1

I. Socio-demographic Data / Identification Data :

Name : Md mahabub Alam.

Age : 37years

Sex : Male

Father / Spouse : Md mahabub Alam

Education : H.S.Passed

Occupation : Farmer

Income : 15000/- per month

Marital status : Unmarried

Religion : Islam

Address :Vill – sahebganj; P.O.- sahebganj; Dist- coochbihar ; Sate – West Bengal

Date & time of admission : 05/07/2018

Diagnosis : Schizophrenia.

Name of ward : J.P.Ward

Informant :

Relationship with client :

Duration of relationship : Not present

Length of acquittance :

Reliability :

II. Presenting chief complaint :

Patient : Amar kichhu valo lagto na ,ghum asto na, dada boudi amar sob jomi jaiga niye
niyechhe r amai ekhane diye giyechhe.

Informant : Not present.

Impression : Patient has violent behavior.

 2

III. History of present illness :

Duration : last 2years

Mode of onset : Insidious

Course :Progressive

Intensity : Unclear

Precipitating factors : Nothing significant

Perpetuating factors : Nothing significant

Predisposing factors : Nothing significant

Description : Patient was apparently well but previously he was verry much anxious and
restless due to suspiciousness.

IV. Treatment History :

Drugs :
Name of the drugs Dose Route Frequency Side effects

Tab. Olanzapine 5mg Oral BDPC Nil

Tab. THP 2mg Oral ODPC
Tab. Vit.b com Oral ODPC
Tab. Alprazolam 0.25mg Oral BDPC

Any Other Therapy : Not given

V. Past Psychiatric and Medical History :

No. of previous episodes / hospitalization ( psychiatric) :
Compliance with medication : Not Present
Duration of each episodes :
Treatment details , its side effects and outcome :

Medical – surgical history : Nothing significant

 3

VI. Family History :

Name of family Relationship Age Education Occupation Health
members status
1.Md mahabub Sk Father 60yrs IV Passed Farmer Healthy

2. Lt sabina bibi Mother 52yrs V Passed House wife Healthy

X Passed
3.sajahan Sk Elder brother 38yrs Auto Driver Healthy

4.Md maharub patients 35yrs H.S.Passed Mentally ill

Alam.

Genogram :

80yrs 78 yrs 70yrs 69yrs

64yrs 62yrs 57yrs 55yrs

60yrs 52yrs

INDEX

38yrs 35yrsMale

Female

Marriage

Index
pateint
 4

Living arrangements:
Head of the family is Mahabub Alam.Home circumstances are good. Total family income is
15000 per month. Economical problem is present in the family. In their family pluralistic
communication pattern is present.

Other information like current attitudes of family members towards the patient’s illness, range
of affectivity in the family, cultural and religious values, and social support system was did
not collected as the informant was not present.

VII. Personal History : Not available for my patient

A. Perinatal History :
Antenatal period :
Intranatal period : Type of delivery-
Birth :
Birth cry :
Birth defects :
Postnatal complications :

B. Childhood History : Not available

Primary caregiver :
Feeding :
Age of weaning :
Developmental milestone :
Behavior & emotional problems :
Illness during childhood :

C. Educational History :
Age at beginning of formal education : 6 years
Academic performance : Medium
Extracurricular activities : Nothing significant
Relationships with peers & teachers : Well maintained.
School phobia : No
Look for conduct disorder : No
Reason for termination of studies : Patient don’t want to continue the study as he did not
like study.

D. Play History :
Games played ( at what stage and with whom) : Peers group
Relationship with playmates : Well maintained.
 5

E. Emotional Problems during Adolescence :

Running away from home / delinquency
/smoking / drug-taking/ any other : Smoking
F. Puberty :
Age at appearance of secondary sexual characteristics : not known
Anxiety related to puberty changes : Not present.
Age at menarche : Not
Reaction to menarche : applicable
Regularity of cycles , duration of flow : as my patient
Abnormalities , if any (menorrhagia , dysmenorrheal etc.) : is male

G. Obstetrical History :
LMP: not applicable
Number of children : as my patient
Any abnormalities associated with is male
pregnancy , delivery , puerperium :
Menopause (including any associated problems) :

H. Occupational History :
Age at starting work : 17years
Jobs held in chronological order : Farmer
Reasons for changes : No change
(including relationship with authorities , colleagues , puerperium)
Whether job is appropriate to patient’s background : Appropriate

