University of Perpetual Help System Dalta

Las Piñas City

Schizophrenia, Undetermined

A Case Study Presented to the

College of Nursing

In Partial Fulfillment for the Course

Requirement RLE 104

Luna, Charleene D
BSN 4K
CCMH
 Demographic Data:
Name: Ogiar, Emylinda
Age: 34 years old
Sex: Female
Marital status: Widowed
Nationality: Filipino
Occupation: None
Religion: Iglesia ni Cristo
Address: Montalban, Rizal
Father’s name: Yabut, Eming
Mother’s name: Yabut, Liling
Name of spouse: Ogiar, Casimiro (widowed)
Admission Date: June 7, 2002
Attending Physician: Dr. Regienald A. Afroilan M.D.
Diagnosis: Schizophrenia, Undifferentiated (chronic)
Chief Complaint:
• “palaboy-laboy”
• “namatay na asawa ko dahil sa kaiigib ng tubig”

General data

She doesn't have any emotion at all, whether her actions are showing happy nor sad. Her face is still the
same “blank” “No emotion”, or sometimes delayed emotions (Blunted affect). She doesn't speak
throughly, it is hard for me to understand what she's saying. She is making her own words (neologism).
When there is an activity example, while were dancing she's just copying what am I doing
(echophraxia).

Past history

According to the informant, she was formed to be roaming around their vicinity talking incoherently
and aimlessly that she was brought at NCMH hence admission.

Past Medical history

Unknown to the informant.

Past Psychiatric history

Unknown to the informant
Family profile
Unknown to the informant

Past Social history

Unknown to the informant

Drug and Alcohol history

Unknown to the informant

Mental Status Examination

Seen an adult female clad and presented orange duster and stripes shorts, poorly groomed with stooped
posture. Patient is behave, cooperative with poor eye contact. Mood is sad with appropriate affect.
Specify hypoproductivew and spontaneous with loosening of associations and flight of ideas. Auditory
or visual hallucinations and no homicidal or suicidal tendencies. Patient has poor memory disoriented
to time, place and person. Unable to interpret proverbs. Has poor insight of illness and fade judgement.
Family Genogram

Father
Mother

E.O.

Brother Brother

Sister Sister

II. Review of System.

• Physical Assessment:

SYSTEM ACTUAL FINDINGS

Vital Signs T: 36.7 C
PR: 84 bpm
RR: 18 cpm
BP: 90/60
HEENT Pale conjunctiva,anicteric sclera, (-) NABS, (-)
TPC, (+) bruise on the right eye
Neck (-) CLAD
Chest/Lungs Symmetrical chest expansion, (-) lugging, (-)
retractions, clear breath sounds
Heart Adynamic, pre cordium, NRRR, (-) murmur
Abdomen flat, NABS, soft, non tender
Extremeties No gross deformities, full and equal pulses
Neurological Exam

Cerebrum: Conscious, disoriented to 3 spheres

 Cerebellum: (-) nystagmus

CN I: N/A

II: 2-3 mins, pupils equally reactive to light

III,IV,VI: Intact EDM

V: (+) corneal reflex

VII: No facial asymmetry

IX,X: (+) gag reflex

XI: Shrugged shoulders

XII: Tongue at medicine

Diagnosis

Schizophrenia, Undifferentiated (chronic)

Description

Psychosis with adjective psychotic, literally means abnormal condition of the mind, and is a generic
psychiatric term for a mental state often described as involving a "loss of contact with reality". People
suffering from psychosis are said to be psychotic.

People experiencing psychosis may report hallucinations or delusional beliefs, and may exhibit
personality changes and disorganized thinking. This may be accompanied by unusual or bizarre
behavior, as well as difficulty with social interaction and impairment in carrying out the activities of
daily living.

ANATOMY AND PHYSIOLOGY:

In this section we will present you with the structures of the brain that are implicated in schizophrenia
and amphetamine psychosis. We hope you gain an understanding of these complex systems, so that
you will know more about what areas of the brain the research in this website will focus on. This
page will focus on three systems in the brain: the basal ganglia, limbic system and tegmentum.

