Nursing Care Plan (NCP) for Schizophrenia
You're watching a preview. 300,000+ students are watching the full lesson.
Included In This Lesson
Study Tools For Nursing Care Plan (NCP) for Schizophrenia
NURSING.com students have a 99.25% NCLEX pass rate.
Outline
Lesson Objective for Nursing Care Plan (NCP) for Schizophrenia
What is Schizophrenia?
Schizophrenia is a mental health condition that affects how a person thinks, feels, and behaves. It’s like the brain is getting mixed signals or confusing information.
Symptoms:
People with schizophrenia might hear voices that aren’t there (auditory hallucinations) or believe things that aren’t true (delusions). They might have trouble organizing their thoughts or seem like they’re not showing any emotion. Sometimes, they might have trouble focusing or remembering things.
Upon completion of this care plan, nursing students will be able to:
- Understand the pathophysiology of Schizophrenia, including neurotransmitter imbalances and structural brain abnormalities.
- Conduct a comprehensive nursing assessment, incorporating signs and symptoms of Schizophrenia, risk factors, and potential co-occurring conditions.
- Formulate and prioritize nursing diagnoses, addressing both the cognitive and psychosocial aspects of Schizophrenia.
- Develop evidence-based nursing interventions, focusing on symptom management, promoting medication adherence, and facilitating therapeutic communication.
- Educate patients and caregivers on coping strategies, stigma reduction, and community resources to enhance the patient’s overall well-being and functioning.
Pathophysiology of Schizophrenia:
Schizophrenia is a complicated mental health disorder that affects how people think, perceive things, feel, and behave. While we don’t fully understand its exact causes, several factors contribute to its development:
- Neurotransmitter Imbalance:
- The dopamine hypothesis suggests that overactivity of dopamine transmission, particularly in the mesolimbic pathway, is associated with positive symptoms of Schizophrenia (hallucinations, delusions, disorganized thinking).
- Neurodevelopmental Factors:
- Genetic Predisposition: Schizophrenia has a strong genetic connection, meaning people with a family history of the disorder are at a higher risk. Multiple genes are believed to contribute, each with a small effect.
- Immunological Factors:
- Immune System Dysfunction: Some individuals with Schizophrenia show abnormalities in their immune system, including inflammation. This suggests a potential role of immunological factors in the disorder.
- Neurochemical Abnormalities:
- Glutamate Dysfunction: Imbalances in glutamate, a key neurotransmitter, may contribute to cognitive issues in Schizophrenia. NMDA receptor hypofunction is one aspect that has been implicated.
- Neurocognitive Impairment:
- Executive Function Deficits: People with Schizophrenia often struggle with executive functions, impacting their decision-making, attention, and working memory.
- Neuroinflammation:
- Microglial Activation: Evidence suggests that the activation of microglia and neuroinflammation may play a role in Schizophrenia, influencing how the brain develops and prunes synaptic connections.
Etiology for Nursing Care Plan (NCP) for Schizophrenia
Diagnostic Criteria:
- Genetic Factors:
- Family History: Individuals with a first-degree relative (parent or sibling) diagnosed with Schizophrenia have an increased risk.
- Polygenic Inheritance: Multiple genes are believed to contribute, each with a small effect.
- Neurodevelopmental Factors:
- Prenatal and Perinatal Influences: Adverse events during pregnancy or birth, such as malnutrition, infections, or complications, may increase the risk.
- Brain Structure and Function:
- Enlarged Ventricles: Structural abnormalities, including enlarged ventricles, suggest neuroanatomical differences in individuals with Schizophrenia.
- Dysregulation of Neurotransmitters: Imbalances in neurotransmitters, particularly dopamine and glutamate, contribute to altered brain function.
- Psychosocial Factors:
- Stressful Life Events: Exposure to chronic stress, trauma, or significant life events may trigger the onset of Schizophrenia in susceptible individuals.
- Urban Environment: Growing up in urban environments has been linked to an increased risk, possibly due to higher stress levels.
- Drug Use:
- Substance Abuse: The use of psychoactive substances, especially during adolescence, can increase the risk of developing Schizophrenia or trigger its onset in vulnerable individuals.
- Immunological Factors:
- Immune System Dysfunction: Abnormalities in the immune system, including autoimmune responses, have been implicated in the etiology of Schizophrenia.
- Neurochemical Imbalances:
- Dopaminergic Dysregulation: Overactivity of the dopamine system, particularly in the mesolimbic pathway, is associated with positive symptoms of Schizophrenia.
- Glutamate Dysfunction: Abnormalities in the glutamatergic system, particularly NMDA receptor hypofunction, have been linked to cognitive deficits.