I. Sexual and Marital History :

Type of marriage :
Duration of marriage : Not applicable as he is
Interpersonal & sexual relations : unmarried
Extramarital relationship :
 6

VIII. Premorbid personality :

Social relationship :
Premorbid functioning :
Taking a responsibility : Not available as informant is
Coping with stress : absent
Intellectual activities :
Hobbies :
Predominant mood :
Character :
Energy and initiation :
Fantasy life :
Habits :
Eating pattern : Regular
Elimination pattern : Regular
Sleep : Regular
Use of drugs , tobacco , alcohol : smoking

 Mental Status Examination:

1.General Appearance &Behavior :
 Appearance : Looking one’s age
 Facial Expression : Pleasant
 Level of grooming : Normal
 Level of cleanliness : Adequate
 Level of consciousness : Fully conscious and alert
 Mode of entry : Came willingly
 Behavior : Normal
 Co-operativeness : Normal
 Eye to eye contact : Not maintained
 Rapport : Spontaneous
 Gesturing : Normal
 Posturing : Normal
 Other movements : Normal
 Other catatonic phenomena : Not present
 Conversion & dissociative signs :Not present
 Compulsive acts or rituals or habits : Not present
 Hallucinatory behavior : Not present
 Psychomotor activity : Normal goal directed activities.
2. Speech :
 Initiation : Speaks when spoken to
 Reaction time : Normal
 7

 Rate : Slow
 Productivity : Elaborately
 Volume : Decreased (soft)
 Tone : Low pitch
 Relevance : Relevant
 Stream : Normal
 Coherence : Coherent
 Others : Not present
 Sample of speech : Q. Sokale ki khabar kheyecho?
A. ‘ Sokale powruti, kola , dudh kheyechi’

3.Disorder of thought:
A. Stream(flow of thought): Normal
B. Form : Not understandable
C. Content :
Delusions:
 Delusion of persecution:
Q: Apnar ki mone hoy keu apner khoti korte chaiche ?
A: Na amar jomi jaiga dada boudi niye niyechhe
Outcome: present,as evidenced by the patient
 Delusion of reference:
Q: Apnar ki mone hoy lokjon apnake nie kotha bolche?
A: Na amar esob kichui mone hoina.
Outcome: Absent
 Delusion of guilt:
Q: Tomer ki mone hoy ja kichu hoy sab kichur jonno tumi dayee ?
A: na .ami kano dayee hobo?
Outcome: Absent in patient.
 Delusion of grandiosity:.
Q: Tomer ki mone hoy tomer kache onek besi khamota ache ?
A: Na. ami to chaser kaj kori
Outcome: Absent in patient.
 Delusion of control:
Q: Tomer r ki mone hoy tomake keu chalona korche?
A: Na na.
Outcome: Absent in patient.
Q: Tomer ki kakhono mone je ami more jai?
 8

A: Na na mone hoi na
Outcome: Absent .
Ideas: Normal
Thought alienation phenomena:
 Thought insertion:
Q: Apnar ki mone hoy apni ja vabchen seta onno karo vabna?
 A: Na na emon mone hoina.
Outcome: Absent
 Thought withdrawl:
Q: Apnar ki mone hoy apni ja vaben onnera ta churi kore nay?
A: Na.
Outcome: Not present
.
 Thought broadcasting:
Q: Apni ja vaben seta ki kokhono T.V ba Radio te bole?
A: na.
Outcome: Not present.

4. Mood &Affect :
 Subjective : Q. Goto ak soptaho theke mon kemon ache?
A. Motamuti , valoi ache.
 Objective : Look happy
 Predominant mood state : Irritable
 Appropriate(relevance to situation & thought congruent)/inappropriate : Approapriate

5. Perception :
 Illusions :
Q. Tomar ki dori ke sap bole mone hoi ?
A. Na na. osob mone hobe keno?
 Hallucinations (specify type & give example) :
 Auditory hallucinations:
Q. Apni ki kane kichu sunte pan ja r keu paina?
A. Na sunte pai na.

 Visual hallucinations:
Q. Apni chokhe kichu dekhte pan ja r keu paina?
A. Na
 9

 Olfactory Hallucinations:
Q. Apni ki sobsomoy kono gondho pan ja r keu paina?
A. Na. kono gondho paina.

