Schizophrenia Case Study
when clients have cognitive disorders and difficulty processing language the beginning of trust is more readily established through nonverbal communication
delusions are fixed, false beliefs that the nurse should avoid trying to logically disprove to the client
it is the manifestation of disorganized thoughts.
The nurse understands that schizophrenia can be differentiated from psychosis by which assessment?
(minimal eye contact, poor grooming and hygiene, and apathy)
flat affect and social inattentiveness, or “spaciness,” are examples of negative symptoms characteristic of schizophrenia.
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disturbed thought processes is a priority problem because Bob is delusional
What is the reason that Prolixin is prescribed for this client?
antipsychotic medications are useful to manage symptoms related to cognitive impairment such as delusions and/or hallucinations, as well as behaviors related to agitation and aggression.
prolixin is a long-acting medication that is administered as an injection every 7-28 days to promote compliance with the medication regimen.
Which client behavior validates the need for involuntary hospitalization?
risk for violence toward self or others is a criterion for involuntary hospitalization
If a client who has voluntarily chosen to be hospitalized should want to leave the hospital, which assessment would be most important in deciding to release the client against medical advice (AMA)?
response to medication is important to consider as it related to the client’s mental status, but it is not most important consideration for releasing the client AMA
The nurse reviews the routine admission lab and medication prescriptions, and notes that the client will resume the fluphenazine decanoate (Prolixin). The benztropine (Cogentin) has not been prescribed.
Which nursing action is best?
the nurse should request a prescription for congentin, which will help prevent the extrapyramidal side effects of the prolixin, with the exception of tardive dyskinesia. there is a risk of decreased efficiency of prolixin when the client is also taking congentin.
traditional antipsychotics generally have high extrapyramidal effects and low anticholinergic effects
What type of reaction should the nurse suspect?
(acute, tonic muscle spasms, often of the tongue, jaw, eyes, and neck, but sometimes of the whole body)
How should the nurse respond?
responding to the underlying feelings rather than the illogical content of the delusion will encourage discussion of fears, anxiety, and anger about hospitalization, without assuming that the delusion is right or wrong
the client’s thoughts are delusional because he has false beliefs about being a movie star and that a limousine will pick him up
when a client is delusional, interacting w/o expressing delusional thoughts is an important short-term outcome. as the client gains insight into the symptoms, the client can differentiate experiences with delusions from those that are reality.
What is the best response by the nurse?
when the client tilts his head to one side, it is a nonverbal cue that he is hearing voices. the nurse should assess for the presence of auditory hallucinations.
Which group will be most therapeutic for Bob?
a structured medication group will be most therapeutic because clients w schizophrenia have concrete thinking processes and will respond best to structured activities. Groups that support medication education are important to promote medication compliance.
Based on Bob’s statement, which nursing problem should the nurse document for the group progress note?
risk for adherence is evident because if the client perceives that the medication has too many side effects, he may choose to stop taking it.
Which understanding is most accurate?
schizophrenia is a brain disorder with many predisposing factors. These factors include biological factors related to genetics, neurobiology, neurotransmitters, and neurodevelopment of structural, functional, and chemical brain changes that occur in early years of life and before birth.
(These triggers can be related to nutrition, lack of sleep, fatigue, housing difficulties, changes in life events, and feeling overpowered)
a client can learn to cope w symptom triggers and prevent relapse and hospitalization
social isolation is manifested by behaviors such as the client sitting alone continuously w/o interacting w others
weight gain occurs w the atypical antipsychotics, especially zyprexa (olanzapine) and clozapine (clozaril)
-dry mouth: anticholinergic side effects such as dry mouth, blurred vision, urinary hesitancy and constipation are commonly experienced w atypical antipsychotics
when a client has failed to respond to antipsychotic medications or long-acting antipsychotics, clozapine (clozaril) may be initiated. clozaril is used for clients w schizophrenia who have not responded to other antipsychotics. the potentially serious side effect of agranulocytosis requires that WBC counts be done weekly or every 2 weeks.
Which speech process should the nurse document on the daily mental status exam record?
a client who demonstrates poverty of speech gives simple one- or two-word answers to questions, even when the nurse asks an open-ended question.
Which thought process does this exemplify?
thought blocking is the sudden stopping in the client’s train of thought or in the middle of a sentence
Which intervention by the nurse will best assess if this goal has been met?
the nurse should be able to talk to the client w/o observing the presence of delusional thoughts
Which statement will assist the nurse to assess if this goal has been met?
the nurse should directly ask the client about thoughts of harm
symptom management exploration is an important activity for clients w schizophrenia so that relapse can be prevented. Clients often continue to experience symptoms such as hallucinations while living in the community
identifying problem symptoms is the first step of effective symptom management
after the client has identified problem symptoms, the client should then identify current symptom management techniques and specific support systems and discuss other ways to manage symptoms
Which strategy is best for clients who hear voices?
avoiding situations that increase symptoms can be helpful to minimize symptoms. other general strategies include distraction, help seeking, or attempts to feel better such as taking a shower or performing relaxation exercise
What is the most common cause of relapse in the client with schizophrenia?
the most common cause of relapse relate in some way to medications. relapse is likely to occur whether the client is taking medications or not, especially if the client has poor health practices
What is the nurse’s best response?
the nurse should explain that relapse can occur even if the client has been taking meds as prescribed
greatest benefit of the case worker is to coordinate services related to housing, finances, and medical appointments, for example.