IntroductionMr. Apo a 49yr old male single patient in dorm two was born on March 12, 1960. He weight 74 pounds and height of 5’10. He lived at barrio matalaba lingayen. He has a Filipino nationality and his religion is Roman catholic. His educational attainment was a 2nd year college only. He was admitted at NCMH on August 13,1960, involuntarily and accompanied by his relatives especially his sister Arlene. His sister decided to admit Mr. Apo due to unwanted behavioral changes like restlessness and Sleeping disturbance. He was diagnosed as undifferentiated schizophrenia and now his current diagnosis was undifferentiated schizophrenia. Undifferentiated schizophrenia is a mental disorder which is part of the family of disorders broadly known as “schizophrenia.” There are a number of subcategories of schizophrenia including paranoid schizophrenia, catatonic schizophrenia, disorganized schizophrenia, residual schizophrenia, and schizoaffective disorder; undifferentiated schizophrenia is often defined as a form in which enough symptoms for a diagnosis are present, but the patient does not fall into the catatonic, disorganized, or paranoid subcategories. Schizophrenia is characterized by a lack of grounding in reality, known as psychosis. People in a state of psychosis can experience hallucinations, delusions, and other events in which they break from reality. Individuals with schizophrenia experience psychosis and can also develop symptoms such as disorganized speech, lack of interest in social interactions, a flat affect, inappropriate emotional responses to situations, confusion, and disorganized thinking. Patients with undifferentiated schizophrenia do not experience the paranoia associated with paranoid schizophrenia, the catatonic state seen in patients with catatonic schizophrenia, or the disorganized thought and expression observed in patients with disorganized schizophrenia. However, they do experience psychosis and a variety of other symptoms associated with schizophrenia, including behavioral changes which may be noticeable to family and friend. Psychopathology Causes One of the reasons for the ongoing difficulty in classifying schizophrenic disorders is incomplete understanding of their causes. It is thought that these disorders are the end result of a combination of genetic, neurobiological, and environmental causes. A leading neurobiological hypothesis looks at the connection between the disease and excessive levels of dopamine, a chemical that transmits signals in the brain (neurotransmitter). The genetic factor in schizophrenia has been underscored by recent findings that first-degree biological relatives of schizophrenics are ten times as likely to develop the disorder as are members of the general population. Prior to recent findings of abnormalities in the brain structure of schizophrenic patients, several generations of psychotherapists advanced a number of psychoanalytic and sociological theories about the origins of schizophrenia. These theories ranged from . Psychosocial factors are now thought to influence the expression or severity of schizophrenia rather than cause it directly. and social inequalities in the new country. As of 2004. As of 2004. Another hypothesis suggests that schizophrenia may be caused by a virus that attacks the hippocampus. Black immigrants from Africa or the Caribbean appear to be especially vulnerable.hypotheses about the patient's problems with anxiety or aggression to theories about stress reactions or interactions with disturbed parents. a part of the brain that processes sense perceptions. as well as human endogenous retroviruses (HERVs). Damage to the hippocampus would account for schizophrenic patients' vulnerability to sensory overload. Psychiatrists in Europe have noted the increasing rate of schizophrenia and other psychotic disorders among immigrants to almost all Western European countries. researchers are focusing on the possible role of the herpes simplex virus (HSV) in schizophrenia. migration is a social factor that is known to influence people's susceptibility to psychosis. the need to adjust to living in large urban areas. The possibility that HERVs may be associated with schizophrenia has to do with the fact that antibodies to these retroviruses are found more frequently in the blood serum of patients with schizophrenia than in serum from control subjects. The stresses involved in migration include family breakup. the German psychiatrist Kurt Schneider proposed a list of so-called first-rank symptoms. etc. such as the notion that one's brain is radioactive. the FBI. .) has the power to put thoughts into one's mind or remove them. Martians. These symptoms include: • • • • • delusions somatic hallucinations hearing voices commenting on the patient's behavior thought insertion or thought withdrawal Somatic hallucinations refer to sensations or perceptions concerning body organs that have no known