 Gustetory hallucinations:
Q. Apni ki sobsomoy kharap kono sadh pan?
A.Na.
 Tactile hallucinations:
Q. Apnar ki mone hoi gayer modhye kichu hete beroche ?
A. Ha. Amar gayer modhye jontu hete barai tai mone hoi.

 Somatic passivity : Not present.

 Déjà vu/jamais vu : Not present.
 Depersonalization/derealization : Not present.

Outcome : Illusion and hallucination is not present.

6.Cognitive Function(Neuropsychiatric Assessment) :

 Consciousness : Patient is conscious.

 Orientation :
Time : Q: Akhon kon somoy?
A: sakal 10.30 ta.
Place : Q: Tumi akhn kothay acho?
A: Berhampore Mental Hospital.
Person : Q: Ami k bolo to?
A: sister didi
Outcome: Patient is oriented to time, place and person.

 Attention:
N- 1 theke 20 porjonto gono to.
p- 1,2,3,4 ..ar parbona.
Conclusion : patient have poor attention.
 Concentration :
N : 40 theke 3 bad diye diye gunun.
P : osob parbo na.
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 Memory:
 Immediate :
N – bolo to table, pen , mobile.
P – table, mobile,pen.
 Recent :
N – Kal rate ki kheyecho?
P - Vat dal sayabiner torkari.
 Remote :
N – Apnar jonmodin kobe?
P – Bolte parbo na.

Conclusion: Patient’s immediate and recent memory is intact but remote memory is
altered.
 Intelligence:
 General fund of information:
N –Amader pradhan montrir naam ki?
P – Jani na.
 Arithmetic ability:
N – 20 er sthe 56 jog korle koto hoi ?
P – Janina
Conclusion: Intelligence is poor
 Abstraction:
 Interpretation of proverbs:
N-‘ Nach na janle uthone byaka mane ki ?’
p- Janina esob.
Similarities between paired objects:
N – Chair ar table er modhye ki mil ache bolun to?
p- Dutoi kather toiri.
Dissimilarities between paired objects:
N- Pen ar pencil er modhe parthakya ki?
P- Pencil er lekha muche doa jae kintu pen er lekha mocha jae na .

Conclusion: Abstract thinking intact.

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Judgement :
 Personal:
Q –Ekhan theke phire gie ki korbe?
A- Chasbas kore .
 Social:
Q-Apnar bari keu ele apni ki korben?
A- Take boste debo.
Test:
 Q-Jodi apni dekhen duto lok jhamela korche ki korben?
A – oder k thamte bolbo.
Conclusion: patient’s social and test judgement is intact but personal judgement is not
intact.

7.Insight :
Q: Apnar ki kono manosik rog hoyeche bole mone hoy?
A: Amar kono manasik rog nei, bari theke jor kore rekhe geche.
Conclusion: 1st grade insight present.
Diagnostic Formulation : Mr. Mahabub alam, a 35 years old male patient admitted
in Berhampore Mental hospital on 05/07 2018 with a complain of disorganized thought,
violent behavior. His general appearance and behaviour is good, speech is spontaneous,
mood and affect is appropriate, thought is impaired. Personal judgement is impaired. His
insight grade is I.

 Physical examination :
 Temp : 96.8 degree farenhite
 Pulse : 70 beats / min
 Resp : 20 breaths / min
 B.P. : 110/ 70 mm of hg
 Respiratory System : Normal
 Abdomen : WNL
 Musculoskeletal System : WNL
 Lymph nodes : Not palpable
 Breasts : WNL
 Pelvic examination : WNL
 Any other sings : Nothing significant
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Undifferentiated Schizophrenia :

 Introduction : The word Schizophrenia was coined in 1908 by the Swiss psychiatrist
Eugen Bleuler. It is derived from the Greek words skhizo (split) and phren ( mind).

Schizophrenia is a psychotic condition characterized by a disturbance in thinking ,

emotions , volitions and faculties in the presence of clear consciousness , which usually
leads to social withdrawal.

 Definition:
Schizophrenia is a psychotic condition characterized by a disturbance in thinking,
emotions, volitions and faculties in the presence of clear consciousness, which usually
leads to social withdrawal.