Basal Ganglia

The basal ganglia is a collection of subcortical (beneath the cortex) nuclei in the forebrain (front area of
the brain). The cortex is the brain matter that makes up the outside of the brain; cortex literally means
"bark," so you can think of it as the bark of the brain. The parts of the brain beneath the cortex are
referred to as subcortical and include the midbrain and hindbrain, as well as structures not a part of the
midbrain and hindbrain. Nuclei are groups of neurons of similar shape.

The major parts of the basal ganglia consist of the caudate nucleus, the putamen and the globus
pallidus.

The basal ganglia is involved in the control of movement. The nucleus accumbens contains neurons
that are part of the basal ganglia. Thus, this structure may play a role in the regulation of movement,
including the control of complex motor activity and the cognitive aspects of motor control. In addition,
this structure has been found to possibly be the area that becomes activated in situations that involve
reward and punishment.

The nucleus accumbens is a nucleus of the basal forebrain. It receives dopamine-secreting terminal
buttons from neurons of the VTA and is thought to be involved in reinforcement and attention.

Limbic System

This system consists of a couple of brain structures. First it includes several regions of one form of
cortex called the limbic cortex; this cortex is also known as the cingulate cortex as shown in the
picture.

Besides the limbic cortex, the most important parts of the limbic system are the hippocampus and the
amygdala. The fornix and mammilary bodies are also parts of the limbic system.

The limbic system has been implicated in learning and memory and emotions. The implication in
emotions involves feelings and expressions of emotions, emotional memories and recognition of
emotions in other people.

Tegmentum

The tegmentum consists of an area of the midbrain. It includes the bottom end of the reticular
formation, the periaqueductal gray matter, the red nucleus, the substantia nigra and the ventral
tegmental area.

The reticular formation is a large structure consisting of many nuclei. It is also characterized by a
diffuse, interconnected network of neurons with complex dendritic and axonal processes. The reticular
formation receives sensory information and projects axons to the cerebral cortex, thalamus and spinal
cord.

The periaqueductal gray matter (PAG) is so called because it consists mostly of cell bodies of neurons
(these appear gray as opposed to axons which appear white) that surround an area of the brain called
the cerebral aqueduct. The PAG has been implicated in pain systems as well as behaviors such as
fighting and mating.

The red nucleus contains a bundle of axons; this is one of the two major fiber systems that bring motor
information from the cerebral cortex and cerebellum to the spinal cord.

The substantia nigra contains neurons whose axons project to the caudate nucleus and putamen parts of
the basal ganglia, this is known as the nigrostriatal system. The ventral tegmental area (VTA) is a
group of dopamine neurons in the midbrain whose axons form the mesolimbic and mesocortical
systems; this area plays a critical role in reward and reinforcement.

Neurons

Cells in the nervous system are called neurons. The neuron is an information processing and
transmitting cell that undermines all bodily functions. It is estimated that the human brain contains
over 100 billion neurons, with each neuron potentially communicating with hundreds of other neurons.
This vast interconnectedness allows simple neuronal activity to translate into complex neuronal
messages creating human behavior.

• A neuron is quite different from other cells in the human body, however there are similarities.
The features that distinguish a neuron from other cells are responsible for their unique activities.
The basic structure of a neuron includes a cell body (soma), dendrites, axon and axon terminal.

• The cell body includes the machinery that produces the proteins as well as other essential
aspects of a cell.

• The dendrites serve as chemical receivers in that they contain receptors for certain chemicals
that are released by other neurons.

• The axon transports a signal from the soma to the axon terminal.

• The axon terminal contains terminal buttons.

• When the signal reaches a terminal button a chemical messenger, known as a neurotransmitter,
is released into the synaptic cleft. This small gap connects the terminal button of one neuron
and the dendrite of another. The neurotransmitter binds to the receptors located on the
dendrites. This is how neurons communicate.
 NEURALTRANSMISSION

Dopamine

Dopamine is a neurotransmitter that is made from an amino acid called tyrosine. Amino acids are the
molecular units that make up proteins which among other things build cells in the body. Tyrosine is an
essential amino acid that humans obtain from their diets. The synthesis of dopamine from amino acid
is controlled by enzymes. The enzymes are responsible for adding or taking off atoms of the molecule,
thus making molecules such as dopamine. Dopamine is synthesized in the terminal buttons of neurons.

tyrosine dopamine

Certain neurons contain dopamine and have receptors that respond to its release. In the brain there are
three primary systems that involve dopamine; the nigrostriatal, mesolimbic and mesorcortical systems.
These circuits have their nuclei (clusters of cell bodies) in the substantia nigra (SN) and the ventral
tegmental area (VTA), respectively. This means that the circuits have dopamine synthesized in these
two areas.

