This guide is about Schizophrenia, Schizophrenia Nursing Diagnosis, Schizophrenia Nursing Treatment, and 3 Schizophrenia Nursing Care Plans. It can be used in the development of nursing care plans for educational purposes.
What is Schizophrenia?
Schizophrenia is a serious mental disorder highly associated with psychosis or the disconnection from reality. It leads to a wide range of manifestations such as hallucinations, delusions, disorganized speech, and cognitive impairment. It highly affects the person’s thoughts and emotions which then lead to the person’s inability to participate socially and maintain meaningful relationships. Schizophrenia is a lifelong disorder which can occur in both men and women of any age. There is still no cure for schizophrenia at present; however, there are treatments available to help manage the condition and control serious complications.
What are the Signs and Symptoms of Schizophrenia?
The clinical manifestations of schizophrenia are categorized into positive, negative, and cognitive.
- Positive Symptoms. These are the easily recognized signs and symptoms and are often referred to as behaviors not seen in healthy people.
- Delusions – delusions are beliefs that are not based in reality
- Hallucinations – these are experiences of seeing, hearing, feeling, or smelling something that does not exist
- Abnormal motor behavior – people with schizophrenia may display child-like silliness or any behavioral changes that include resistance to instructions, inappropriate posture, lack of response, or useless and excessive movements
- Negative Symptoms. These symptoms are sometimes more difficult to diagnose. They are related to the reduced ability to function normally and may include the following:
- Diminished emotional expression
- Anhedonia or the lack of ability to experience pleasure
- Social withdrawal
- Cognitive Symptoms. These symptoms are typically non-specific hence they tend to be severe enough to be noticed by another individual.
- Disorganized thinking or speech – schizophrenia can affect the person’s ability to communicate. It may be noted that people with schizophrenia may display the use of different words being put together without any meaning at all.
In teenagers, schizophrenia may be difficult to recognize since its signs and symptoms may overlap with typical teenage development. Signs and symptoms of schizophrenia in teenagers may include:
- Social withdrawal
- Changes in school performance
- Trouble getting sleep
- Depressed mood
- Lack of motivation
What are the Causes of Schizophrenia?
Despite extensive research on this condition, the exact cause of schizophrenia is still unknown. However, it is generally accepted that several factors can precipitate the development of the disorder.
- In utero. Some studies suggest that schizophrenia starts due to fetal disturbances in utero. It has been linked to bleeding during pregnancy, gestational diabetes, having emergency caesarean section, asphyxia, and having low birth weight.
- Genetics. It is also believed that genetics plays a role in the occurrence of schizophrenia. It is found that the risk of developing the illness is high in people with family history of the disorder.
- Environmental factors. Environmental stressors are highly associated to the development of schizophrenia. It may include childhood trauma, social isolation, minority ethnicity, and having to live in an urban area.
- Changes in the brain chemistry. Although changes in brain structure is not evident in all cases of schizophrenia, some researchers believe that the imbalance of the neurotransmitters in the brain causes the condition to develop.
What Happens if Schizophrenia is Left Untreated?
- Suicide. One of the common causes of deaths in people with schizophrenia is suicide. Having suicidal thoughts and committing suicide can be due to the hallucinations such as hearing voices to harm themselves, depression due to the diagnosis of schizophrenia, or substance abuse.
- Depression. This is seen in almost half of people with schizophrenia. It is not always identified and diagnosed hence it raises the risk of suicide in people suffering from the condition.
- Anxiety. Anxiety is quite common in people with schizophrenia. It is recorded that about 30-80% of cases have had anxiety at some point in their condition.
- Homelessness. Schizophrenia can greatly affect the person’s ability to function and hone social relationships. This may bring lack of support from friends and family and cause them to be socially isolated and disconnected. This often leads to them ending up in the streets and homeless.
- Self-injury. Hallucinations can predispose people with schizophrenia to injure themselves.
- Violence. Not all cases of schizophrenia are associated with violence. However, the condition involves several factors that can increase the risk of violent behaviors.
Schizophrenia Nursing Diagnosis
How do you diagnose Schizophrenia?
The Diagnostic and Statistical Manual of Mental Disorder (DSM-5) suggests that the criteria for diagnosing schizophrenia should include the presence of 2 or more of the symptoms lasting for a month wherein one of the symptoms should include delusions, hallucinations, or disorganized speech.
The following are the procedures that can be performed to help achieve a diagnosis:
- Physical exam – a thorough physical examination can be done to rule out other relevant problems and assess for possible complications.
- Tests and screenings – blood and urine tests may be performed to identify the presence of alcohol and drugs, or any other medical conditions that can cause the symptoms. An imaging study of the brain may also need to be performed such as an CT scan or an MRI scan of the brain.
- Psychiatric evaluation – since schizophrenia is a mental health disorder, a psychiatric evaluation may be needed to assess mental health status.
Schizophrenia Nursing Treatment
What Treatment Options are Available for Patients Suffering from Schizophrenia?
Unfortunately, the treatment for schizophrenia is life-long. It includes the use of medications and therapies.
- Medications. Certain drugs are often helpful in controlling the effects of the condition and in the prevention of possible complications.
- Second generation antipsychotics – these drugs are preferred due to their lower risk of side effects.