Undifferentiated schizophrenia:A person exhibits the symptoms of more than one subtype
of schizophrenia, but does not exhibit enough symptoms of one subtype to be classified
as that subtype.

Incidence : Schizophrenia is the most common of all psychiatric disorders and is

prevalent in all cultures across the world. About 15 % of new admissions in mental
hospitals are schizophrenic patients . It has been estimated that patients diagnosed as
having schizophrenia occupy 50% of all mental hospital beds.

About three to four per 1000 in every community suffer from schizophrenia . About one
percent of the general population stand the risk of developing this disease in their lifetime
. Schizophrenia is equally prevalent in men and women . The peak ages of onset are 15 to
25 years for men and 25 to 35 years for women . About two thirds of cases are in the age
group of 15 to 30 years . The disease is more common in lower socio-economic groups.

 Classification of Schizophrenia:
According to book According to
patient
1. Paranoid Schizophrenia:
Paranoid schizophrenia is characterised by the following clinical
features, in addition to the general guidelines of schizophrenia.
a. Delusions of persecution, reference, grandeur (or ‘grandiosity’), Not present
control, or infidelity (or ‘jealousy’). The delusions are usually well-
systematised (i.e. thematically well connected with each other).
b. The hallucinations usually have a persecutory or grandiose content.
c.No prominent disturbances of affect, volition, speech, and/or motor
behaviour
2.Disorganised (or Hebephrenic) Schizophrenia:
 13

Disorganised schizophrenia is characterised by the following features, in

addition to the general guidelines of schizophrenia.
a. Marked thought disorder, incoherence and severe loosening of
associations. Delusions and hallucinations are fragmentary and Not present
changeable.
b. Emotional disturbances (inappropriate affect, blunted affect, or
senseless giggling), mannerisms, ‘ mirror-gazing’ (for long periods of
time), disinhibited behaviour, poor self-care and hygiene, markedly
impai red social and occupational functioning, extreme social withdrawal
and other oddities of behaviour.
3. Catatonic Schizophrenia:
It can present in three clinical forms: excited catatonia, stuporous Not present
catatonia, and catatonia alternating between excitement and stupor.
4.Residual Schizophrenia:
Symptoms of residual schizophrenia include emotional blunting, Not present
eccentric behavior, illogical thinking, social withdrawal and loosening of
associations. This category should be used when there has been at least
one episode of schizophrenia in the past but without prominent psychotic
symptoms at present.
5. Undifferentiated Schizophrenia:
This is a very common type of schizophrenia and is diagnosed either: a. Present
When features of no subtype are fully present, or b. When features of
more than one subtype are exhibited, and the general criteria for
diagnosis of schizophrenia are met.
6. simple schizophrenia :
It is characterised by an early onset (early 2nd decade), very insidious Not present
and progressive course, presence of characteristic ‘negative symptoms’
of residual schizophrenia (such as marked social withdrawal, shallow
emotional response, with loss of initiative and drive), vague
hypochondriacal features, a drift down the social ladder, and living
shabbily and wandering aimlessly. Delusions and hallucinations are
usually absent.
7. Post-Schizophrenic Depression:
Some schizophrenic patients develop depressive features within 12
months of an acute episode of schizophrenia. The depressive features Not present
develop in the presence of residual or active features of schizophrenia
and are associated with an increased risk of suicide.
8. Other subtypes:
Other subtypes include : Pseudoneurotic Schizophrenia,
Schizophreniform Disorder, Oneiroid Schizophrenia, Van Gogh Not present
Syndrome , Late Paraphrenia , Pfropf Schizophrenia , Type I and Type II
Schizophrenia
 14

 Etiology :

