‫‪Case Study‬‬

‫حتت اشساف‪-:‬‬

‫اعداد الطالبة ‪-:‬‬

 Case Study
Student name: Zahra Abdullah Al-salat

*General information about pt. :-

Name of patient : najla Abdullah alquaod Age: 26 old years Sex: female

Marital status:- marred Occupation: dressing Education: secondary

-Room : 3 bed : 1

Medical diagnosis : schizophrenia Date of aadmission:08/2/2017

Schizophrenia
Definition
Is a functional psychosis characterized by disturbance in thinking, emotions, volition, and perception, which
occur in a state of, clear consciousness, which usually lead to social withdrawal
Incidence:- Is the most common disease of psychiatric disease prevalent in all cultures and in all part of the
world . Three to four per 1000 persons in any community suffer from schizophrenia.
About 15% of new admission in mental hospitals are schizophrenia pt.

nomic group.

ETIOLOGY
The main causes is still unknown but there are some of involved factor:-
A)) predisposing factors:-
These factors determine an individual's susceptibility to illness which it
involve the following:
1)) Genetic factors: - it play important role in causation of
schizophrenia the incidence of schizophrenia in specific population.
2)) Biochemical factors:-
-Increase of dopamine and neurotransmitters:-Norepinephrine , Serotonin
Acetylcholine ,(GABA)

-Increase of neuroregulator:-Prostaglandins -Endorphins

B)) precipitating factors:-
This factors help to fast appear of illness
- Poverty High social mobility
Unemployment Disorganization
-

Mother-child relationship
Dysfunctional family system as hostility between parents

-bind communication Clinical feature:-

Essential feature:-

Positive symptoms: Negative symptoms:

-Delusion -Flat effect or blunting

-Hallucination -volition -apathy

-Disorganized speech & behavior -A logia

-catatonic -A socialty

-Anhedonia

-Attention impairment

Signs and symptoms of disorder

In addition, there are fundamental groups of signs and symptoms, which
may occur singly or together in various clinical patterns. The group of
symptoms are according to function of mind.
A)) THOUGHT AND SPEECH DISORDER:-
1) Autistic thinking
2) Thought blocking

3) Loosening of association
4) Neologism
5) Poverty of speech
6) Poverty of ideation
7) Echolalia
8) Preservation
9) Verbigeration
10)Delusions
11)Other thought disorder
Over inclusion impaired abstraction
Concreteness ambivalence

B)) PERCEPTION DISORDER:-

-Hallucination:-
- Auditory - Tactile - Gustatory - Olfactory - Visual

2 -Illusion
C)) AFFECTS DISORDER:-
o Emotional flattening.
o Anhedonia
o incongruent emotion
o inappropriate emotional response
D)) BEHAVIORS disorder:-
o Increase or decrease in psychomotor activity
o Mannerisms
o Stereotypes
o Decrease self-care
o Poor grooming
o Insomnia
 o Aggressive
o Suicide

E)) MEMORY:-
o Impaired intelligence.
o Poor Insight.
o impaired concentration
o Poor judgment

SUBTYPES OF SCHIZOPHRENIA :-
1) Paranoid schizophrenia

2) Hebephrenic (disorganized) schizophrenia

3) Catatonic schizophrenia
4) Residual schizophrenia

5) Undifferentiated schizophrenia
6) Simple schizophrenia
7) Post -schizophrenia depression

Prognostic factors in schizophrenia-:

* Good prognostic factor Poor prognostic factor

- Abrupt or acute onset -Insidious onset

- Later onset - Younger onset

- Female sex -Male sex

- Married Single, - divorced or widowed

- Out-patient treatment - institutionalization

- Family history of mood disorder - Family history of SZP

-Presence of precipitating factor - Absence of precipitating factor

 - Good personality - Poor personality

- Predominance of positive symptoms - Predominance of negative symptoms

- Good social support - Poor social support

- Short duration 6 months - Long duration 6month

-Paranoid and catatonic subtype. - Simple and undifferentiated subtype

Management

1)Pharmacological therapy⇨Antipsychotic drug (( typical , atypical ))