 The substantia nigra projections are part of the nigrostrital system. The axons of the
nigrostriatal system project to the caudate nucleus and putamen of the basal ganglia. Because
the basal ganglia is highly implemented, a decrease in the number of dopamine neurons in the
SN and its pathway is believed to lead to Parkinson's Disease and Parkinsonian-like symptoms.

 The mesolimbic system involves the VTA and its projections lead to areas of the limbic system,
including the nucleus accumbens (NAc), amygdala, and hippocampus. The NAc is important in
the reinforcement aspects of many normal activities as well as drugs of abuse. When a person
eats, drinks, has sex or takes a drug, this pathway is excited. The excitation is pleasurable and
people want to further stimulate it to feel good. This is partly why people will become
gluttonous, sex addicts, and why certain drugs of abuse are so dangerous.
  The third system, the mesocortical system, also originates in the VTA, but it projects to the pre-
frontal cortex, instead of the limbic system. These neurons have an excitatory effect and are
involved in memory formation, planning, decision-making and problem solving. The
interworkings of the mesolimbic and mesocortical systems are the main focus of addiction
theory.

Pathophysiology

Prognosis

How well a person will do depends on the specific disorder. Long-term treatment can control many of
the symptoms

Treatment

The treatment of psychosis depends on the cause or diagnosis or diagnoses (such as schizophrenia,
bipolar disorder and/ or substance intoxication). The first line treatment for many psychotic disorders is
antipsychotic medication (oral or intramuscular injection), and sometimes hospitalisation is needed.
There is growing evidence that cognitive behavior therapyand family therapy can be effective in
managing psychotic symptoms. When other treatments for psychosis are ineffective, electroconvulsive
therapy (ECT) (aka shock treatment) is sometimes applied to relieve the underlying symptoms of
psychosis due to depression. There is also increasing research suggesting that Animal-Assisted Therapy
can contribute to the improvement in general well-being of people with schizophrenia.
LABORATORY EXAMINATION

 Hematology Test

HEMATOLOGY RESULTS
9.8
WBC
Hemoglobin 118
Hematocrit 36
Platelet count Adequate
Segmenters 0.71
Lymhocytes 0.25
Monocytes 0.04

 Urinalysis Examination

URINALYSIS RESULTS
Color Straw
Transparency Clear
Reaction (Ph) Acidic
Specific Gravity 1.01