Book picture Patient picture

1. Biological Theories
 Genetic Hypothesis : About 8-10% of first degree relatives (and 3% of
second degree relatives and 2% of third degree relatives) of patients with Not present
schizophrenia can present with schizophrenia, as compared with the 0.5-
1% prevalence rate in general population. The concordance rate for
monozygotic twins is 46% and for dizygotic twins is 14%. If one parent
has schizophrenia, the chances of the child developing schizophrenia are
10-12%. However, if both parents have schizophrenia, chances of the
child developing schizophrenia increase to about 40%.
 Biochemical Theories: Schizophrenia is presently thought to be
probably due to a functional increase of dopamine at the postsynaptic Present
receptor, though other neuro transmitters such as serotonin (especially 5-
HT2 receptors), GABA and acetyl choline are also presumably involved.
 Brain imaging: Cranial CT Scan, MRI Scan, and postmortem studies
show enlarged ventricles (not amounting to hydrocephalus) and mild Not identified as
cortical atrophy (with an overall reduction in brain volume and cortical CT and MRI was
grey matter by 5-10%) in some patients of schizophrenia. PET (positron not done
emission tomography) scan shows hypofrontality and decreased glucose
utilisation in the dominant temporal lobe.
 Other theories: Drugs such as amphetamines and mescaline can cause
schizophrenia-like symptoms in normal subjects.
Viral and autoimmune factors have also been implicated by some, while Not present
others (e.g. Wein berger) have suggested a neurodevelopmental
hypothesis for schizophrenia.
2. Psychological Theories
 Stress: Increased number of stressful life events before the onset or
relapse probably has a triggering effect on the onset of schizophrenia, in Present
a genetically vulnerable person (Stress-Vulnerability Hypothesis) .
According to this hypo thesis, higher the genetic vulnerability in a
person, lesser the environmental stress needed to precipitate a relapse.
 Family Theories: Several theories have been propounded in the past but
are currently of doubtful value. These include ‘ schizophrenogenic Not present
mothers’, lack of ‘real’ parents, dependency on mother, anxious mother,
parental marital schism or skew, double-bind theory, communication
deviance, and pseudomutuality.
 Information Processing Hypothesis: Disturbances in attention, inability
to maintain a set, and inability to assimilate and integrate percepts are Present
common findings in schizophrenia. There is possibly a breakdown in the
 15

internal representation of mental events.

 Psychoanalytical Theories : According to Freud, there is regression to
the pre oral (and oral) stage of psychosexual development, with the use Not present
of defense mechanisms of denial, projection, and reaction formation.
There is a loss of ego-boundaries ( described by Federn), with a loss of
touch with reality.
3. Sociocultural Theories:
Although the prevalence of schizophrenia is quite uniform across cultures, it
was found to be more common in lower socioeconomic status in some
studies. This has now been explained due to a ‘ downward social drift’, Not present
which is a result of having developed schizophrenia rather than causing it.
Higher rates of schizophrenia have been found among some migrants, not
only among the first generation migrants but also among the second
generation.

 Clinical manifestations:
Patient with undifferentiated schizophrenia can experience positive, negative, and/or cognitive
symptoms, but their symptom pattern does not fit neatly into one of the other schizophrenia
subtypes.

Book picture Patient picture

positive Symptoms:
This refers to behaviors and beliefs that are not normally present in
healthy people. Positive symptoms include:

 Hallucinations: A sensory experience that is not real, such as Not present

hearing voices, or seeing things that are not there.
 Delusions: Erroneous but firmly held beliefs, despite concrete
evidence that disputes the belief or a lack of factual evidence to back Not present
up the belief. This might include thinking people on TV are sending
special messages or it could involve paranoia, such as thinking
people are spying on them or "out to get them".
 Thought disorder: Unusual thinking or disorganized speech. Present
 Catatonia or other movement disorders: Excessive movement or Not present
decreased movement.

Negative Symptoms:
Negative symptoms refer to an absence of behaviors that are
considered normal. Negative symptoms include: Social withdrawal
 Loss of motivation is present
 Social withdrawal
 Lack of interest or enjoyment in activities
 "Flat affect," reduced facial expression and/or vocal
intonation
 Difficulty expressing emotion
 16

 Difficulty planning activities

 Difficulty beginning and sustaining activities
 Reduced feelings of pleasure
 Reduced speaking

Cognitive Symptoms:
Cognitive symptoms include substantial challenges with thinking
skills.Cognitive symptoms include:

 Problems with attention

 Difficulty concentrating or focusing This all are
 Impaired memory, such as remembering appointments present in my
 Diminished ability to process information patient.
 Problems with decision making
 Difficulty learning and using information
 17

 Psychopathology :

  Psychobiology Of Undifferentiated Schizophrenia

Predisposing factors : Precipitating factors :

 Genetics  Environment
 Neuro-anatomy  Immunovirologic
 Neuro-chemical factors
 Unknown

Neuro- anatomy:  Viral exposure

 Increased
dopamine  Cold environment
 Less brain tissue &
 Increased serotonin  Cytokine
cerebrospinal fluid
inflammatory
 Enlarged ventricle  Excessive
mediator inhibitor
in the brain neurotransmission
 Triggers
 Cortical atrophy
 Diminished
glucose
metabolism &
oxygen in the
frontal area.

