SAINT PAUL UNIVERSITY DUMAGUETE

COLLEGE OF NURSING

NURSING CARE PLAN FORM

Name: J.A Diagnosis/CC: Schizophrenia

Age: 19 years old Sex: Male Physician: Dr. A

NC P # 1
SUBJECTIVE OBJECTIVE NURSING SCIENTIFIC ANALYSIS PLANNING INTERVENTIONS RATIONALE Expected Outcome
DIAGNOSIS
Patients Upon the Impaired People with SHORT TERM GOAL SHORT TERM:
has limited interaction, verbal schizophrenia After 4 hours of
response the student communication exhibit wide After 3 hours nursing After 3 hours of
and nurses r/t altered ranging deficits in of nursing intervention the nursing
sometime s observed: perception as most cognitive intervention, patient will be interventions the
no 1. Anhedoni evidenced by domains, such as client will be able to: client was able
response. a having goal maintenance, able to: to:
2. Blunt disturbances working memory, and - establish Independent - established
affect in cognitive processing speed. A trust - Assess the - to be aware trust with
and flat associations. schizophrenia with mental of caregiver a
affect. Definition: symptom caregiver status. psychologica means of
3. Limited Due to several consistently s and a l conditions communicatin
words causes like associated with means of such as g needs.
(Alogia) disordered poor cognitive task communica schizophreni - demonstrate
4. Limited thinking, performance is ting a, manic reality-
eye trouble disorganized needs. depressive, based
contact concentrating, speech. - demonstra or bipolar thought
5. Tangenti and auditory Disorganized speech te disorders processes in
ality ty hallucinations symptoms, such as reality- may disrupt verbal
6. No , patients communication based the speech. communicatio
energy with impairment, have thought n.
(Anergia schizophrenia been consistently processes
) frequently associated with verbal - Assess if - establishing - spend time
experience poor performance on
 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

decreased cognitive control communica incoherence a baseline with one or

verbal tasks which are tion. in speech to two other
communication. tasks that require - communic is chronic facilitate people in
It may be goal directed ate in a or if it is the structured
difficult for behavior in the manner more establishmen activity
the patient to face of conflict. that can sudden, as t of neutral
communicate However, whether be in an realistic topics.
eloquently and disorganized speech understo exacerbatio goals, the - communicate
clearly as a is associated with od by n of foundation in a good
result of poorer performance others symptoms. for planning manner with
these on a broader range with the effective the help of
symptoms, of tasks that do help of care. the
making not require medicati - Identify - therapeutic medications.
meaningful cognitive control ons. the levels of an
communication (i.e., non- duration of antipsychoti
difficult. cognitive control Long Term: the c aids clear Evaluation:
tasks, such as After 2 days psychotic thinking and
processing speed on of nursing medication diminishes After 3 hours of
Reference: an automatic task) intervention of the derailment nursing
is unclear. , the client. or looseness intervention the
Bsn, P. M., patient will of patient was able
RN. (2023c, Reference: be able to: association. to:
March 1). 6 • Use a
- Keep the - keep anxiety - established
Schizophrenia Bsn, P. M., RN. form of
environment from trust with
Nursing Care (2023d, March 1). 6 communica
calm, escalating caregiver a
Plans. Schizophrenia tion to
quiet, and and means of
Nurseslabs. Nursing Care Plans. get needs
as free as increasing communicatin
https://nurses Nurseslabs. met and
stimuli as confusion g needs.
labs.com/schiz https://nurseslabs. to relate
possible. and - demonstrate
ophrenia- com/schizophrenia- effective
hallucinatio reality-
nursing-care- nursing-care-plans/ ly with
n based
plans/ persons
s/delusions. thought
on her
SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

environme - Use simple - client might processes in

nt. and clear have verbal
• Demonstra words and difficulty communicatio
te keep processing n.
congruent directions even simple - spend time
verbal simple as sentences. with one or
and non- well. two other
verbal - Use simple, - Minimizes people in
communica concrete, misunderstan structured
tion and literal d ing and/or activity
explanation incorporatin neutral
s. g those topics.
misunderstan - communicate
d ings into in a good
delusional manner with
symptoms. the help of
the
- Use - Even if the medications.
therapeutic words are
techniques hard to
to try to understand,
understand try getting
a client's to the
concerns. feelings
behind them.
Dependent
- Administeri
ng
medication

