,

.
Paranoid Schizophrenia
Jerry, age 37, was diagnosed with paranoid schizophrenia when he was 23 years old. At
the time, he had dropped out of college because of his illness and was living at home with
his parents. He subsequently was stabilized on antipsychotic medication, was placed
under case management, moved to a group home, and worked in a sheltered workshop.
He lived in the group home for 11 years. Last year, he stopped taking his medication,
believing he no longer needed it. The nurse at the group home arranged for Jerry to start
receiving monthly injections of a depot form of antipsychotic medication. He took the
injections for 4 months, but then refused to take any more. He was told that he must take
his medication in order to remain in the group home. He packed his clothes and took a
bus to his parents' home, where he has been living ever since, taking no mediation for his
illness. He has progressively become more withdrawn and suspicious. His mother reports
that he talks to himself all the time. He doesn't bathe or have his hair cut, and he wears
dirty clothes, despite efforts by his parents to provide assistance with his self-care. He
takes his food to his room and eats alone.
Last night, his father went to Jerry's room and told him he was going to have to
"straighten up and do something about his situation, or he was going to be out on the
street." Jerry became angry, picked up a baseball bat, and started swinging it at his father.
He hit him once on the back, but his father was able to get away without further injury.
Jerry's mother called the police, who came to the home, put Jerry in handcuffs, and took
him to the emergency department of the local hospital. He was admitted to the psychiatric
unit. He continues to talk to himself and tilts his head to the side occasionally, as if he is
listening to something. He sits quietly, remains mute, and looks angry at present. Jery is
admitted and started on anti-psychotic medication.
Identify the positive symptoms of schizophrenia displayed by Jerry:
Identify the negative symptoms of schizophrenia displayed by Jerry:
o
Identify four (4) nursing diagnoses
l-
2-
3-
4-
.
Which is the prority nursing
diagnosis?
whv?
.
Identify goals/ int entions/ rationales for the priority nursing diagnosis.
(Includemedicationswh appropriate).
Develop nursing care plans with appropriate goals, interventions and rationales for
each of the other nursing diagnoses. (Include medications where appropriate).Use
nursing care plan sheets
/
A ,rrrtt.
notes that on the fourth day that Jerry is more agitated, talking to
himself,
giddy, incontinent of urine and ataxic. Which assessment(s) is/are the
prioritY at this time?
o Why?
o
Identify
interventions related to this change: (Include medications where
apProPriate).
.
Identify
four adverse / side effects that Jerry is at high risk for and how a nurse
should
assess for them:
o
a
a
o
.
Identify
discharge nursing diagnoses with specific contenV teaching modality
relevant
to patient/ family education
DEFENSE MECHANISMS: are unconscious responses used by persons to protect
themselves from stress/stressors and reduce anxiety levels. They can be viewed as
adaptive when used for the short term to allow a person to consider more effective means
to manage stress/stressors. They can be viewed as maladaptive when used excessively or
for prolonged periods because the person does not recognize the stress nor effectively
manage the stress/ stressors. Some defense mechanisms, such as projection and splitting,
are usually considered maladaptive. Below are common defense mechanisms with
definitions. After reviewing each develop an example for each.
Defense mechanism Definition
Example
denial Negation of reality/ presence of a
threat (physical or psychological)
despite factual evidence
projection Attributing one's own thoughts/
feelings (usually
less desirable)
to others
represslon Unconscious blocking from
awareness thoughts/ feelings/
situations that are threatenins or
painful
rationalization Excusing oneself/blaming
others
for one's own mistakes/ lacks
identification Assuming/ taking on the
characteristics/ behaviors of
one's role model/ idol
splitting Failing to integrate the positive
and negative characteristics of
another
compensatron Making up for a perceived lack
by focusing n another aspect of
oneself
displacement Transfer of feelings or reactions
evoked from one event to a less
threatening obi ectl person
regression Using behaviors associated with
a previous development level
sublimation Channeling of socially
undesirable feelings/ impulses
into more accepted activities
undoing Making amends/ atonement for
perceived wrong doings
reaction formation Expression of feelings that are
opposite of what one is actually
feelins
Diabetic person eating chocolate
candy
Spending money freely when broke
`
PHASE
AGE FOCUS/ BEHAVIORS INDICATIONS PROBLEMS
Oral birth-
18
months
Anal 18-36
months
Phallic 3 - 6 years
Latency 6 - 12
years
Genital 12-18
years
STAGE AGE
CHARACTERISTICS
Sensorimotor Birth- 2 vears
Preoperational 2-7yearc
Concrete
operations
7 - 12years
Formal
operations
age 12 and
beyond
STAGE
AGE TASK PROBLEMS
Trust vs mistrust littt*t
Autonomy vs
shame/ doubt
toddler
Initiative vs guilt
pre-school
Industry vs
inferiority
school age
Identity vs role
conf.rsion
adolescent
Intimacy vs
isolation
young adult
Generativity vs
stagnation
middle adult
Integrity vs
despair
I older adult
1. What clients are candidates for admission on a9391 emergency
involuntary status?
2. What client behaviors indicate readiness for discharge? Why?
3. Which clients will benefit from cognitive therapy? Why?
4. Which clients are NOT candidates for cognitive therapy? Why?
I
l. Which clients are at increased risk of developingll andwhat are the manifestations of;
* *Neuroleptic
malignant syndrome
**Dystonia?
* *
Pseudo-parkinsonism
**Akithisia
**Tardive
dyskinesia
2. What strategies should a nurse use if a client is delusional?
3. what labs/ parameters should a nurse monitor to determine if a client has
Water intoxication?
NMS?
Agranulocytosis
14.
What strategies should a nurse plan for a client who is in the residual phase
of
schizophrenia?
5. What are effectivellor less effective strategies to use when teaching a chronic schizophrenic
client?