Schizophrenia

Nursing management
 Aim of mangement

• To prevent injury to self and others

• To promote social interaction
• To promote self esteem
• To rehabilitate the patient
 Environment

• Safety for both the client and the nurse is the

priority.
• Remove all dangerous objects from the
environment such as sharps, belts which the
patient may use to hurt self or others.
 Environment Con’d
• If the there are any broken windows, these
must be fixed to avoid patients from using
them as weapons to hate others or self
• Nurse him or her in a less stimulating
environment, an environment with no noise,
less volume if using television or radio.
 Aggression
• Observe for Signs of increasing agitation.
• They include increased restlessness, Motor
activity (e.g., pacing), voice volume, verbal
cues (I’m afraid of losing control.), threats,
decreased frustration tolerance, and frowning
or clenching fists.
 Aggression
• Be aware of PRN medication and procedures
for obtaining seclusion or restraint orders.

• The client may fear loss of control and may be

afraid of what he or she may do if he or she
begins to express anger.
 Aggression

• Showing that you are in control without

competing with the client can reassure the
client without lowering his or her self-esteem.
• Involve the client in physical activities such as
cleaning the surrounding washing clothes and
plates to divert the energy to a meaningful
activity to raise self activity.
 Aggression
• Praise the client if he/ she shows signs of
being able to control himself.
• In an aggressive situation you will need to
make decisions and act quickly whether to
restrain or seclude
 Therapeutic Relationship

• Establish and maintain therapeutic

relationship with the client based on trust,
empathy, positive regard, acceptance and
genuineness and non judge mental.
• Be with the client even if he is not talking,
• Initially the client may tolerate only 5 or 10
minutes of contact at one time.
 Therapeutic Relationship
• Provide explanations that are clear, direct,
and easy to understand.
• Always approach client in a calm manner.
• Call the client by name not by diagnosis to
promote trust as well as reality orientation.
 Observations
• Observe the patients behavior closely to
detect abnormal behaviors and intervene
promptly
• Observe for side effects of drugs such as extra
pyramidal side effects because some such as
Tarditive dyskinersia can be irreverssible
 Observations
• Observe the patients eating pattern to ensure
that he is eating.
• Observe the client closely during medication
time to ensure that he/ she is swallowing.
• Observe signs of aggression such as bunging
doors and tone of voice to enable you
intervene before the anger escalates
 Observations
• The nurse must observe for signs of building
agitation
• Or escalating behavior such as increased
intensity of pacing, loud talking or yelling, and
hitting or kicking objects.
 Delusions
• A void openly confronting the delusion or
arguing with the client to avoid aggression.
• The nurse also must avoid reinforcing the
delusional belief by “agreeing” with what the
client says.
• It is the nurse’s responsibility to present
reality by making simple statements
 Delusions
• Present reality to the patient, such as I do not see evidence
of that.
• Or cast doubt “It doesn’t seem that way to me.” (casting
doubt)
• Diversional techniques, such as listening to music, watching
television, writing, or talking to friends, are useful.
 Hallucinations

• Initially, determine what the client is

experiencing—that is, what the voices are
saying or what the client is seeing.
• To increases the nurse’s understanding of the
nature of the client’s feelings and behavior.
 Hallucinations
• Focus on what is real and to help shift the
client’s response toward reality.
 Hallucinations
• In command hallucinations, the client hears
voices directing him or her to do something,
often to hurt self or someone else.
• For this reason, the nurse must elicit a
description of the content of the hallucination
so that health-care personnel can take
precautions to protect the client and others as
necessary.
 Hallucinations
• The nurse might say,“I don’t hear any voices;
what are you hearing?”
(presenting reality/seeking clarification)
• This also can help the nurse understand
how to relieve the client’s fears or paranoia

• Acknowledge the clients feelings.

 Hallucinations
• For example, the client might be seeing ghosts
or monster like images, and the nurse could
respond,
• “I don’t see anything, but you must be
frightened.
• You are safe here in the hospital.” (presenting
• reality/translating into feelings)
 Hallucinations
• This acknowledges the client’s fear but
reassures the client that no harm will come to
him or her.
• Clients do not always report or identify
hallucinations.
• At times, the nurse observe from the client’s
behavior that hallucinations are occurring.
 Hallucinations
• A helpful strategy for intervening with
hallucinations is to engage the client in a
reality-based activity such as playing cards,
• It is difficult for the client to pay attention to
hallucinations and reality-based activity at the
same time,.
 Hallucinations
• It also may be useful to work with the client to
identify certain situations or a particular frame
of mind that may precede or trigger auditory
hallucinations

• Therefore, monitoring and intervening to

lower a client’s anxiety may decrease the
intensity of hallucinations.
 Hallucinations

• Talking with other clients who have similar

experiences with auditory hallucinations
through group therapy can help
 Hygiene

• Dress and Glooming

• Because of apathy or lack of energy over the
course of the illness, mostly patients look
unkempt with poor personal hygiene.
 Hygiene
• Direct the client through the necessary steps
for bathing, shampooing, dressing, and so
forth
• Enable the client to establish structure that
incorporates his or her preferences or decide
about hygiene tasks rather than performing
them randomly.
 Hygiene