Sugar Negative

 Chest x-ray

Lungs fields are clear

Heart is not enlarged
Diaphragm is normal in contour and position
Bony thorax is intact
Drug Study
Drug Name Indication Administration Contrain Special Adverse Drug Interactions Nursing Responsibility
and Dosage dications Precautions Effect
May be taken Comatose Parkinson's Drowsine Potentiation of -Assess for mental statues:
Generic: Management with or without states, disease; CV ss, anticholinergic delusions, hallucinations,
Chloroproma of food. (May be presence disease; jaundice, effects of disorganized speech,
zine manifestation taken w/ meals of large renal or postural antiparkinson disorganized or catatonic
s of to reduce GI amounts hepatic hypotensio agents and TCAs behavior, and negative symptom;
-Brand: psychotic discomfort.) of CNS impairment; n, may lead to an before and during therapy.
Laractyl, disorders, to depressant cerebrovasc extrapyra anticholinergic -Check for swallowing of oral
Psynor, control s, presence ular and midal crisis. Additive administration medication; check
Thorazine nausea and of large respiratoty effects, orthostatic for hoarding or giving of
vomiting, amounts disease; Persistent hypotensive effect medication to other patient.
- relief of of CNS jaundice; abnormal in combination -Monitor input and output ratio;
Classification restlessness depressant DM; movement with MAOIs. palpate bladder if low urinary
Antipsychotic and s, presence hypothyroid , cerebral Reverses output occurs, especially in
Drug apprehension of bone ism; edema, antihypertensive elderly, urinalysis recommended
before marrow paralytic hematolog effect of before, during prolonged therapy.
Action: surgery, acute depression ileus; ic guanethidine, -Monitor bilirubin, CBC, liver
treatment of . prostatic disorder, methyldopa and function studies monthly.
Blocks post tetanus, to Hypersens hyperplasia EKG clonidine. -establish baseline before starting
synape control itivity. or urinary changes. Potentially Fatal: treatment; report drops of 30
dopamine manifestation retention; Additive mmHg; obtain baseline ECG, Q-
receptors in s of manic epilepsy or depressant effect wave, and T-wave changes.
the brain. type of history of with sedatives, -Assess for EPS including
depressive seizures; hypnotics, akathisia (inability to sit still),
illness, relief myasthenia antihistamines, tardive dyskinesia (bizarre
of intractable gravis; general movements of the jaw),
hiccups: pregnancy; anaesthetics, pseudoparkinsonism.
Impulsivity, elderly opiates and alcohol -Give drug in liquid form mixed
difficulty in (especially in glass of juice or cola if
sustaining with hoarding is suspected.
attention, dementia), -Caution patient to avoid
aggressivity, and hazardous activities, blurred
mood debilitated vision may occur
liability and patients. - photosensitivity may occur
poor Avoid direct -Instruct patient to take anatacids
frustration sunlight. 2 hours before or after taking this
tolerance. drug.
-Instruct patient to report sore
Dosage: PO throat, malaise, fever, bleeding,
Intractable mouth sores; if these occur, CBC
hiccup should be drawn and drug
Initial: 25-50 discountinued.
mg 3-4
times/day for
2-3 days.
Psychaitric
conditions
25 mg 3
times/day.
Maintenance:
25-100 mg 3
times/day,
increased to
≥1 g/day if
needed in
psychotic
patients. IM
Psychoses;
Nausea and
vomiting
associated
w/ surgery
25-50 mg 6-8
hrly. Rectal
Psychiatric
conditions
As supp: 100
 mg 6-8 hrly .
Haloperidol Dosage:PO May be taken Severe Parkinsonis Tardive Carbamazepine Haloperidol can cause side
Psychoses with or without toxic CNS m; epilepsy, dyskinesia and rifampicin effects that may impair your
Category: 0.5-5 mg 2-3 food. (May be depression allergy, ; reduce plasma thinking or reactions. Be careful
Antipsychopot times/day, up taken w/ meals ; angle- extrapyra concentrations. if you drive or do anything that
ic/ to 100 to minimise GI preexistin closure midal Symptoms of CNS requires you to be awake and
butyrophenon mg/day in irritation.) g coma; glaucoma, reactions. depression may be alert.
e severe cases. Parkinson' benign Anxiety, enhanced by CNS Avoid getting up too fast from a
Maintenance: s disease; prostatic drowsines depressants e.g. sitting or lying position, or you
Trade Name: 3-10 mg/day. lactation. hyperplasia; s, alcohol, hypnotics, may feel dizzy. Get up slowly
Haldol Severe tics; severe depression general and steady yourself to prevent a
Tourette's cardiac or , anorexia, anaesthetics, fall.
syndrome hepatic transient anxiolytics and
Initial: 0.5- disease; tachycardi opioids. May Avoid drinking alcohol. It can
1.5 mg 3 extremes in a, postural reduce increase drowsiness or dizziness
times/day, up temp (hot hypotensio antihypertensive caused by haloperidol.
to 10 mg/day and cold n, action of Avoid becoming overheated or
in Tourette's weather); leukopenia guanethidine. May dehydrated during exercise and
syndrome. presence of ; increase risk of in hot weather. You may be more
Adjunct in acute anticholin arrhythmia when prone to heat stroke while you
severe infections or ergic side used with drugs are taking haloperidol.
anxiety or leucopenia; effects. that prolong QT
behavioral hyperthyroid interval or
disturbances ism; diuretics that can
