Nursing Care Plan

Nursing Diagnosis for Schizophrenia : Risk for Self or Other- Directed Violence

Goal: The patient can control violent behavior,
with the following criteria:

• Bright face, smiling.
• Want to get acquainted and there is eye contact.
• Willing to tell the feeling.
• Telling cause irritation / anger.
• Can identify signs of violent behavior.
• Can identify, form of violence that is done.
• Can be identified as a result of violent behavior.
• Able to practice taught how to control anger.
• Able to engage in group activity therapy.
• Can taking medication with minimal assistance.
• Clients can continue the relationship in accordance with the responsibilities of the role.

Interventions

Client Intervention

1. Perform a trusting relationship.
2. Identify the causes of violent behavior.
3. Identify the signs and symptoms of violent behavior.
4. Identification form of violence that is ever done.
5. Identification due to violent behavior.
6. Teach how to control violent behavior, among others:
   • Physically (relaxation, activities and sports)
   • Verbally (sharing / telling others)
   • Spiritually (pray).
7. Help the patient to practice healthy ways to express the way to control the violent behavior that has been taught.
8. Suggest to choose how to control violent behavior accordingly.
9. Suggest to include ways to control violent behavior that have been to the daily activity schedule.
10. Help the patient to plan the schedule of daily activities.
11. Explain to patients on oral medication (type, dose, time drinking, benefits and side effects of drugs)
    Give appropriate medication treatment program.
12. Monitor the effectiveness of the treatment and its side effects (vital signs and physical examination of the other).
13. Involve patients in group therapy, cognitive therapy, and in the day-to-day activities in the room.
14. Keep the patient environment at low stimulus levels (low irradiation, little people, the decor is simple and low noise level).
15. Strict observation of behavior and signs of angry patient every 15 minutes.
16. Remove objects that can harm the environment around the patient.
17. If necessary, do fixation or restrain and observation every 15 minutes.

Family Interventions

1. Discuss family perceived problems in patient care violent behavior.
2. Provide health education on understanding the signs and symptoms of violent behavior occurrence of violent behavior.
3. Explain how to care for patients with violent behavior.
4. Teach and practice how to involve the family in caring for patients with violent behavior directly in hospital (constructive manner, Follow-up)

Treatment of Schizophrenia

Treatment should be as fast as possible, because the psychotic state in a long time lead to a greater likelihood of patients leading to mental deterioration. Even though the patient may not recover completely, but with treatment and good guidance, the patient can be helped to be able to function continuously, simple work at home or outside, and can raise and educate their children (Maramis, 2009). The type of treatment in patients with schizophrenia (Maramis, 2009), are as follows:

1. Pharmacotherapy

An indication of antipsychotics in schizophrenia is to control the active symptoms and prevent relapse.

Treatment strategy depends on the phase of the disease is acute or chronic. The acute phase is usually characterized by psychotic symptoms (experienced new or recurrent) that need to be addressed immediately. The aim here is to reduce the treatment of severe psychotic symptoms. With phenothiazines, delusions and hallucinations usually disappear within 2-3 weeks. Even still there are delusions and hallucinations, patients are less affected again and become more cooperative, willing to participate in environmental activities and would also work therapy.

After 4-8 weeks, the patient entered the stage of stabilization when the symptoms had resolved to some extent, but the risk of relapse is still high, especially when treatment is interrupted or patients experiencing stress. After the symptoms subside, then the dose was maintained for several more months, if the attack is new the first time. If an attack of schizophrenia was already more than once, then after symptoms subside, the drug was given continuously for one or two years.

After 6 months, patients maintenance phase that aims to prevent recurrence. Patients with chronic schizophrenia, neuroleptic given within a period of unspecified length of time with doses up and down according to the patient's condition. Always have to be wary of the side effects of drugs.