• For example, the client may prefer to shower

and shampoo on Monday, Wednesday, and
Friday upon getting up in the morning.
 Hygiene
• The nurse can assist the client to incorporate
this plan into the client’s daily routine, which
leads to it becoming a habit.
• Give directions in short, clear statements to
enhance the client’s ability to complete the
tasks. Eg. Washing the face, body, limbs etc.
 Hygiene
• Attend to the skin of the patient because the
patients are prone to develop skin problems
such as scabies, eczema.
• Encourage the patient to change clothes
because they are prone to lice infestation.
 Nutrition
• Food and drink
• Adequate food and fluids are essential to the
client’s physical and emotional well-being.
• Involve client in less consuming activities
• Give energy foods to replace lost energy when
the patient is pacing around
 Nutrition
• Sit with client during meals and encourage
him or her to eat
• If the client is refusing food, ask why.
 Nutrition
• Be positive in offering food
• Provides assistance with eating as long as
needed and then gradually promote the client’s
independence as soon as the client is capable.
• For suspicious patients allow the client to eat
with others.
• Provide canned foods and an opener if able.
• Relatives can test the foods in the presence of
the patient when they have brought.
 Nutrition
• Let the foods be served from the same source
to all the patients and if possible with staff.
• Weigh the patient weekly
• Observe the eating pattern
• Some patients have bad eating habits such as
grabbing foods from other patients, eating
before washing hands;
 Nutrition
• Teach and encourage the client good eating
habits
• Such as eating only foods served to them,
• Washing hands, and
• Sitting while eating.
 Nutrition
• If client is pacing around give finger foods that
will eat while pacing.
• Observe the patient closely if he/ she is eating
• Record the food and fluid intake
• Praise the patient for any effort to eat to
reinforce a good habit
 Elimination
• Because of impaired thought process, and
impaired judgment and lack of social skills, the
client may defecate and urinate any where,
• Keep orienting the client to the toilet.
• Provide clear signs of where the toilet is
situated.
• Show the patient how to use if he/she is
having difficulties to use the toilet.
 Elimination
• Ensure that the patient takes a lot of fluids
and high fiber foods to prevent constipation.
(side effects of antipsychotics)
 Sleep and rest

• Sleep
• Sleep disturbance is a major problem for
patients with schizophrenia.
• Due to delusions, hallucinations and
restlessness.
• Create and maintain a less stimulating
environment at night to promote sleep.
 Sleep and rest
(Avoid very bright light and noisy
environment).
• Allow the client to take a warm shower before
going to bed to relax muscles.
• Avoid stimulating drinks such as caffeine
drinks before going to bed.
 Sleep and rest

• Administer prescribed PRN drugs such as

diazepam to calm the patient and prevent
exhaustion

• Rest
• Allow the patient to rest at least for two hours
after lunch to prevent exhaustion.
 Work and play
• Work
Assess the patients abilities and engage them in
activities they prefer to do at home such as;
• washing his /her own clothes, plates
sweeping their room and making their bed to;
 Work and play Con’d
 Help patient gain the lost social skills
 Boast patients self esteem
 Divert the patient from hallucinations and
delusions.
 And this is part of rehabilitation.
 Work also helps to divert energy from
episodes of aggression to physical activity.
 Work and play
Play
Involve the patient in recreation activities that the
patient would like to such playing draft with
fellow patients, music, taking a walk, reading
magazines.
But avoid competitive games, where there is a
loser and a winner, such can cause the loser to
lose self esteem.
 Work and play
• Work also helps to divert the patient from
delusions and hallucinations.
 Individual therapy
• Explore the patients feelings, attitudes,
thinking, and behavior and this involves one-
to-one relationship.
• Reassure the client that you are doing every
thing possible help him or her to allay anxiety
 Individual therapy

• Also explain all the procedures done to the

patient in simple and clear explanation to gain
cooperation
• Allow the patient to ask questions to alley
anxiety Allow the client to verbalize all his
concerns to allay anxiety.
 Family therapy
• Is a form of group therapy in which the client
and the client and his or her family members
participate. Involve the family in the care of
the client.
• The goal is to understand how family
dynamics contribute to the client’s
psychopathology.
 Family therapy
• Mobilizing the family’s strengths.
• To identify family behavioral styles, and
strengthen family problem-solving behaviors.
• Done by allowing the family members to
verbalize their concerns about the patient’s
condition.
 Health Education
1. Drug adherence
• Patient should not stop taking drugs even
when they no longer experience the
symptoms of the condition.
2. Side effects of drugs
• Explain the side effects of drugs such as
drowsiness and drooling of saliva.
 Health Education
• Explain some extrapyramidal side effects such
as tarditive dyskinesia which may come after
long term use of antipsychotic (fluphenazine
decoanate) and are irreversible.
• Advise the patient to report such immediately
to the hospital.
 Health Education
4. Review date
• That the patient should come for review, and
to come back to the hospital if the patient
relapses.
5. Signs of relapse
Recognizing early signs of relapse such as social
isolation and agitation.
 Health Education

6. Avoiding alcohol with antipsychotics.

• May counteract the benefits of the antipsychotics
making symptoms more difficult to treat.
• Alcohol increases anxiety.
 Health Education

7. Food and drinks

• Patient to be encouraged to take a lot of water
• The patient to take balanced diet
8. Stigmatisation
Can lead the patient to stopping medication and
relapse.
 Health Education
9. Support groups
• Encouraging the patient to join the sopport
groups found in the community.
 Rehabilitation
Refer to the notes on rehabilitation
.
 Evaluation

Identify 5 problems of a patient with

schizophrenia and use a nursing care plan to
manage.