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28 Cards in this Set

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goals of treatment for schizophrenia
build trust
provide safe/secure environment
clarify & reinforce reality
promote/build self esteem
encourage independent behavior
provide care to meet basic human needs
assist in medical treatment
deal w/withdrawn behavior
deal w/hallucinations and/or delusions
ways to build trust w/a schizophrenia pt
comes from interactions, even just sitting with them. Maybe then do a 1:1 activity (coloring) within their abilities. Get person who is withdrawn, mistrustful to interact w/you or get used to you. Brief, frequent contact. And then they may be able to participate in Milieu.
ways to build clarify & reinforce reality w/a schizophrenia pt
matter-of-factly. Remember you were brought here to the hospital because you weren’t taking care of yourself, taking your meds.
ways to promote/build self-esteem
no competitiveness involved – oh, you fixed your hair different today! – nothing positive or negative just acknowledge the change.
ways to deal with withdrawn behavior
meet people where they are. (in their room, then encourage them to leave room)
which nursing diagnosis for schizophrenia is high priority diagnosis
risk for violence, self or other-directed
goal for nursing diagnosis risk for violence
seek out staff for support when they feel more anxious.
interventions for nursing diagnosis risk for violence
if anxiety is going up, decrease stimuli (go to room), offer medication, observe more frequently than Q15 checks – matter of unit routine, physical exercise, have calm attitude and if necessary get sufficient staff if they can’t be redirected. The more empathetic you can be when they are worked up, the better you will be able to manage the person. Previously established relationship w/person is very helpful.
long term goal for nursing diagnosis social isolation
participate in milieu
interventions for nursing diagnosis social isolation
brief frequent contact, unconditional positive regard, stay w/client during groups to be supportive, orient PRN, watch touching people w/schizophrenia – can be tactile defensive
interventions for nsg diagnosis ineffective coping, family
Educate patient in small increments about their illness when appropriate – also family
Round during visiting hours to see interaction w/family
Educate about medicines
short term goal for nsg diagnosis disturbed sensory perceptions: auditory/visual hallucinations
discuss content of hallucination
long term goal for nsg diagnosis disturbed sensory perceptions: auditory/visual hallucinations
recognize this is a symptom & part of illness and help find ways to interrupt that.
interventions for nsg diagnosis disturbed sensory perceptions: auditory/visual hallucinations
If you see them gesturing/posturing – ask what they are hearing/seeing. Call them voices. Acknowledge they are real to person but not something that I hear. Try to connect increased anxiety with symptoms. Key to helping them become less prominent is for person to feel less anxious. Key to managing is less anxious. When they can recognize that, help them be distracted – listen to radio or TV to drown out voices may help. Some tell voices to leave them alone – gives them control over voices. In conversation focus on hear & now – reality based. After you know about hallucination, focus on feeling (empathy). That must be very frightening to you. Or it sounds like what the voices are telling you is very confusing to you because it is different than what we are telling you.
interventions for disturbed thought processes
Specifically delusions - can’t convince them that they are wrong. Redirect them to reality (whatever topic you want to discuss). Just find out what they are – don’t argue, deny, defend.
Reasonable but doubt – geez I find that hard to believe. You know what, I’ve never heard such a thing. If you don’t understand what they are saying, never assume, ask them. Can you give me an example, I’m not sure what you mean. I’ve noticed that when you’re thinking about ____, I notice how nervous/anxious you look. Do you recognize that having (those thoughts) makes you anxious? Discuss ways to reduce anxiety, or how meds may help.
Reinforce & focus on reality – assist them in attempt to identify feelings
Once delusion is voiced & understood, discourage repetitive talk about it by distracting with activity or talking about reality. Focus on the feeling.
interventions for impaired verbal communication
Want same staff, want to try to decode what they are saying. Don’t pretend you understand when you don’t. if you continue to not understand, try to relate to feeling – I know it’s frustrating for you to try to make me understand. Do you mean . . . .. ask them to explain it. If totally mute, verbalize the implied. Meet their needs – try guessing what they are talking about
general interventions
Set limits on behavior that interfere or are disruptive to others (decrease stimuli if acting up)
Don’t go along with delusions/hallucinations
Simple, concrete activities – card playing, whatever is within their means
Stay with someone who is frightened – reduce anxiety (decr stimuli, stay with, med)
Remove patient from group if behavior too disturbing
With people having hard time verbalizing – give other options – writing, music, art
Monitor them for potential for acting out – don’t let them escalate
Having same staff helps build trust
general considerations for dissociative disorders
women dissociate more often
symptoms of mild dissociative disorders
Feeling of watching self in movie
Look in mirror and don’t recognize self
2/3 young adults feel like in dream world
symptoms of dissociative amnesia
Inability to recall important information about life/identify
Aware that they cannot remember
Coping mechanism is repression (unconscious)
Onset may be brief clouding
Not due to substance use or medical conditions
symptoms of dissociative fugue
Assume new identity in a new place – lose memory of previous life
Extremely rare
Duration is brief – hours, day, rarely months
Do not function abnormally in new life
Can be briefly confused when they come out of it
characteristics of depersonalization disorder
People who are borderline personality disorder can have this as a symptom
Schizophrenia can too
Disorder when persistent feeling of being detached from body/thoughts
Sense of body changing in some way, feel detached from environment
Has to do with their own subjective experience
differentiate depersonalization and derealization
depersonalization has disturbed perception of self
derealization has disturbed perception of external environment
most recognized dissociative disorder
dissociative identity disorder
characteristics of dissociative identity disorder
Formerly multiple personality disorder
Most spectacular & controversial
Don’t have multiple personalities, but a fracturing of the personality
Broken up personalities referred to as alters and can have different behavior patterns (different genders, names)
Connectivity/comorbidity with early trauma – do this to protect themselves
Can be psychotic, have depression, eating disorders, panic attack, high incidence of substance abuse
** list Yalom's Curative Factors - what makes a group helpful
instillation of hope
universality
education/information
altruism
re-experience & attempt to resolve earlier life conflicts
development/correction of socialization skills
role modeling
interpersonal learning
group cohesion
catharsis
existential factors
considerations for group therapy
Goal – important
Physical conditions that influence group dynamics – group rules needed, once they are laid out they usually follow them
Group mix – if people cannot adhere to rules, it’s unrealistic to believe they could be part of it
Leadership style – good leader facilitates the group interactions, adopt leadership style that best fits group
Role of RN – facilitate
Type of Group – vary
Group development phase
two aspects of group treatment
Content - what the group is talking about
Process - good group therapist pays attention to this - how they interact, who responds a lot, who doesn’t talk. Try to incorporate others into the conversation. If someone rolls eyes or interrupts, you need to call them on it. Make lots of observations, noticed being fidgety don’t say you looked nervous