- Social Isolation and Loneliness:
- Social Factors: Lack of social support, social isolation, or feelings of loneliness may increase the vulnerability to Schizophrenia.
Desired Outcome for Nursing Care Plan (NCP) for Schizophrenia
- Symptom Management:
- Short-Term Goal: Reduce the severity and frequency of psychotic symptoms (e.g., hallucinations, delusions).
- Interventions: Administer antipsychotic medications as prescribed. Monitor and document changes in symptomatology.
- Medication Adherence:
- Intermediate-Term Goal: Promote consistent adherence to prescribed medications.
- Interventions: Educate the patient and family about the importance of medication compliance. Explore and address any concerns or barriers to adherence.
- Functional Independence:
- Long-Term Goal: Enhance the patient’s ability to perform activities of daily living (ADLs) independently.
- Interventions: Collaborate with occupational therapists to develop and implement strategies for improving ADLs. Provide ongoing support and encouragement.
- Community Integration:
- Intermediate-Term Goal: Facilitate the patient’s integration into the community and reduce social isolation.
- Interventions: Encourage participation in community-based activities, support groups, or vocational programs. Foster social connections and provide resources for community engagement.
- Cognitive Functioning:
- Long-Term Goal: Improve cognitive function and executive skills.
- Interventions: Implement cognitive remediation strategies. Collaborate with the mental health team to address cognitive deficits through therapy and skill-building activities.
- Relapse Prevention
- Long-Term Goal: Minimize the risk of relapse and hospital readmission.
- Interventions: Develop a relapse prevention plan with the patient, including early warning signs and coping strategies. Encourage regular follow-up appointments.
- Therapeutic Alliance:
- Short-Term Goal: Establish and maintain a positive therapeutic alliance between the patient and the healthcare team.
- Interventions: Utilize therapeutic communication techniques. Foster a non-judgmental and supportive environment to build trust.
Schizophrenia Nursing Care Plan
Subjective Data:
- Hallucinations
- Feeling of being watched (paranoia)
- Change in personality
- Inability to sleep
- Inability to concentrate
- Feelings of indifference
Objective Data:
- Awkward body positioning
- Decreased or impaired speech
- Decline in academic or work performance
- Inappropriate behavior
- Extreme preoccupation with religion or the occult
- Flat affect
- Unprovoked outbursts or uninhibited actions
- Tense, anxious or erratic movements
- Wandering
Nursing Assessment for Schizophrenia
- Mental Status Examination:
- Appearance and Behavior: Observe the patient’s appearance, grooming, and overall behavior.
- Thought Process: Assess for thought disorders like derailment or thought blocking.
- Mood and Affect: Evaluate the patient’s mood and affect, noting any signs of depression, anxiety, or mood swings.
- Perception: Explore the presence of hallucinations or delusions.
- Functional Assessment:
- Activities of Daily Living (ADLs): Evaluate the patient’s ability to perform self-care tasks independently.
- Occupational Functioning: Assess the patient’s current employment status, if applicable, and the impact of symptoms on work performance.
- Social and Interpersonal Relationships:
- Family Dynamics: Explore the patient’s relationships with family members and the level of family support.
- Social Connections: Assess the patient’s social network, friendships, and community involvement.
- Isolation: Determine the degree of social isolation and its impact on the patient’s well-being.
- Cognitive Functioning:
- Memory and Concentration: Evaluate memory and concentration abilities.
- Executive Function: Assess problem-solving skills, decision-making, and ability to plan and organize.
- Medical History:
- Co-occurring Conditions: Explore the presence of any co-occurring medical conditions, such as diabetes or cardiovascular disease.
- Medication History: Review the patient’s history of medication use, including adherence and any side effects experienced.
- Substance Use History:
- Substance Abuse: Assess for any history of substance use or dependence, as it can impact the course of Schizophrenia.
- Current Substance Use: Inquire about current substance use, including tobacco, alcohol, or illicit substances.
- Suicide and Self-Harm Risk Assessment:
- Suicidal Ideation: Screen for thoughts of self-harm or suicide.
- Self-Harm History: Explore any history of self-harm or suicide attempts.
- Protective Factors: Identify protective factors, such as supportive relationships or coping strategies.
- Medication Adherence:
- Current Medication Use: Assess the patient’s current use of prescribed medications.
- Barriers to Adherence: Identify any barriers to medication adherence, such as side effects or forgetfulness.
- Insight and Judgment:
- Insight: Evaluate the patient’s awareness and understanding of their mental health condition.
- Judgment: Assess the patient’s judgment and decision-making abilities.
- Therapeutic Relationship:
- Patient-Caregiver Relationship: Evaluate the quality of the therapeutic relationship between the patient and the healthcare team.
Communication Skills: Assess the effectiveness of therapeutic communication techniques.
