FREVILYN H.

ABASTA NCMB 317

BSN 3Y2-2A

“John, 33 years old, has been admitted to the hospital for the third time with a diagnosis of
Schizophrenia. John had been taking Haloperidol (Haldol) but stopped taking it 2 weeks ago,
telling his case manager it was, and “The poison that is making me sick”. Yesterday John was
brought to the hospital after neighbors called the police because he had been up all night yelling
loudly in his apartment. Neighbors reported him saying, “I can’t do it. They don’t deserve to die!”
And similar statements. John appears guarded and suspicious and has very little to say to anyone.
His hair is matted, he has a strong body odor, and he is dressed in several layers of heavy clothing
even though the temperature is warm. So far, John has been refusing any offers of food and fluids.
When the nurse approached John with a dose of Haloperidol, he said “Do you want me to die? “

DISCUSSION: ANSWER THE FOLLOWING QUESTIONS.

1. Discuss your understanding of Schizophrenia Spectrum

 Schizophrenia spectrum and other psychotic disorders is the category of mental
health conditions in which psychosis is the primary symptom. Psychosis
involves hallucinations (sensory experiences that are not real)
and/or delusions (persistent false beliefs that are not based in reality). While all
people who have schizophrenia spectrum disorder experience psychosis, psychosis
is a symptom for other conditions as well. Individuals with schizophrenia spectrum
and other psychotic disorders lose contact with reality and experience a range of
extreme symptoms that may include hallucinations, delusions, disorganized
thinking (speech), and/or grossly disorganized or abnormal behavior (including
catatonia).
 Schizophrenia is a complicated illness that is often misunderstood. It is a chronic
illness that can be debilitating since people with schizophrenia often cannot
distinguish between reality and their hallucinations and delusions. This can result in
poor compliance with treatment including poor compliance with taking critical and
effective medications as prescribed. Schizophrenia often first appears in men in
their late teens or early twenties. Onset in women is typically twenties or early
thirties. Schizophrenia has a strong genetic component and may run in families, but
can be effectively treated with medication and therapy.

2. Describe various theories of etiology of Schizophrenia

 Up until now, genetic, neurodevelopmental, and neurobiological theories have been
regarded as major theories explaining the etiology of schizophrenia. It is important
to note that these theories should not be envisioned as being separate from each
other because they emphasize relatively different focuses on the development of
schizophrenia
 Genetic Theory - Through epidemiological studies (including those with
twins, in adoption settings, and with siblings), the heritability of
schizophrenia has been reported as being approximately 80% to 85%.
Through molecular genetic studies, including candidate gene studies,
genome-wide linkage studies, and genome-wide association studies (GWAS),
genetic theories have contributed explanations about the development of
schizophrenia.
 Neurodevelopmental theory - Along with the growing evidence of genetic
contributions in schizophrenia, it has also been suggested that
neurodevelopmental theory plays a pivotal role in understanding
schizophrenia. This theory concerns about linkage of genetics,
environmental exposures, and pathogenic occurrences. Adverse

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 environmental exposures during perinatal period such as maternal viral
infections, fetal malnutrition, or extreme prematurity, may cause
pathological alterations in cerebral cortex, cerebellar vermis, limbic system,
brain stem, and cerebral symmetry. Furthermore, structural abnormalities
such as lateral ventricular enlargement and third ventricle enlargement in
the brain of schizophrenic patients are founded as strong evidences for
neurodevelopmental origin
 Neurobiological theory - With the development of neuroimaging, another
possible explanation of the etiology of schizophrenia has been addressed. As
per neurobiological theory, schizophrenia is regarded as the result of
structural and functional abnormalities of the brain. Several domains such as
the structure of the brain, physiology, chemistry, and neuropathology, are
involved in this theory to explain schizophrenia. Etiological finding are as
follows: 1) reductions in white matter structures, 2) functional alterations
and impaired functional connectivity in prefrontal cortex, 3) reductions in
neuronal and membrane integrity, and 4) neurotransmitter abnormalities.
Decrease in hippocampus volume is an important neuropathology finding of
schizophrenia in terms of adult neurogenesis. Because of the complexity of
both the brain and neurobiological markers, more sophisticated systematic
approaches are needed to better understand this theory. However, the most
widely held theory is the neurobiological one, because of its importance in
helping to: a) explain causative mechanisms of schizophrenia, b) identify
targets for treatment, and c) predict outcomes.
3. Identify three (3) priority problems of John
 Delusion and Hallucinations/ Command Hallucinations
 He appears guarded and suspicious

 Poor Hygiene

4. Make a nursing care plan of John based rom the problem identified.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION
Objective Data: After nursing  Offer scheduled Outcome met;
 Dx:  Ineffective intervention, client medications - Client was able to
schizophrenia therapeutic will take  Assess for side take prescribed
 Appears regimen medication as effects, and give medicine
guarded, treatment prescribed medications - Client was able to
suspicious, and  Provide factual verbalize
speaks to no After nursing information to the difficulties in
one intervention, client client: "This following
 Hair is matted will verbalize medication will medication
 Has a strong difficulties in decrease the voices regimen and
body odor following you're hearing." identify ways to
 Dressed in medication abide in the
several layers of regimen regimen
thick clothing After nursing  Provide supplies Outcome met;
 Refuses any  Self-care deficit intervention, client and privacy for - Client was able to
offers of food will shower or hygiene activities maintain proper
and drinks bathe, wash hair,  Give feedback hygiene and wear
and clean clothes about body odor, appropriate
Subjective Data: every other day dirty clothes clothing
 Pt verbalize “Do  Help client store
you want me to After nursing extra clothing
die?” when intervention, client where he has
approached will wear access to it and
with a dose of appropriate believes it is safe.
haloperidol clothing for the
weather or activity.

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 Disturbed thought During nursing  Engage client in Outcome met;
processes intervention, client present, here-and- - Client was able
will have 5-minute now topics not to express
interactions that related to feelings and
are reality based delusional ideas emotions
 Focus on client's
After nursing emotions and
interventions, client feelings.
will express
feelings and
emotions.

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