- First generation antipsychotics – these drugs carry higher risks of having neurological side effects which may not be reversible.
- Long-acting injectable antipsychotics – some drugs may be given true intramuscular or subcutaneous injection every 2-4 weeks. These may be the drug of choice if daily intake of pills is a concern.
- Psychosocial interventions
- Individual therapy
- Social skills training
- Family therapy
- Vocational rehabilitation and supportive employment
- Electroconvulsive therapy (ECT) – this can be considered if the person does not respond to other treatments. ECT involves the delivery of electrical shocks to the person’s brain to induce seizure in an attempt to relieve schizophrenic symptoms.
3 Schizophrenia Nursing Care Plans
What are Some of the Available Nursing Care Plans for Schizophrenia?
Nursing Care Plan 1
Nursing Diagnosis: Impaired Verbal Communication related to altered perceptions due to biochemical alterations in the brain secondary to schizophrenia as evidenced by difficulty of establishing verbal communication, inability to discern usual or normal communication patterns, cognitive disturbances such as thought blocks, hallucinations/ delusions, and poverty of speech
Desired Outcome: The patient will be able to establish reality-based thought process and effective verbal communication.
|Assess and monitor the patient’s coherence of speech and cognitive ability.||To help establish baseline, as well as short-term and long-term goals.|
|Ensure that the patient receives anti-psychotic medications on time, with the right dosage and route. Have the patient take the medication in front of you.||Correct administration of anti-psychotic mediations helps the patient have clear thinking and a more functional cognitive ability. Patients with mental health problems such as having schizophrenia may not take medications correctly, or at all, so it is crucial for the nurse or carer to ensure that the patient has swallowed the oral medication completely.|
|Create an environment that is calm, quiet, well-lit, and conducive to effective communication.||Having an environment that is free from disturbing stimuli helps in preventing confusion or hallucination in a patient with schizophrenia.|
|Speak slowly, keep voice in low volume, and use clear and simple words when communicating with the patient.||Loud or high-pitched voice may trigger anxiety, agitation, or confusion in a patient with schizophrenia. Using simple words and speaking clearly can help the patient understand what is being said.|
|Educate the patient on ways to improve verbal communication, such as: Focusing on important activities of daily living and meaningful tasksReplacing irrational thoughts with rational thoughtsPerforming deep breathing exercises and calming techniquesSeeking support from staff, carer, family, or other supportive people||To gradually help the patient achieve effective cognitive thinking and functional speech.|
Nursing Care Plan 2
Nursing Diagnosis: Disturbed Thought Process related to cognitive impairment secondary to schizophrenia as evidenced by problems with coordination and motor functions, difficulty handling complex tasks, confusion and disorientation, and inability to do activities of daily living (ADLs) as normal
Desired Outcome: The patient will be able to establish optimal mental and physical functioning.
|Assess the patient’s level of confusion.||To monitor effectiveness of treatment and therapy.|
|Assist the patient performing activities of daily living. Consider one-to-one nursing.||To maintain a good quality of life and promote dignity by allowing the patient to perform their ADLs while maintaining safety.|
|Simplify tasks for the patients by using simple words and instructions. Label the drawers with simple words and big letters, and use written notes when necessary.||Schizophrenia patients may have difficulty handling complex tasks.|
|Provide opportunities for the patient to have meaningful social interaction, but never force any interaction.||To prevent feelings of isolation. However, forced interaction can make the patient agitated or hostile due to confusion.|
|Allow the patient to display abnormal behaviors within acceptable limits and while maintaining patient safety.||To prevent agitation and increase the sense of security while allowing the patient to perform activities that are difficult to stop for him/her.|
Nursing Care Plan 3
Nursing Diagnosis: Defensive coping related to perceived threat to self as evidenced by agitation/ aggression, anxiety, suspiciousness, confusion, irritability, hallucinations/delusions, difficulty establishing relationships, and verbalization of powerlessness
Desired Outcome: The patient will demonstrate effective coping with the disorder as evidenced by being able to establish relationship, seeking support and help as needed, staying calm and oriented, and verbalization of being in control of his/her life.
|Assess the current cognitive level / mental status of the patient, anxiety triggers and symptoms by asking open-ended questions.||To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding suspicions, hallucinations, and delusions.|
|Initially, support the patient by meeting dependency needs if deemed necessary.||The patient can become more anxious if the avenues for dependency are suddenly and/or complete eliminated.|
|Encourage the patient to be independent and provide positive reinforcement for being able to do self-care and other independent behaviors.||To enhance the patient’s self-esteem and encourage him/her to repeat desired behaviors.|
|Discuss with the patient and significant other/s the available treatments for schizophrenia, such as anxiolytics and anti-psychotic medications.||Psychotherapy involves speaking with a licensed therapist and going through how to gradually cope with the symptoms. Medication such as anxiolytics and anti-psychotics can help the patient cope with his/her condition.|
|Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation. Promote a calm, noise-free, and well-lit environment.||To promote relaxation and reduce stress levels.|
Other possible nursing diagnoses:
- Disturbed Sensory Perception: Auditory/Visual
- Impaired Social Interaction
- Interrupted Family Process
- Self-Care Deficit
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.