- Patient-Caregiver Relationship: Evaluate the quality of the therapeutic relationship between the patient and the healthcare team.
Nursing Interventions and Rationales
- Obtain history and assess patient for hostile or self-destructive behaviors
- Determine the risk of harm to the patient or others and what precautions may be required. Stress response often triggers hallucinations.
- Provide encouragement in a non-judgemental, compassionate way, understanding that symptoms are real to the patient
- Develop trust between patient and nurse to improve the effectiveness of interventions and cooperation.
- Encourage the patient to communicate (verbally, by drawing, and writing) how hallucinations make them feel
- Helps understand and anticipate behaviors and helps identify stressors such as fear or helplessness. Reduce anxiety.
- Ask if hallucinations are instructing them to harm themselves or others. Provide safety for patients and others per facility protocol if needed.
- Patients may be inclined to obey commands given by hallucinations that instruct them to harm themselves or others. Notify security or police if necessary.
- Follow your facility’s specific protocol regarding supervision, restraint, and documentation.
- Provide redirection for inappropriate behaviors, and maintain boundaries and guidelines.
- Avoids the need for intervention and exacerbated behaviors. Redirecting patients helps remove the focus from the current perceived threat to a more positive activity.
- Boundaries and guidelines should be held consistently among caregivers to prevent splitting (turning one caregiver against another).
- Encourage reality-based activities (music, art, playing cards, etc.)
- Help redirect the patient to acceptable activities and behaviors and reduce the risk of hallucinatory distractions.
- Explain all procedures slowly and carefully before beginning
- Reduces paranoia and encourages cooperation. Patients are less likely to feel “tricked” if they understand what is happening to them. Even taking blood pressure can be frightening if not fully explained first.
- Avoid using large gestures or touching the patient except when necessary
- The patient’s distortion of reality may interpret the touch or gesture as an aggressive or threatening action.
- Gently reorient the patient as necessary
- Reorienting patients helps them differentiate between reality and hallucination.
- Avoid arguing with a patient regarding delusions or hallucinations
- If reorienting is initially ineffective, avoid persistent attempts or arguing as it can agitate the patient or cause feelings of isolation.
- Never confirm a delusion or hallucination (“I see Jesus, too!”) – this can exacerbate agitation or confusion.
- Teach patient coping skills to help manage hallucinations or delusions
- Exercise
- Singing/listening to music
- Writing
- Drawing
- Talking with someone they trust
- Help the patient learn how to cope with and manage symptoms to improve daily functioning and behaviors.
- As symptoms improve, allow the patient to make small decisions such as what to eat, wear or choose activities
- Allows patient to feel that they have more control over themself and their care. Promotes independence.
- Administer medication appropriately
- Routine medications may be given to help improve symptoms.
- Atypical antipsychotics
- IM medications may be given PRN for acute exacerbations.
- Diphenhydramine
- Haloperidol
- Lorazepam
Desired Outcomes for Nursing Care Plan (NCP) for Schizophrenia
- Symptom Management:
- Short-Term Goal: Reduce the severity and frequency of psychotic symptoms (e.g., hallucinations, delusions).
- Interventions: Administer antipsychotic medications as prescribed. Monitor and document changes in symptomatology.
- Medication Adherence:
- Intermediate-Term Goal: Promote consistent adherence to prescribed medications.
- Interventions: Educate the patient and family about the importance of medication compliance. Explore and address any concerns or barriers to adherence.
- Functional Independence:
- Long-Term Goal: Enhance the patient’s ability to perform activities of daily living (ADLs) independently.
- Interventions: Collaborate with occupational therapists to develop and implement strategies for improving ADLs. Provide ongoing support and encouragement.
- Cognitive Functioning:
- Long-Term Goal: Improve cognitive function and executive skills.
- Interventions: Implement cognitive remediation strategies. Collaborate with the mental health team to address cognitive deficits through therapy and skill-building activities.
- Relapse Prevention:
- Long-Term Goal: Minimize the risk of relapse and hospital readmission.
- Interventions: Develop a relapse prevention plan with the patient, including early warning signs and coping strategies. Encourage regular follow-up appointments.
- Therapeutic Alliance:
- Short-Term Goal: Establish and maintain a positive therapeutic alliance between the patient and the healthcare team.
- Interventions: Utilize therapeutic communication techniques. Foster a non-judgmental and supportive environment to build trust.
References
- https://emedicine.medscape.com/article/288259-overview
- http://www.mentalhealthamerica.net/conditions/schizophrenia
- https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml
Unlock the Complete Study System
Used by 300,000+ nursing students. 99.25% NCLEX pass rate.