medical cause or reason. which he regarded as diagnostic of the disorder.Symptoms Patients with a possible diagnosis of schizophrenia are evaluated on the basis of a set or constellation of symptoms. the CIA. In 1959. Thought insertion and/or withdrawal refer to delusions that an outside force (for example. there is no single symptom that is unique to schizophrenia. The patient was on regular diet. The fasting blood sugar of the patient is 5.History The patient diagnosed as undifferentiated schizophrenia and current undifferentiated schizophrenia. The patient’s temperature 36. The patient scars was located at leg. The color of urinalysis is light yellow. He has lesions in legs. and at the back of the body.31 and specific 1.010. respiratory rate 20. Nursing physical assessment Apo was alert and oriented to person. His medications are only for his mental illness. arms. The skin of the patient was dry with scar. Related Treatment . The patient has no skeletal deformities. The bowel sounds of the patient is good. His previous medications are Nozinan and haloperidol. blood pressure was 120/90. place and time. arms.0 Celsius. transparency was slightly turbid. haloperidol and chlorpromazine. back of the body and knee. The musculoskeletal status of the patient are weakness and tremors. The patient stated her pain level. pulse rate was 80. The weight of Apo is 74 pounds. He does not undergo in any surgery. Apo was regular exercise everday. His current medications are nozinan. It is used to treat undifferentiated schizophrenia. Nozinan 10mg/ capsule it is used in the treatment of schizophrenia and is also used in the management of pain. Researchers have. not on the basis of internal psychological processes. Chlorpromazine is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking. nausea and vomiting associated with terminal illness. distress. a condition that causes episodes of mania. Nursing care plan Nursing Diagnosing & Patient Goal A doctor must make a diagnosis of schizophrenia on the basis of a standardized list of outwardly observable symptoms. discovered that patients with schizophrenia have certain . loss of interest in life. Apo is now receiving a Haloperidol 1mg tablet. There are no specific laboratory tests that can be used to diagnose schizophrenia. and other abnormal moods). however. abnormally excited mood) in people who have bipolar disorder (manic depressive disorder. distress. which an typical antipsychotic medication. Haloperidol 10mg/capsule it is used in the treatment of schizophrenia and is also used in the management of pain. episodes of depression. It works by changing the effects of chemicals in the brain. and strong or inappropriate emotions) and other psychotic disorders (conditions that cause difficulty telling the difference between things or ideas that are real and things or ideas that are not real) and to treat the symptoms of mania (frenzied.Mr. nausea and vomiting associated with terminal illness. negative symptoms . many individuals were incorrectly diagnosed as schizophrenic. prion diseases. Huntington's chorea. These disorders include mood disorders with psychotic features. the patient must meet a set of criteria specified: • the patient must have two (or more) of the following symptoms during a onemonth period: delusions. the clinician will consider other psychiatric conditions that may include psychotic symptoms or symptoms resembling psychosis. The doctor will also need to rule out heavy metal poisoning and substance abuse disorders. delusional disorder. or paranoid personality disorders. Some patients who were diagnosed prior to the changes in categorization should have their diagnoses. he or she will begin by excluding physical conditions that can cause abnormal thinking and some other behaviors associated with schizophrenia. After other conditions have been ruled out. These conditions include organic brain disorders (including traumatic injuries of the brain). and also identify learning problems or disorders. and treatment. schizotypal. and atypical reactive disorders. In children. After ruling out organic disorders. reevaluated. temporal lobe epilepsy. dissociative disorder not otherwise specified (DDNOS) or multiple personality disorder. schizoid. disorganized or catatonic behavior. especially amphetamine use. and encephalitis. These discoveries have been made with the help of imaging techniques such as computed tomography scans (CT scans). disorganized speech. Wilson's disease. When a psychiatrist assesses a patient for schizophrenia. hallucinations. In the past.abnormalities in the structure and functioning of the brain compared to normal test subjects. the doctor must distinguish between psychotic symptoms and a vivid fantasy life. substance abuse disorders. Administer medication to decrease symptoms and anxiety. Assess the patient's ability to carry out the activities of daily living. Use physical restraints according to your facility's policy to ensure the patient's safety and that of others. Maintain a safe environment. 