Collaborative
- The student
SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

nurses
assess the
client with
the help of
different
of
psychothera
pies.
- Conduct
health
teaching to
the client
and family

NURSING CARE PLAN FORM

 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

Name: J.A Diagnosis/CC: Schizophrenia

Age: 19 years old Sex: Male Physician: Dr. A

NCP # 2
SUBJECTIVE OBJECTIVE NURSING SCIENTIFIC ANALYSIS PLANNING INTERVENTIONS RATIONALE Expected Outcome
DIAGNOSIS
Student - manifesting Impaired Social isolation is After 3 hours After 4 hours After nursing 3 hours of
nurses asociality social the condition of nursing of nursing interventions, the patient
noticed interaction aloneness interventions, intervention was able to:
that the - shy person related to experienced by the the client will the patient
patient has self-concept individual and be able to: will be able - demonstrate the positive
a problem -not disturbance as perceived as to: changes in behavior and
in social participative evidenced by imposed by others Short term interpersonal relationship
situation. in games observed and as a negative - The patient Independent: - active with others
during the discomfort in or threatened will improve - Encourage listening
activity social state; impaired social the patient could help - demonstrate willingness
situations. social interaction interaction with to verbalize to identify to participate in the
- discomfort Definition: is an insufficient friends, family, perceptions the factors activities
in social Trouble in or excessive and neighbors of problems that
interaction creating peer quantity or and causes. triggers his - acquired new
relationships ineffective social - The patient asociality. relationships with others
and forming exchange. will maintain Long term:
friendships, interaction with - Observe and - helps
which is another client describe identify the
characterized while doing an social and kinds and After 1 week of nursing
by impairment activity. interpersonal extent of intervention the patient
of qualities behaviors problems will be able to:
including eye -The patient will client is
contact, use appropriate exhibiting -start socializing to
smiling, social skill student nurses
suitable interactions - Maximize - contact -start to open up about
 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

facial the client’s with others his feeling to others

expressions, -The patient will contacts with can help the
and body use appropriate others. client to
postures. Reference: skills to gain Self- Evaluation:
Impaired social initiate and confident After 3 hours of nursing
Reference: interactions maintain an intervention, the patient
Impaired (Concept Id: interaction Dependent: was able to:
social C0150080)  - MedGen - Provide the - to provide
interactions - NCBI. (n.d.). prescribe calmness to - demonstrate the positive
(Concept Id: https://www.ncbi.nl Long Term medication by patient and changes in behavior and
C0150080)  - m.nih.gov/medgen/57 the physician relieved the interpersonal relationship
MedGen - NCBI. 707 After 1 week of to the symptoms with others
(n.d.). nursing patient experienced
https://www.nc intervention the - demonstrate willingness
bi.nlm.nih.gov patient will be - Assess to participate in the
/medgen/57707 able to: together with -to prepare activities
the student patient to
- start nurses the be open to - acquired new
socializing to skills of others relationships with others
student nurses socializing
with others.
- start to open
up about his - attending Long term:
feeling to others Collaborative activities
- Involve the such as After 1 week of
client in a games can nursing intervention the
group promote the patient was able to:
activity client’s
social - start socializing to
interpersona student nurses
l
- start to open up about
SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

- Refer for - this his feeling to others

family therapy
therapy as helps the
indicated patient to
improve
interaction
with his
family