0.5 mg twice pregnancy, cause electrolyte
daily. elderly, imbalance. May
Restlessness children. increase plasma
and Patients levels of
confusion 1-3 receiving haloperidol when
mg 8 hrly. anticoagulan used with
Intractable ts. clozapine or
hiccup 1.5 Discontinue chlorpromazine.
mg 3 upon signs Potentially Fatal:
times/day. of Increases lithium
IM Acute neurological blood levels and
 psychosis 2- toxicity in may predispose to
10 mg hrly or patients neuroleptic
4-8 hrly until taking malignant
symptoms haloperidol syndrome.
are and lithium.
controlled.
Max: 18
mg/day.
Nausea and
vomiting 0.5-
2 mg/day. SC
Restlessness
and
confusion 5-
15 mg over
24 hr.
Clozapine PO May be taken History of Leukocyte Drowsines Reduced plasma Check the Vital Signs regularly.
Schizophreni with or without bone counts s, concentrations Daily weight.
a 12.5 mg 1- food. marrow should be dizziness, with concomitant Record input and output.
2 times on disorders monitored headache; use of phenytoin. Provide Safety
day 1, including regularly nausea, May enhance the Check Baseline WBC count
followed by agranuloc and for at vomiting, central effects of before initializing treatment.
25 mg 1-2 ytosis, least 4 wk constipatio MAOIs. Check and observe for signs of
times on day circulatory after n; anxiety, Potentially Fatal: agranulocytosis.(sorethroat,
2. Increase collapse, treatment confusion, Concurrent use fever, malaise)
gradually alcoholic discontinuati fatigue, with bone marrow
according to or toxic on. Renal, transient suppressants e.g.
response. psychosis, hepatic or fever. carbamazepine, co-
Usual range: drug cardiac Rarely, trimoxazole,
200-450 intoxicatio impairment; dysphagia, chloramphenicol,
mg/day. n, prostatic acute penicillamine,
Max: 900 uncontroll enlargement pancreatiti sulfonamides,
mg/day. ed , narrow- s, antineoplastics or
Psychoses in epilepsy, angle cholestatic pyrazolone
parkinsonism severe glaucoma; jaundice; analgesics; long-
 Initial: 12.5 renal, elderly; orthostatic acting depot
mg/day at hepatic or immobilised hypotensio antipsychotics.
night, cardiac patients n,
increase disease; tachycardi
gradually. paralytic a;
Usual range: ileus. seizures;
25-37.5 Pregnancy hypersaliv
mg/day. and ation.
Max: 100 lactation. Potentiall
mg/day. y Fatal:
Rarely,
thromboe
mbolism.
Reversible
neutropeni
a which
may
progress to
a
potentially
fatal
agranuloc
ytosis.
Fatal
myocarditi
s.
This comatose or May be Presence of Hypersen Reduces Advise client not to start, stop or
medication is severely taken with convulsive sitivity; antihypertensive change the dosage of any
-Generic: a long-acting depressed states. comatose effects of medicine before checking with
Prolixin form of not intended for or without disorders; or severely guanethidine, them first.
Decanoate fluphenazine use in children food. hepatic, depressed methyldopa and Check to see if client is taking
that is used to under 12 years states; clonidine. Lithium any of the following drugs:
-Brand: treat certain of age. renal, blood toxicity. Reduced anticholinergics (e.g., atropine),
FLUPHENAZ mental/mood patients who cerebrovasc dyscrasias; bioavailability dopamine agonists (e.g.,
INE problems have shown liver with antacids. cabergoline, pergolide),
DECANOAT (chronic hypersensitivity ular, resp disease; Increased risk of guanadrel, guanethidine, lithium,
E INJ schizophreni to fluphenazine; and CV bone arrhythmia when sibutramine
a). cross-sensitivity marrow used with drugs Precaution:
Classification: Fluphenazine to phenothiazine diseases; depression that prolong QT There may be a slightly
phenothiazine decanoate is derivatives may elderly or ; interval. May increased risk of serious,
s and is also usually used occur. phaeochro cause electrolyte possibly fatal side effects (e.g.,
referred to as in patients debilitated mocytoma disturbance when pneumonia, heart failure) when
a neuroleptic. who have patients. ; suspected used with this medication is used in older
benefited May elevate or diuretics. adults with dementia. This
from regular establishe Potentially Fatal: medication is not approved for
doses of prolactin d Additive CNS the treatment of dementia-related
short-acting levels which subcortical depressant effects behavior problems
forms of brain with alcohol,
fluphenazine may persist damage barbiturates,
and who may after chronic with or hypnotics,
benefit from admin. May without sedatives, opiates
long-term hypothala and antihistamines.
(maintenance exacerbate mic
) treatment depression. damage;
with less pregnancy
frequent Closed- (3rd
dosing. angle trimester),
Dosage: PO glaucoma. lactation.
Mania;
Psychoses; History of
Schizophreni jaundice,
a Initial: 2.5-
10 mg/day in parkinsonis
2-3 divided m, DM,
doses. hypothyroid
Maintenance:
1-5 mg/day. ism,
Adjunct in myasthenia
severe
gravis,
anxiety or
behavioral paralytic
disturbances ileus,
1 mg twice
daily, up to 2 prostatic
mg twice hyperplasia
daily if
needed. IM or urinary
Mania; retention.
Psychoses; Regular eye
Schizophren
ia As examination
decanoate: s in patients
Initial: 12.5
mg, adjust receiving
subsequent long term
doses and therapy.
dosing
intervals Avoid direct
based on sunlight
patient's
response. exposure.
Maintenance:
12.5-100 mg
2-6 wkly.
 Nursing Care Plan