5. and developmental disorders have been ruled out. but only do for the patient what he can't do for himself. allow him to fix his own food when possible. Adopt an accepting and consistent approach with the patient. medical conditions. paying special attention to his nutritional status. repeated contacts are best until trust has been established. Reward positive behavior to help the patient improve his level of functioning. Avoid promoting dependence. Don't avoid or overwhelm him. allow the patient to open the container. Meet the patient's needs. and sheltered workshops. If you give liquid medication in a unit-dose container. minimizing stimuli. interpersonal. Provide . outpatient day care. Nursing intervention 1. or occupational functioning. Engage the patient in reality-oriented activities that involve human contact: inpatient social skills training groups. 4.• decline in social. 6. Keep in mind that short. or offer him foods in closed containers that he can open. 3. Monitor his weight if he isn't eating. If he thinks that his food is poisoned. including self-care • • the disturbed behavior must last for at least six months mood disorders. 2. clearly explain to him. Also monitor the patient carefully for adverse effects of drug therapy. 7. Choose words and phrases that are unambiguous and clearly understood. explaining to the patient that what he says isn't understood by others. Encourage compliance with the medication regimen to prevent relapse. determine if they're command hallucinations that place the patient or others at risk. Don't touch the patient without telling him first exactly what you're going to do. Avoid arguing about the hallucinations. For example. 8. if possible. Don't tease or joke with the patient. explore the content of the hallucinations. set limits on inappropriate behavior. Mobilize community resources to provide a support system for the patient and reduce his vulnerability to stress. including drug-induced . thinking he is being told to lie down on the floor. may become frightened. autistic inventions. 10. 9. or neologisms. institutionalization may produce new symptoms and handicaps in the patient that aren't part of his diagnosed illness. If the patient is hallucinating. a patient who's told. change the subject. 11. For instance. Ongoing support is essential to his mastery of social skills. postpone procedures that require physical contact with facility personnel until the patient is less suspicious or agitated. That procedure will be done on the floor. If necessary.reality-based explanations for distorted body images or hypochondriacal complaints. 12. I'm going to put this cuff on your arm so I can take your blood pressure. If he has auditory hallucinations. Tell the patient you don't hear the voices but you know they're real to him. Remember. so evaluate symptoms carefully. If necessary. Clarify private language. parkinsonism. He should realize the importance of complying with his medication and the benefits this practice would bring to the improvement of his well-being. The patient was demonstrate behaviors that show positive self esteem as evidenced by inability to have an eye contact. still we have to render amounts of effort. acute dystonia. Even if nursing students find it difficult to establish therapeutic relationships with mentally-ill patients because of the relatively short time spent in the clinical area. tardive dyskinesia. the medication and therapeutic regimen designed for his rehabilitation. akathisia. and malignant neuroleptic syndrome. He is oriented to time when asked what day it is. that we may play a part in the rehabilitation of our mentally-ill patients. Evaluation The client was able to maintain reality orientation. Recommendation He is advised to take part in complying with the treatment. and improve our therapeutic technique in caring for our patients. Make sure you document and report such effects promptly. . time and trust to our patients. A case study Presented to the faculty of Our lady of Fatima University College of Nursing . Group A Nursing care plan Assessment Subjective “Sobrang lamig ng tubig nakakatamad maligo. ay ang haba pala ng kuko ko” as verbalized by the patient . Leyden Dela cruz RN Clinical instructor Submitted by Belardo. Gillian abegail F.A Case Study on Undifferentiated Schizophrenia Submitted to: Ms. 3. Orient client to different equipment for self-care like various toiletries. Establish rapport. The patient has an impaired ability to provide self care requisites due to environmental and psychological factors. R: basic hygienic needs may be forgotten. 4. Planning After 2 hours of nusing care. R: underlying cause affects choice of interventions/ strategies. R: to gain client’s trust and facilitate a good working relationship. 5. 