Schizophrenia is a serious mental disorder that affects how a person thinks, feels and behaves. Patients often have difficulty distinguishing between reality and imagination and have difficulty communicating with others. Schizophrenia tends to run in families, but most frequently appears to be related to an imbalance of neurotransmitters (dopamine, glutamate and serotonin) that change the way the brain reacts to stimuli. Patients are not normally violent, but may react defensively to even the most well-intended gestures or stimuli.
The patient must have experienced at least two of the following symptoms, one of which must be a positive symptom.
Symptoms must be present for at least 6 months with at least one month of active symptoms. Symptoms are not related to substance use/abuse or any other medical condition.
Patient will communicate effectively. Patient will demonstrate reality-based thought processes. Patient will demonstrate ability to distinguish between reality and hallucinations.
Determine risk of harm to patient or others and what precautions may be required. Stress response often triggers hallucinations.
Develop trust between patient and nurse to improve effectiveness of interventions and cooperation.
Helps understand and anticipate behaviors and help identify stressors such as fear or helplessness. Reduce anxiety.
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.
Avoids need for intervention and exacerbated behaviors. Redirecting patient 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).
Help redirect patient to acceptable activities and behaviors and reduce the risk of hallucinatory distractions.
Reduces paranoia and encourages cooperation. Patients are less likely to feel “tricked” if they understand what is happening to them. Even taking a blood pressure can be frightening if not fully explained first.
Patient’s distortion of reality may interpret the touch or gesture as an aggressive or threatening action.
Reorienting patient helps them differentiate between reality and hallucination.
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.
Help patient learn how to cope with and manage symptoms to improve daily functioning and behaviors.
Allows patient to feel that they have more control of themself and their care. Promotes independence.
Routine medications may be given to help improve symptoms.
IM medications may be given PRN for acute exacerbations.
For more information, visit www.nrsng.com/cornell
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