Changes in neural activity

symptoms

Positive or Hard Negative or Soft

symptoms : symptoms :

 Ambivalenc  Catatonia
e
 18

 Diagnostic evaluation :
Book picture Patient picture
1. ICD 10:
If the duration of illness is less than 1 month, then a diagnosis of It was done.
acute schizophrenia-like psycho tic disorder should be made. These
symptoms include (ICD-10): Thought
echo/insertion/withdrawal/broadcasting; delusions of
control/influence/passivity; delusional perception; hallucinatory
voices commenting or discussing the patient, or other voices
coming from some part of body; and/or persistent culturally
inappropriate delusions.
2. History taking History was taken.
3. Mental status examination MSE was done.
4. CT scan and MRI Not done.

 Management:
Book picture Patient picture
1. Pharmacological Management: o Tab. Olanzapine ,5mg BDPC, orally
An acute episode of schizophrenia o Tab. THP,2mg,ODPC,orally
typically responds to treatment with o Tab.Lithium,300mg,TDSPC,orally
classic antipsychotic agents, which are o Tab. Alprazolam,0.25 mg, BDPC,
most effective in its treatment. Some orally
commonly used drugs include:
 Chlorpromazine: 300-1500 mg/ day PO;
50-100 mg/day IM
 Fluphenazine decanoate: 25-50 mg IM
every 1-3 weeks
 Haloperidol: 5-100 mg/day PO; 5-20
mg/day IM
 Trifluoperazine: 15- 60 mg/day PO; 1-5
mg/ day IM
 Clozapine: 25-450 mg/ day PO
 Risperidone: 2-10 mg/ day PO
 Olanzapine: 10-20 mg/day PO
2. Electroconvulsive Therapy (ECT)
Schizophrenia is not a primary indication
for ECT. The indications for ECT in
schizophrenia include: Catatonic stupor, Not given
Uncontrolled catatonic excitement, Acute
exacerbation not controlled with drugs,
 19

Severe side-effect with drugs, in presence

of untreated schizophrenia. Usually 8-12
ECTs are needed (although up to 18 have
been given in poor responders),
administered two or three times a week.
3. Psychosocial treatment :
 Psycho-education
 Group psychotherapy
 Family therapy Not given
 Milieu therapy
 Individual psychotherapy
 Psychosocial rehabilitation
20
 21

Nursing Management:
 Day 1 (Date - 14/03/2022)

Assessment Nursing Planning Implementation Evaluation

(Orientation diagnosis (Identification phase) (Exploitation phase) (Resolution
phase) Phase)
 22

Subjective data: Disturbed Goal setting was done  Carried out plan Patient was
Patient say’s thought along with the patient. mutually agreed upon. free to express
“amar jaiga process the feelings
jomi sob amar related to Patient will achieve without any
dada boudi niye possible improved thought hesitance.
niyechhe biochemical process as evidenced by
factors, showing suspecious Therapeutic
stressful life thinking. relationship
events as  MSE is to be done.  MSE has been done to was
evidenced by identify any abnormality established.
Objective data: patient’s in thought process.
On observation verbalization  Therapeutic
patient has and relationship is to be  Therapeutic relationship Psychotic
inappropriate established. has been established to symptoms are
 Inappropriate non reality promote trust and assist reduced
non reality based the patient in problem slightly.
 Patient is to be
based thinking solving.
encouraged to
thinking.
express feelings as  Patient has been
 Inaccurate encouraged to express
much as possible.
interpretation feelings as much as
of possible to relief from
environment.  All promises is to be
stress.
kept.
 All promises has been
kept to promote trust.
 Laughing,
whispering, talking  Laughing, whispering,
quietly where the talking quietly where
patient can see is to the patient can see has
be avoided. been avoided to prevent
patient from feeling
 Antipsychotic drug is threatened.
to be administered as
per doctor’s order.  Tab Olanzapine, 5mg
BD has been
administered as per
doctor’s order to reduce
the psychotic
symptoms.