NURSING CARE PLAN FORM

 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

Name: J.A Diagnosis/CC: Schizophrenia

Age: 19 years old Sex: Male Physician: Dr. A

NCP # 3
SUBJECTIVE OBJECTIVE NURSING SCIENTIFIC ANALYSIS PLANNING INTERVENTIONS RATIONALE Expected Outcome
DIAGNOSIS
Dili Risk for An increased risk Short term: At the end of 3 days
ganahan mu Self-Directed of violence among Independent Independent quality nursing
express sa - Facial Violence patients with intervention, pt. will be
iyahang expressi related having schizophrenia has After 8 able to:
feelings, on of hallucination,been repeatedly hours of 1. Established 1. To promote
sige ug anger inadequate confirmed by nurse therapeutic development
lakaw lakaw - Verbaliz management of evaluation of patient nurse and of - Free from any self-
balik balik ation of anger ascriminal records interaction: patient trusting harm.
sa selda, anger evidenced byand recently in a relationship. relationship.
ganahan - Avoidanc aggressive large sample of 1. Patient - Expressed his feelings
iloom loom e of behavior. persons who will be able 2. Encouraged 2. Expressing freely about why he
ang gibati” student committed homicide. to diminish the client to feelings can wants to harm himself.
as nurses In all Western signs of express help the
verbalized Definition: countries, the doing feelings; convey client to
- Restless
by increased risk of self-harm. acceptance of identify, - Verbalized techniques on
ness
The A word that isviolent crimes the client’s accept, and developing copings
- Hopeless
significant frequently among patients with 2. Patient feelings. work through skills to help his handle
ness
other of used by mentalschizophrenia is will be able them, stressful situations.
the - Lonely health expertsdemonstrated by the to find ways even if they
patient. to describe a fact that they to manage are painful
variety of account for about his anger or
violent half of all uncomfortable
behaviors is patients in 3. Patient .
self-directed forensic detention will be able
violence, or because of to express 3. To help
 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

SDV. This insanity. his emotions 3. Educate the handle

term includes regarding patient about stressful
non-suicide self-harm to the techniques situations.
purposeful Reference: the student on developing Evaluation
harm and both nurses. coping skills: After 3 days of
fatal and 4. To manage nursing intervention the
deadly https:/ 4. Practicing depression/an patient was able to:
suicidal schizoprenicmedical Long term: meditation and xiety
conduct. Self- re After 1 week relaxation - Free from any self-
directed of nurse techniques harm.
intentional patient 5. To divert
behavior that interaction 5.Engaging in the attention - Expressed his feelings
puts oneself the patient physical freely about why he wants
in danger or will: activity or to harm himself.
has the exercise
capacity to do - Be free - Verbalized techniques on
so. There is from Dependent developing copings skills
proof of any self- 1. In order to help his handle
suicidal harm. Dependent for the stressful situations
intent, 1. Provide the patient to be
whether it is - Express prescribed relief, to
tacit or his feelings medication by promote
explicit. freely about the physician to calmness and
why he wants the patient diminish what
to harm he is
himself. anxiously
feeling.
Reference:
- Verbalize
violence/ techniques
article/ on 2. Prepare
2219798098over developing when patient
 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

view coping becomes

skills 2. Assist severely
to help his together with aggressive
handle the other nurses
stressful when patient is
situations to be ordered
for restrain by
the physician.

NURSING CARE PLAN FORM

 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

Name: J.A Diagnosis/CC: Schizophrenia

Age: 19 years old Sex: Male Physician: Dr. A

NCP # 4
SUBJECTIV OBJECTIVE NURSING DIAGNOSIS SCIENTIFIC PLANNING INTERVENTIONS RATIONALE EXPECTED OUTCOME
E ANALYSIS
“Ang Upon the Disturbed sensory Sensory Short-term goals After 4 hours After 4 hours of
manok ni interaction, the perception related perceptual of nursing nursing
langgoy student nurses to sensory alteration is - The patient intervention intervention the
sa sapa” observed: perceptual defined when will be able to the patient patient will be
as stated alteration as there is a identify and will be able able to:
by the evidenced by change in the describe any to:
patient. inappropriate pattern of changes in - Patient
- Frequently sensory Independent demonstrated an
responses and sensory stimuli
touching his perception, such 1. To obtain an understanding of
delusions. followed by an
head, face, as delusions, 1. Assess the nature of the
abnormal overview of
and swinging within 24 hours ability to sensory perceptual
response to client’s mental
his both of nursing speak, hear, alteration and the
such stimuli. and cognitive
arms. intervention. interpret, and reasons behind the
Such status and
- Irritability respond to inappropriate
Definition: perceptions ability to
- Impaired - The patient simple commands responses and
could be interpret
communicatio Change will demonstrate delusions.
in the increased, stimuli.
n. a decrease in
amount of decreased, or
the frequency
- Disorientati patterning of distorted with
and severity of 2. It may
on. incoming stimuli the patient's 2. Observe - Patient
inappropriate indicate mental
- Restlessness accompanied by a hearing, behavioral maintained
responses, such or emotional
- Sexual diminished, vision, touch responses. appropriate
as agitated problems or
delusions exaggerated, sensation, responses to
behavior, within chemical toxicity
distorted, or smell, or sensory stimuli.
- Poor 72 hours of or be associated
impaired response kinesthetic
concentratio nursing with brain or
to such stimuli. responses to
n
 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