2. R: makes client aware of how hygiene is vital in caring for oneself. . the client will be able to a) Verbalize self care need b) Demonstrate techniques to meet self care needs Interventions 1. Identify reason for difficulty in self-care. Discuss on importance of hygiene. Determine hygienic needs and provide assistance as needed with activities like care of nails and brushing teeth.Objective Untrimmed fingernails and toenails with visible dirt noted Diagnosis Self care deficit bathing/ hygiene related to lack of motivation. Do not rush client. 9. R: promotes independence and sense of control. may decrease feelings of helplessness. Allot plenty of time to perform tasks. Discuss the possible negative implications of not taking a bath such as infections and odor. 8. the client was able to: a) b) verbalize self care need but was unable to demonstrate techniques to meet self-care needs. Let the patient enumerate his ideas on the importance of hygiene. Assist with dressing neatly or provide colorful clothes. . Encourage client to perform self-care to the maximum of ability as defined by the client. R: Encourages the patient to understand the need for hygiene. R: Enhances esteem and convey aliveness. 10. 7. Evaluation GOAL PARTIALLY MET After 2 hours of nursing care. R: cognitive impairment may interfere with ability to manage even simple activities. 6.R: increases the client’s awareness of different materials for self-care. R: Broadens the patient’s idea about the problem and encourages him to meet the need. Nursing care plan Assessment Subjective “Hindi ako masyado makatulog sa gabi” as verbalized by the patient Objective restlessness . positions. Assess past patterns of sleep in normal environment: amount. . length. depth. aids.5˚C P: 54 R: 12 BP: 110/ 80 Diagnosis Disturbed Sleep Pattern related to hyperactivity Planning After 8 Hours. and interfering agents. bedtime rituals. Patient will be able to report feeling rested and show improvement in sleep/rest pattern. dark circles under eyes irritability frequent change of mood V/S taken as follows T: 36. Intervention INDEPENDENT 1. g. the patient was able to show improvement in his sleeping pattern. Recommend an environment conducive to sleep or rest (e. 4.g. 6. Note physical (e. comfortable temperature. Nursing care plan Assessment Subjective “Ang aking mga sugat ay nangangati” as verbalized by the patient . ventilation.. Instruct patient to follow as consistent a daily schedule for retiring and arising as possible. anxiety) circumstances that interrupt sleep. Document nursing or caregiver observations of sleeping and wakeful behaviors. quiet. fear. pain or discomfort. Avoid including in the meal alcohol or caffeine as well as heavy meal 5. Record number of sleep hours.g. Evaluation After 8 hours of Nursing Interventions. closed door). urinary frequency) and/or psychological (e. Increase daytime physical activities as indicated. COLLABORATIVE Administer sedatives as ordered.. darkness. noise.. 3.2. Demonstrated good skin hygiene.Objective (pain) Localized erythema Disruption of the skin Diagnosis Impaired skin integrity related to inflammatory response secondary to infection. Absence of purulent discharge. Noted color. Absence of itchiness. turgor. and sensation.. Intervention Assessed skin. Absence of redness or erythema.g. Planning Following a 3-day nursing intervention. the client will be able to display improvement in wound healing as evidenced by: Intact skin or minimized presence of wound. wash thoroughly and pat dry carefully. . Described and measured wounds and observed changes. e. Demonstrated to the family members on how to make a guava decoction to apply to the wound as alternative disinfectant. Several wounds have dried up. Minimized erythema. Is it important to people to love in able to attain peace or to unite people and be happy . (Continue cleaning the wound with disinfectant) Presence of itchiness (Continue instructing client to avoid scratching the wound) Nursing process Recording Mr. in the way that people can appreciate the true meaning of LOVE. He described the drawing as a symbol love and passion. My patient thinks of love and the way people express it. Emphasized importance of adequate nutrition and fluid intake. the client was able to display improvement in wound healing as evidenced by: Minimized presence of wounds. preferably cotton fabric (any Tshirt). Instructed family to maintain clean. He also said that symbolizes people who love each other. Minimized purulent discharge. Provided and applied wound dressings carefully. Evaluation At the end of the 3-day nursing intervention. Instructed family to clip and file nails regularly. Why do people fall in love and what is it for. dry clothes. Apo drawn a heart and uses a red crayon to make it. and show it. The answer is clear and the only thing that makes people happy is because of LOVE.with their special someone. .
Report "Case Study of Undifferentiated Schizophrenia"