Townsend Essentials 9E Sneak Preview

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UNIT 3 ■ Care of Patients With Psychiatric Disorders

Clinical Vignette: Jordan has been admitted to the psychiatric unit with a diagnosis of schizophrenia. He is socially isolated and stays in his room unless strongly encouraged by the nurse to come out. He says to the nurse, “You have to be your own boss. You can’t trust anybody.” He refuses to eat any food from his tray, stating that the voice of his deceased grandfather is telling him it is poisoned. His clothes are dirty, and he has an objectionable body odor. The nurse develops the following concept map care plan for Jordan.

Signs and Symptoms

• Delusional thinking • Suspiciousness

• Verbalizes

• Social

• Offensive body odor • Soiled clothing • Unkempt appearance

hearing voices • Listening pose

withdrawal • Expresses fear of failure

Nursing Diagnosis

Disturbed thought processes

Disturbed sensory perception (auditory)

Low self-esteem

Self-care deficit (hygiene)

Nursing Actions

• Observe for signs of hallucinations • Cautious with touch • Use “the voices” instead of “they” when asking for content of hallucinations • Use distraction to bring patient back to reality

• Don't whisper to others in patient's presence • Serve food family style • Mouth checks for meds • Cautious with touch • Use same staff • Meet patient needs and keep promises to promote trust

• Spend time with patient and develop trust • Attend groups with patient at first to offer support • Encourage simple methods of achievement • Teach effective communication techniques • Encourage verbalization of fears

• Encourage independence in ADLs, but intervene as needed • Offer recognition and positive reinforcement for independent accomplishments

Medical Rx: Risperidone 2 mg bid

Outcomes

• Demonstrates ability to trust • Differentiates between delusional thinking and reality

• Discusses content of

• Attends groups willingly and without being accompanied by nurse • Interacts appropriately with others

• Performs ADLs independently • Maintains personal hygiene at an acceptable level

hallucinations with nurse • Hallucinations are eliminated or recognized as nonreality

FIGURE 15–2 Concept map care plan for a patient with schizophrenia.

Treatment Modalities The prognosis for schizophrenia has often been reported in a paradigm of thirds. About one-third of the people achieve significant and lasting improve- ment. They may never experience another episode of

psychosis following the initial occurrence. One-third may achieve some improvement with intermittent relapses and residual disability. Their occupational level may have decreased because of their illness, or they may be socially isolated. Finally, one-third expe- rience severe and permanent incapacity. They often