A. Typical antipsychotic

Ex:chlorpromazpine,Haloperidol

B. Atypical antipsychotic

Ex:Clozapine,Risperidone

2) Electroconvulsive therapy (ECT)

3) Psychological therapies:-

-Group therapy -Behavior therapy

-Cognitive therapy -Family therapy

4) Psychosocial Rehabilitation:-

This include activity therapy to develop the work habits training in new vocation or

retraining in previous skill, vocation guidance and independent job placement

5)Education about the illness for p.t and families.

Nursing care for schizophrenia:- According to symptoms

1) Delusion:

1.-Acceptance p.t as she is .

2. -Encourage p.t to express his feeling.

3. -No judgement

4. -Giving emotional support and make p.t feel that he is in safe.

5. -Do not conflict p.t and not share her.

6. -Avoid use any express that tell p.t that you accept her hallucination.

7. -Try to district the client from every from the hallucination by:- listen to radio or watch T.V talk with
other sas sign small responsibites to the p.t

8.-Avoid touching pt without warning

9.- Avoid laughing or talking guilty where the pt can be see.

10.- Avoid competitive activities.

2)Hallucination

1. -Acceptance p.t as he is .

2. -Encourage p.t to express his feeling.

3. -Observe signs and symptoms of hallucination and content of it –do not reinforce the hallucination.

4. -Giving emotional support and make p.t feel that he is in safe.

5. -Do not conflict p.t and not share his or her.

6. -Avoid use any express that tell p.t that you accept him in his or her hallucination.
7. -Try to district the client from every from the hallucination by:- listen to radio or watch T.V talk with
other sas sign small responsibites to the p.t

3) Social isolation:

1.- convey an acceptance attitude and unconditional positive regard .

2.- Make brief frequent contact be honest and keep all promises.

3.- Provide group activities with patient that may be frightening for her.

4.- Give recognition and positive reinforcement for voluntary interaction with other.

5.- Encurage patient about relaxant technique.

4) Insomnia:

1.- observe patient of sleeping in morning and weaning and don't allow the patient to sleep for long
time during day.

2.- cnourage pt. to get up from her bed.

3.- provide calm enviroment .

4.- provide comfortable measure .

5.- Avoid the pt. to drink tea and coffee.

6.- Encourage pt. to do relaxation technique.

7.- Help pt. to express her feelig.

8.- Give pt. sedative as order.

5) Ineffective family coing:

 1. Determine indivdual situation and feeling of individual family member.
2. Assess pattern of communication
3. Determine pattern of behavior displayed by pt in her relationship with other
4. Assess the role of pt in family
5. Provid information about behavior patter and expected course of the illness.

6)Risk for violence

maintain low level of stimuli in client environment

-protect yourself don't approach alone and call for assistance to manage any situation

-donot challenge aviolent patient

-remove all dangerous objective from clint environment

-calm attitude to words the clieny

7)Risk of nutration impalance

find out likes and dislikes and provide favorits foods

-provide 6-8 glasses of fluids per day

-maintain accurate record of intake and output regularly

-supplement diet with patient and minerals

-walk or sit with pateint while he ea

8)Defect self care

Enseure that he take his bathk reqularly and remind the p.t to go to the toilet at regular intervals.

-Complinment the p.t when he looks good.

-When the p.t has taken care for him self express realistic appreciation.

-Remember to check finger and toes nails eat the if p.t cat not to do it by himself.