stimuli. intervention. neurological - Patient

trauma identified and
Altered sensory - The patient 3. Reorient to reported any
processi-ng and will identify at person, place, 3. To reduce Changes in sensory
perceptual least two coping time, and confusion and perception or
inference are mechanisms to events as provide a sense experiences of
References:
responsible for manage altered necessary. of normalcy to delusions to
Doenges, the positive sensory the client's healthcare
Moorehouse, Murr, symptoms of perception daily life. providers.
A,C.(2020). Nurses schizophrenia. within 48 hours
4. Delusion al
Pocket Guide (15th neurotransmitt of nursing
patients are
ed).F.A Davis er signaling in intervention. 4.Present
the sensory extremely - Patient was able
Company pp. 790 reality
pathway and - The patient sensitive about to differentiate
concisely and
abnormal will participate others and can between reality
briefly and do
cortical in activities recognize and delusions.
not challenge
plasticity that promote insincerity.
illogical
mechanisms are sensory Evasive comments
thinking. Avoid
implicated in stimulation, or hesitation
vague or - Patient
the pathology such as reinforces
evasive demonstrated
of listening to mistrust or
remarks. improved ability
schizophrenia. music or viewing delusions
to cope with the
One of the art, at least
altered sensory
once daily for
5.Clear,consisten perception and
core features the next 7 days.
of both t limits provide managed associated
schizophrenia a secure anxiety.
5. Be
and ASD are structure for the
consistent in
patient.
Doenges, M. E., dysfunctional setting
Moorhouse, M. F., face emotion expectations,
& Murr, A. C. recognition and enforcing
Long-term goals: Evaluation
(2019). Nurse’s motion rules, and so
Pocket Guide: processing. forth.
 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

Diagnoses, - The patient 6. Decrease the After 24 hours of

Prioritized will demonstrate potential for nursing
Interventions and an ability to anxiety that interventions,
Rationales. self-manage 6.Decrease might trigger the patient was able
environmental patient. to regain or
altered sensory stimuli when maintain usual
References:
perception by possible (low level of cognition
Weilnhammer V, identifying and noise, minimal 7.Client may and recognize,
Röd L, Eckert utilizing activity). misinterpret and correct or
AL, Stuke H, effective coping believe compensate for
Heinz A, mechanisms with 7.Minimize references are to sensory
Sterzer P. minimal nursing discuss ion of himself. perceptions
intervention. negatives
Psychotic
within client’
Experiences in
- The patient s hearing 8.Client may or
Schizophrenia
will demonstrate may not be aware
and Sensitivity
an improvement of changes.
to Sensory
in overall 8.Ascertain
Evidence.Schizo
mental health client’s
phr Bull.
status, as significant
202008;46(4):92
evidenced by a other’s percept
7-936
reduction in ion of
inappropriate problem/change
responses, s in activities
within the next of daily living
6 months. 9. To divert the
thought of the
9.Use patient through
relaxation effective
techniques such therapeutic
- The patient as deep activities.
will participate breathing
in ongoing exercises and
 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

therapy, such as psychotherapies

cognitive-behav such as music
ioral therapy or therapy and art
talk therapy, to therapy
address
underlying 1.To promote
causes of calmness and
Dependent
altered sensory diminished
perception and 1. Provide the symptoms
improve overall prescribed experienced.
mental health medication
outcomes.