- Full lesson outlines
- NCLEX simulator (SIMCLEX)
- 6,500+ practice questions
- 2,000+ lesson videos
- 300+ cheatsheets
200% NCLEX Pass Guarantee.
No Contract. Cancel Anytime.
Example Nursing Diagnosis For Nursing Care Plan (NCP) for Schizophrenia
- Impaired Thought Processes: Schizophrenia is characterized by disorganized thinking. This diagnosis addresses cognitive deficits related to the disease.
- Risk for Violence: Some individuals with schizophrenia may exhibit violent behaviors. This diagnosis emphasizes the potential for violence and the need for safety measures.
- Social Isolation: Schizophrenia can lead to social withdrawal and isolation. This diagnosis focuses on addressing social and interpersonal issues.
Transcript
Hey guys, in this care plan, we will explore schizophrenia. In this schizophrenia care plan, we’re going to talk about the desired outcome, the subjective and objective data, along with the nursing interventions and rationales for each.
So our medical diagnosis is schizophrenia. Schizophrenia is a mental disorder that affects the brain, and is going to affect how the patient thinks, how they feel and how they behave. Schizophrenia is thought to involve the imbalance of neurotransmitters like dopamine, glutamate, and serotonin in the brain that change the way the brain reacts to stimuli, so the exact cause is unknown, but it’s thought to be a combination of genetic, psychological, and environmental factors. The disease is thought to be triggered by an extremely stressful life event. Our desired outcome is that the patient will be able to communicate effectively and demonstrate reality based processes. The patient will be able to demonstrate the ability to distinguish between reality and hallucinations.
Now, let’s take a look at our care plan. So, subjective data that your patient may experience that has schizophrenia includes hallucinations, paranoia, and a change in personality due to the imbalances in the brain. So, these in turn cause the patient to have difficulty sleeping and concentrating, which may create feelings of indifference.
Objective data that you might notice in your patient with schizophrenia include inappropriate behavior, a flat affect, unprovoked outbursts. This is all due to the disruptive brain chemicals that are here in her brain. You may notice tense, anxious or erratic movements due to paranoia and hallucinations, so the patient will likely have a decline in academic or work performance, especially when they’re having these schizophrenia episodes.
Now let’s look at our nursing interventions. So you will obtain a history and assess the patient for hostile or self-destructive behaviors. Doing so is going to help determine if the patient is at risk for harming themselves or others. That way, the most appropriate precautions can be taken, especially according to the protocol of your organization. You want to provide non-judgemental compassion, encouragement, and just reorient them gently. You want to develop trust between you and the patient. It’s hard for them to trust people. They’re feeling paranoid. They’re feeling like they can’t trust anybody, so just be there for them. Listen, and just try to help them maintain a touch with reality. You definitely want to make sure that you encourage communication about the patient’s experience and their feelings. Listen to them. This is the biggest thing I can tell you to do. Listen, help them to reduce their anxiety and encourage them to have a sense of control. You should redirect inappropriate behaviors and maintain boundaries. Do not let them walk all over you because they will try.
You want to prevent escalation of behaviors and avoid manipulation in these patients. Make sure that you explain any procedure slowly and carefully. You want to reduce their paranoia. Remember they’re already paranoid. They already don’t might not trust you or the organization that they’re in right now, so you want to help them to reduce their paranoia. You want to encourage cooperation, avoid arguing, and never confirm delusions ever, ever, ever. Do not just go along with something, just to make things easier. This patient has a lot going on in their head. Let’s not make it any worse than it already is. Let’s try to reorient them.
Okay, we want to reduce agitation. We want to reduce their confusion. They need therapeutic communication to keep their mind on the right path. Administer medications as ordered, such as anti-psychotics to help reduce those symptoms.
We love you guys. Now, go out and be your best self today and as always, happy nursing!
Study Faster with Full Video Transcripts
99.25% NCLEX Pass Rate vs 88.8% National Average
- Full lesson outlines
- NCLEX simulator (SIMCLEX)
- 6,500+ practice questions
- 2,000+ lesson videos
- 300+ cheatsheets
200% NCLEX Pass Guarantee.
No Contract. Cancel Anytime.
Nursing Clinical 360
With the rapid expansion of the COVID-19 pandemic many schools, instructors and students are left wondering what just happened?Students can’t access the tools and onsite clinical help they desperately need and instructors are trying to piece together online learning that prepares their students for success.It is because of this uncertainty and abrupt change that we have developed the Nursing Clinical 360 Course.Featuring:38 Highly Detailed Nursing Skills Video Lessons18 Health Assessment Lessons26 IV Skills Videos42 Case Studies30+ Care PlansWe want to give students the practical knowledge they need to feel confident going into a clinical or practical situation, as well as give instructors a concise library of online resources to handle the sudden demand for distance learning.