Maintenance strategy is to find the lowest effective dose that can provide protection against recurrence and does not interfere with the patient's psychosocial functioning. Results of treatment would be better if antipsychotic start given in the first two years of the disease. There is no standard dose for this drug, but the dose set individually.

More drug selection based on the profile of side effects and the patient's response to previous treatment. There are some special conditions that need to be considered, such as pregnant women preferred haloperidol, because these drugs have data with the best security. In patients who are sensitive to extrapyramidal side effects better given the atypical antipsychotic, as well as in patients presenting with symptoms of cognitive or prominent negative symptoms.

For the first time patient experienced episodes of schizophrenia, drug treatment should be sought in order not to give any side effects, because a bad experience with the treatment will reduce ketaatanberobatan (compliance) or ketidaksetiaberobatan (adherence). It is recommended to use atypical antipsychotics or typical antipsychotics, but with a low dose.


2. Electroconvulsive Therapy

Electroconvulsive therapy, good results on the kind of catatonic, especially stupor, against schizophrenia simplex effect is disappointing, if only mild symptoms then given electroconvulsive therapy, sometimes the symptoms become more severe.


3. Psychotherapy and rehabilitation

Psychotherapy in the form of psychoanalysis did not bring the expected results, some have argued should not be performed in patients with schizophrenia because it can add insulation and autism. Supportive Psychotherapy individual or group can help patients as well as practical guidance for the purpose of restoring the patient to the community. Cognitive behavioral therapy techniques to try to psien schizophrenia with promising results.

Therapy is an excellent work to encourage people to hang out again with another person, other patients, nurses and doctors. It means that patients do not isolate themselves anymore, because if the patient withdrew and formed bad habits.


From : various source

Nursing Care Plan for Schizophrenia, Nursing Diagnosis : Disturbed Sensory Perception

Schizophrenia is a disease that affects the brain and cause thoughts, perceptions, emotions, movement, strange and disturbed behavior (Videbeck, 2008).

Nursing Diagnosis : Disturbed Sensory Perception hearing / vision related to:

• freaking out
• withdraw
• strss heavy, threatening the weak ego.

Defining characteristics:

• talking and laughing themselves
• behave like listening to something (tilt the head to one side as if someone was listening to something).
• stop talking in the midst of a sentence to listen to something.
• disorientation
• low concentrations
• rapidly changing minds
• chaos groove mind
• response is not appropriate.

Expected outcomes:

• Patients can be admitted that the hallucinations occur during extreme anxiety increased.
• Patients can say signs of increased anxiety and use certain techniques to break the anxiety.

Planning:

General purpose :
Patients are able to define and examine the reality, reducing the occurrence of hallucinations.

Specific purpose :
Patients can discuss the content of the hallucinations to nurse within 1 week.

Intervention and Rationale :

1. Observe the patient of the signs of hallucinations (attitude like listening to something, talk or laugh alone, silent in the midst of the conversation).
Rationale :
Early intervention will prevent aggressive response that ruled from hallucinations.

2. Avoid touching the patient before beckoned.
Rationale :
Patients can only interpret the touch as a threat and respond in an aggressive way.

3. Acceptance will encourage the patient to tell the contents of hallucinations with nurses.
Rationale :
It is important to prevent the possibility of injury to the patient or another person because of the command of hallucinations.

4. Do not support hallucinations. Use the words "voice" instead of the words "they", which indirectly will validate it. Let the patient know that nurses are not being distributed perception. Say "although I realize that these sounds real to you, I did not listen to the voices that speak anything."
Rationale :
Nurses need to be honest with the patient so that the patient realizes that the hallucinations are not real.

5. Try to connect the timing of the hallucinations, with a time of increased anxiety. Help the patient to understand this relationship.
Rationale :
If the patient can learn to stop the increase in anxiety, hallucinations can be prevented.

6. Try to divert patients from hallucinations.
Rationale :
Patient involvement in activities interpersonal and explain about the situation of these activities, it will help the patient to return to reality.