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Pagaran Topic: Care of Clients with Neurologic Functioning
BSN 4 NE
Situation: Mr. D is a 26 year-old business man. Over the past few weeks his family and friends have noticed increasingly bizarre behaviors. On many occasions they’ve overheard him whispering in an agitated voice, even though there is no one nearby. Lately, he has refused to answer or make calls on his cell phone, claiming that if he does it will activate a deadly chip that was implanted in his brain by evil aliens. DIAGNOSTIC TEST: Mental status examination. No laboratory findings have been identified that are diagnostic of schizophrenia. Routine laboratory tests may be useful in ruling out possible organic etiologies, including CBC, urinalysis, liver function tests, thyroid function test, RPR, HIV test, PET scan, CT scan, and MRI. TREATMENTS AND MEDICATIONS: Currently, there is no method for preventing schizophrenia and there is no cure. Minimizing the impact of disease depends mainly on early diagnosis and, appropriate pharmacological and psycho-social treatments. Hospitalization may be required to stabilize ill persons during an acute episode. The need for hospitalization will depend on the severity of the episode. Mild or moderate episodes may be appropriately addressed by intense outpatient treatment. A person with schizophrenia should leave the hospital or outpatient facility with a treatment plan that will minimize symptoms and maximize quality of life. A comprehensive treatment program can include:
Antipsychotic medication Education & support, for both ill individuals and families Social skills training Rehabilitation to improve activities of daily living
Coping with socially inappropriate behaviors: Redirect client away from problem situations. > engage client in reality-based activities such as card playing. role modeling. - NURSING INTERVENTIONS: For clients with Schizophrenia: Promoting safety of client and others and right to privacy and dignity Establishing therapeutic relationship by establishing trust Using therapeutic communication (clarifying feelings and statements when speech and thoughts are disorganized) Interventions for delusions: > do not openly confront the delusion or argue with the client > establish and maintain reality for client > teach the client positive self-talk. or listening to music. do not scold Try to reintegrate the client into the treatment milieu as soon as possible Do not make the client feel punished or shunned for inappropriate behaviors. Vocational and recreational support Cognitive therapy Another important part of treatment is psychosocial programs and initiatives. they can help ill individuals effectively manage their disorder. Teach social skills through education. Interventions for hallucinations: > help present and maintain reality by frequent contact and communication with client > Elicit description of hallucination to protect client and others. Deal with inappropriate behaviors in a non-judgmental and matter-of-fact manner. give factual statements. The nurse’s understanding of the hallucination helps him or her know how to calm or reassure the client. and practice. Client and family teaching Establishing community support systems and care . positive thinking. Combined with medication. Talking with your treatment team will ensure you are aware of all available programs and medications. occupational therapy. and to ignore delusional beliefs.
. How would the nurse react to it? Ans: The nurse must avoid a thrash about the patient’s eating habits to prevent any further increase of paranoia. 2. the nurse should also monitor the patient’s physical status closely. His behavior is a characteristic of? Ans: Hallucination. should the child remain with the parent? What factors influence this decision? Who should be able to make such decision? Ans: For safety reasons of the young child. What activities should the nurse be encouraging to the patient? Ans: The patient should be encouraged to participate in a non-competitive and non-threatening physical activity. hearing voices when there are no external stimuli. If a client with schizophrenia who experiences frequent relapses has a young child. After 2 days on the unit. But if the parent will have the time to request the presence of the child then it is possible to let the child go to the parent also to increase self concept as long as there is a guardian or staff that will look after them. D begins to trust the environment and the people around it and his psychotic symptoms subside with medication. For example. 3. Auditory hallucinations. He has been observed drinking soda and juices bought from a vending machine in the hospital lobby. and talking to himself.Questions: 1. and is common in schizophrenic patients. he will begin to eat. Physical activity is an important part of the schizophrenic patient’s treatment plan. it would be better if the child will not stay with the parent because we do not know what possible behavior will the parent show to the child. Basketball should be avoided because it requires the patient to have a physical contact with others. D continues to refuse to eat any hospital meals. having a brisk walk with a staff member. yelling. Mr. Mr D is observed laughing. As Mr. After several days. However. 4. The patient should be allowed to eat whatever he wants as long as no existing medical condition is present. The psychiatrist can make the decision so as not to trigger the illness and for early management and the other parent can also decide for safety purposes of the child.