-Encourag the p.t to remove dirty clothes and wear of clean

9)risk for injury

keep environment stimuli to minimu assign single room limit interaction with other

-remove hazardous objects and substances caution the pateint when there is possibility of accident

-assist patient to engage in activity such as writing and drawing

-administer medication as prescribed by physician

9)impared verbal cimmunication

attempt to decode incomprehensible communication pattern

facilitate trust and understanding by maintaining staff assignment as consistently as possible

-anticipate and fulfill clint's needs until functional communication pattern returns

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 ‫ ماكهت مصدقة وكرلك اطمكت مو شوجي واخر مين ابهيت لرلك كهت‬, ‫فكدت امي قبن شًسيو انصدمت بوفاتًا‬
. ‫اضازب اخوتي النًم يصتوا يكتموا بهيت‬

‫ سهني مو فرتة ارتطوبة الى شوجًا ليس مو مستوايا لكو عهدما ماتت امًا‬4 ‫بدأت االسسة مالحظة مسضًا مهر‬

‫بعديا بأسبوع يجمت عمي مسة اخويا بالسكني وتعادتت عهد شيخ ثم طبيب نفسي لكو زفضت استددام العالج‬

Nursing Nursing Nursing intervention Nursing

Evaluation
Diagnosis planning

Jealousy to decrease 1.-Acceptance p.t as she is .

pattern of
delusion 2. -Encourage p.t to express his feeling.
delusion
3. -No judgement
thinking

4. -Giving emotional support and make p.t feel that he is in safe.

5. -Do not conflict p.t and not share her.

6. -Avoid use any express that tell p.t that you accept her

hallucination.

7. -Try to district the client from every from the hallucination by:-
 listen to radio or watch T.V talk with other sas sign small

responsibites to the p.t

8.-Avoid touching p.t without warning

9.- Avoid laughing or talking guilty where the pt can be see.

10.- Avoid competitive activities.

Risk of injury To prevent 1. keep environment stimuli to minimu assign single room limit

RT irritability injury interaction with other

2. -remove hazardous objects and substances caution the pateint

when there is possibility of accident

3. -assist patient to engage in activity such as writing and drawing

4. -administer medication as prescribed by physician

ineffective To improve 1.-Determine individual situation and feeling of individual family

Family coping family member.

relationship
2.-Assess pattern of communication

3.-Determine pattern of behavior displayed by pt in her

relationship with other

4.-Assess the role of pt in family

 5.-Provid information about behavior patter and expected course

of the illness.

Anxity To decreas 1.Stay with P.t and offer reassurance of safety security .

anxity
2.maintain clam and non-threatening

3.Use simple ward and brief massage

4.Keep quite environment .

5.Encourage P.t to explain him feeling

6.Admenister Tranquillizing medication

Dry mouth Rt to reduce 1-Encourage p.t to increase fluid intake.

medication dryness
2-Encourage p.t to do not eating this that he is belief that it gat.
side effect
3-Assess of signs of dehydration.
 ‫‪Follow up‬‬
‫‪18/3/2017 : Saturday‬‬

‫مت ادتموس مع املسيضة وكانت حالتًا افضن مو السابل‬

‫ذكست املسيضة انًا استفادت مو العالج وكرلك بدأت ختتمط باألخسى‬
‫بدأت تستبصس مبسضًا‬
‫نظافتًا جيدة‬
‫اخرت ادويتًا‬
‫تصازك باألنصطة يف الكسم‬
‫اكمًا جيد‬
‫نومًا جيد‬
‫‪19/3/2017 : Sunday‬‬

‫مت ادتموس مع املسيضة وحالتًا تتخسو مو يوم ليوم‬

‫اخرت عالجًا وكرلك اخرت وجبة الصبوح وبعديا متصت باذتوش جمست مع باقي املسيضات‬
‫اكمًا جيد‬
‫نومًا جيد‬
‫كرلك مًتمة بهظافة نفسًا‬
‫‪20\3\2017 : Monday‬‬
‫مت ادتموس مع املسيضة وكانت يادئة ومستكسة ومتجاوبة‬
‫شازكت بعمن الهظافة‬
‫تهاولت الدواء‬
‫تهاولت وجبة الصبوح‬
‫كالمًا جيد ومرتابط‬
‫نومًا جيد ومًتمة بهظافة نفسًا‬
‫اكمًا جيد‬