Assessment Nursing Planning Implementation Evaluation

(Orientation diagnosis (Identification phase) (Exploitation phase) (Resolution
phase) Phase)
 23

Subjective data: Impaired Goal setting was done  Carried out plan Patient was
Patient say’s “ami verbal along with the patient. mutually agreed upon. free to
bari jate chai,amar communication express the
mama doctor , related to Patient will be able to feelings
ami bari giye sarir possible communicate without any
business korbo. biochemical appropriately as hesitance.
alternations, evidenced by showing
as evidenced appropriate thought Therapeutic
by patient’s and feelings in a  MSE has been done to relationship
verbalization coherent ,logical identify any was
Objective data: and manner. abnormality in established.
On observation inappropriate  MSE is to be done. communication.
patient has verbalization,
poor eye  Therapeutic Patient
 Difficulty in contact.  Therapeutic relationship has been communicate
communicating relationship is to be established to promote appropriately
thought established. trust and assist the to some
verbally patient in problem extent.
 Illogical solving.
thinking  Patient has been
 Inappropriate  Patient is to be encouraged to talk
verbalization encouraged to talk with other to improve
with others. communication.
 Therapeutic
 Therapeutic communication
communication technique has been
technique is to be used to collecting
used. information regarding
patient problem.

 Anticipate and fulfil

 Anticipate and fulfil patient’s need to
Patient’s needs until assist the patient in
functional maintaining their self
communication care needs.
pattern return.

 Day 2 (Date : 15/03/2022)

Assessment Nursing Planning Implementation Evaluation

 24

(Orientation diagnosis (Identification phase) (Exploitation phase) (Resolution

phase) Phase)
Subjective data:Impaired Goal setting was done  Carried out plan Patient was
Patient say’ssocial along with the patient. mutually agreed upon. free to
“amar karorinteraction express the
sathe kotharelated to Patient will be able to feelings
bolte valo lage difficulty with interact with others without any
na”. communication appropriately as hesitance.
as evidenced evidenced by patient
by patient’s will voluntarily spend Therapeutic
verbalization time with others.  MSE has been done to relationship
and  MSE is to be done. identify mental was
Objective data: dysfunctional condition of the patient. established.
On observation interaction
patient has with others.  Therapeutic  Therapeutic relationship
relationship is to be has been established to Patient
 Dysfunctiona established. promote trust and assist interact
l interaction the patient in problem appropriately
with other. solving. with others to
 Appears  Patient has been some extent.
agitated  Patient is to be encouraged to talk with
when others encouraged to talk other to improve
come in with others. communication.
close contact .
with the  Unconditional  Unconditional positive
patient. positive regards is to regards has been shown
be shown. to increase the feelings
of self worth.

 Recognition and
 Recognition and positive reinforcement
positive has been provided when
reinforcement is to the patient is voluntarily
be provided when interact with others to
the patient is encourage the repetition
voluntarily interact of successful behavior.
with others.

Assessment Nursing Planning Implementation Evaluation

 25

(Orientation diagnosis (Identification phase) (Exploitation phase) (Resolution

phase) Phase)
Subjective data:Self care Goal setting was done  Carried out plan
Patient say’sdeficit along with the patient. mutually agreed upon.
“amar snanrelated to Patient was
korte valo lage cognitive Patient will be able to complete
na, tai ami dui impairement complete daily activities daily living
din snan korini” as evidenced with minimum activities with
by patient’s assistance as evidenced minimum
verbalization by patient will assistance
and difficulty demonstrate increasing
in interest in self care  Patient’s ability to
Objective data: maintaining activities. maintain self care Patient
On observation personal  Patient’s ability to activities has been demonstrate
patient is hygiene. maintain self care assessed to collect base adequate
activities is to be line data. personal
 Looking assessed. hygiene skills.
unclean and  A structured schedule
untidy  A structured schedule for patient’s routine for
 Difficulty in for patient’s routine hygiene, toileting and
carried out for hygiene, toileting meals has been
activities of and meals is to be developed to develop
daily living developed. habit in the patient.
 Patient has been
 Patient is to be encouraged to perform
encouraged to self care activities
perform self care independently as much
activities as possible to enhance
independently as self esteem and promote
much as possible. repetition of desirable
behavior.
.
 Positive appreciation has
 Positive appreciation been provided when the
is to be provided patient complete
when the patient activities of daily living
complete activities of to promote desirable
daily living. behavior.