- The patient 1.To achieve

will participate Collaborative maximal gains in
in community- function and
1. Collaborate psychosocial
based activities
with other well-being.
that promote
health team
socialization
members in
and sensory
providing
stimulation,
rehabilitative
such as
therapies and
attending
stimulating
concerts or
modalities
visiting
museums, on a
regular basis to
enhance overall
well-being.

NURSING CARE PLAN FORM

Name: J.A Diagnosis/CC: Schizophrenia

 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

Age: 19 years old Sex: Male Physician: Dr. A

NCP # 5
SUBJECTIV OBJECTIVE NURSING DIAGNOSIS SCIENTIFIC PLANNING INTERVENTIONS RATIONALE EXPECTED OUTCOME
E ANALYSIS
“dili na - Patient is Ineffective coping Schizophrenia Short-term -Set a - to note prevalent After nursing
sya not related to patients showed goals: working interaction pattern. interventions,
ganahan expressive negative signs of compromised relationship the patient is
mo storya to his Schizophrenia as coping with the able to:
maam ug thoughts. evidenced by lack abilities patient
After 1 week of - Identify
iyaha - Alogia of self-efficacy. relative to through
nursing feelings that
rang ig- - Asocial nonclinical continuity of
interventions led to poor
agaw ang controls, care.
- Blunted the client will social
iyang particularly a
affect be able to: -Assist interactions.
amigo. lack of - Individuals with
- Flat affect patient set
Ulawon Definition: engaging in - Effectivel these conditions may
realistic - Express desire
pod kayo Repeated adaptive y cope and find communication
goals and for and was able
sya maam projection of coping. express barriers are
identify to be involved
dili falsely positive feelings. increased, social
Psychotic personal in and achieving
ganahan self-evaluation - Maintain interaction is
episodes have skills and positive changes
makig involvemen knowledge affected, and
long been in social
halobilo, t in interventions need
conceptualized behaviors and
motingog family to be designed to
as inevitable interpersonal
usahay ug relationsh promote involvement
incidents relationship.
dili ako ips. with others in
ang mo triggered by
- Participat positive ways.
storya” endogenous
biological e in
as stated
impairments. treatment -Provide - helps identify the
by the
programs/ chances to kinds and extent of Evaluation
significa
It is now well- therapy. express
nt problems client is
accepted that concerns, After nursing
other.. interventions,
the ability of fears,
 SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

Reference: an individual feeling, and exhibiting. patient is able

Doenges, to deal with expectations. to Identify
Moorehouse, Murr, social and Long-term goals: feelings that
A, C. (2020). environmental led to poor
Nurses Pocket challenges -Convey social
Guide (15th ed). plays an feelings of interactions and
After a 6 month -Symptoms associated
F.A Davis Company important role acceptance expressed
of nursing with social anxiety
pp. 790 in regard to and Desires to be
interventions affect ability to be
whether or not understanding involved in
the patient will involved in social
a vulnerability . Avoid false positive changes
be able to: situations, making
to psychosis reassurances. in social
client’s life
translates into - Identify miserable and behaviors and
symptoms. areas of seriously interpersonal
concern/ interfering with relationship.
problems. work, friendships,
- Demonstrat and family.
e ability
-Provide
Reference: to manage
information - Problems with
https://pubmed. ineffectiv
the patient communication lead
ncbi.nlm.nih. e coping
wants and to frustration and
gov/27210727/ by
needs. Do not anger, leaving the
identifyin
give more individual with few
g and
than the coping skills, and
utilizing
Patient can may result in
effective
handle. destructive
coping
mechanisms behaviors.
- Point out
signs of
positive
progress or - Music has been
change. used to calm, to
enable feelings of
SAINT PAUL UNIVERSITY DUMAGUETE
COLLEGE OF NURSING

safety, and to
reduce the social
-Encourage distance between
use of people.
cognitive
behavioral
relaxation. - for reinforcement
of positive
behaviors after
professional
-Be
relationship has
supportive of
ended.
coping
behaviors;
give client
time to relax