
quality of life.