 Day 3 (Date:16/03/2022)
 26

Assessment Nursing Planning Implementation Evaluation

(Orientation diagnosis (Identification phase) (Exploitation phase) (Resolution
phase) Phase)
subjective data:Ineffective Goal setting was done  Carried out plan
Patient say’shealth along with the patient. mutually agreed upon.
“amar khetemaintenance Patient was
iccha korena,related to Patient will be able to maintain
thik kore ghum cognitive maintain optimum adequate
hoina.” impairement health as evidenced by nutrition,
as evidenced patient will take hydration.
by patient’s adequate diet, have  Patient’s ability to
verbalization adequate sleep. maintain optimum Patient was
and difficulty  Patient’s ability to health has been assessed maintain
Objective data: in falling maintain optimum to collect base line data. adequate
On observation asleep, poor health is to be sleep and rest
patient has dietary intake assessed.  Food and fluid intake
has been observed to patient was
 Poor dietary  Food and fluid intake know the patient dietary take
intake is to be observed. pattern. medication as
 Difficulty in administered
falling asleep  Patient has been
 Patient is to be encourage to take food
encourage to take in gentle manner to
food in gentle ensure that the patient is
manner. taking food.

 Day time naps has been

 Day time naps is to avoided by engaging the
be avoided by patient in any activity to
engaging the patient induce sleep at night.
in any activity

 Tab Alprazolam 0.25

 Sedative is to be mg BD has been given
given as per doctor’s to promote sleep.
order.
 27

Assessment Nursing Planning Implementation Evaluation

(Orientation diagnosis (Identification phase) (Exploitation phase) (Resolution
phase) Phase)
Subjective data: Altered Goal setting was done  Carried out plan
Patient say’s thought along with the patient. mutually agreed upon.
“amar dada process Patient was
amar birudheye related to Patient will suspecious not showing
sorojontro delusions as behaviour, patient will violent
korchhe. evidence by decreased feeling of behavior to
mental status agitation.  Observe patient’s others.
examination.  Observe patient’s behavior frequently to
behavior frequently ensure patient’s and
other safety Patient was
verbalize the
Objective data: feelings of
On observation anger
patient become  Talk with the patient in a
 Talk with the patient low calm voice to help
 Agitated in a low calm voice. in calm the patient
when some
one close to
him  As agitation subsides,
 As agitation subsides, encourage the patient to
encourage the patient express his feelings to
to express his decrease anxiety.
feelings.

 Help the patient identify

 Help the patient and practice ways to
identify and practice relieve anxiety like deep
ways to relieve breathing exercise to
anxiety reduce anxiety.
 28

 Health education:
 Explain to the patient that schizophrenia is a chronic disorder with symptoms that affect
the person’s thought processes , mood , emotions and social functions throughout their
person’s lifetime.
 Teach the patient about the importance of medication compliance and therapeutic / non
therapeutic effects of antipsychotic medications.
 Instruct the patient to recognize impending symptom exacerbation and to notify physician
when the patient poses a threat or danger to self or others .
 Teach the patient to identify psychosocial or family stressors that may exacerbate
symptoms of disorder and of prevent them.

 Conclusion :
Patients withschizophrenia are no longer hospitalized for long periods. Most return to live
in the community with assistance provided by family and support services . Complete
remission is uncommon in patients with schizophrenia. Individuals who chronically
experience hallucinations , especially the auditory command type , require closer
supervision.
 29

 Bibliography:
Books:
 Ahuja N. A Short Textbook of Psychiatry. 7 th ed. New Delhi : Jaypee Brothers
Medical Publishers (P) Ltd ; 2011. P. 54-68.
 Townsend MC. Psychiatric Mental Health Nursing : Concepts of Care in
Evidenced-Based Practice . 8th edition. Philadelphia : F.A. Davis Company ; 2015.
P. 489-510.
 Sreevani R . A Guide to Mental Health and Psychiatric Nursing . 3 rd ed. New Delhi :
Jaypee Brothers Medical Publishers (P) Ltd ; 2010. P. 76-87.

Webpages :
 Undifferentiated schizophrenia[Internet]. 2021 Apr 06.
Available from : https://www.scribd.com/document/190377220/Psychopathology-
of-Undifferentiated-Schizophrenia