Assessment Diagnosis Planning Intervention Rationale Evaluation

Objective: Disturbed Long Term • Utilize safety measures • During acute phase Goal
• Restlessn Thought Goals: Client to protect clients. client’s delusional or Partially
ess Processes will demonstrate • Attempt to understand flight of ideas might Met. The
• (+)Flight related to two effective the significance of dictate to them that patient able
of ideas Chemical coping skills that these beliefs to the they might have to to talk about
• Good skin Alterations as minimize client at the time of hurt others. External concrete
turgor manifested by delusional their presentation. control might be happenings
• Weak in Memory thoughts by One • Be aware that client’s needed without flight
appearanc Deficit. month nursing delusions represent the • Important clues to of ideas but
e Intervention. way that he experiences underlying fears and still irritable
• Irritable reality. issues can be found in (standing
at times Short Term • Identify feelings related the clients seemingly up).
Goals: to flight of ideas or illogical fantasies
• Vital
Client will Talk delusions. • Identifying the clients
signs:
about concrete • Do not argue with the experience allows the
BP:
happenings in clients belie or try to nurse to understand
110/70M
the correct false beliefs the client’s feelings.
Mhg
environmental using facts. • When people believe
Temp:
without flight of that they are
36.5C • Do not touch the client;
ideas for Five understood anxiety
RR: 21 Use gestures carefully
minutes during might lessen.
CPM
the nurse-patient • Interact with clients on
PR: 88 the basis of things in • Arguing will only
interaction. increase client’s
BPM the environment. Try to
distract client from defensive position,
their delusions by thereby reinforcing
engaging in reality false beliefs. This will
based activities (Cards, result in the client
simple board games feeling even more
and simple arts and isolated and
crafts). misunderstood.
• Teach client coping • A psychotic person
skills that minimize might interpret touch
“Worrying” thoughts. as either aggressive or
Coping skills include: sexual in nature and
 Talking a might interpret
trusted friend gestures as aggressive
 Phoning a moves. People who
helpline are psychotic need a
 Singing lot of personal space.
 Going to a gym • When thinking is
 Thought- focused on reality-
stopping based activities, the
techniques client is free of
• Encourage healthy delusional thinking
habits to optimize during that time. Help
functioning: focus attention
externally.
 Maintain
regular sleep pattern. • When client is ready,
teach strategies client
 Reduce alcohol
can do alone.
and drug intake.
• All are vital to help
• Encourage patient in
keep client in
participation in
remission.
regular exercise
program.
• Recommend quiet
activities
• Instructed patient to do
relaxation techniques.
 Assessment Diagnosis Planning Intervention Rationale Evaluation

Objective: Long Term • Decrease • Decrease potential for Goal Met. The
• Restlessn Disturbed Goal: environmental anxiety that might patient was able
ess Sensory Client will stimuli when trigger hallucinations, to demonstrate
• (+)Flight Perception demonstrate possible (Low Help calm client. one stress
of ideas related to techniques that noise, Minimal reduction
• Weak in Psychosis as will reduce Activity) technique with in
appearanc manifested by anxiety within • Validating that your the 5 hours
e Altered One month of • Accept the fact reality does not include nurse-patient
• Irritable communication nursing that the voices are voices can help client interaction.
at times pattern. intervention. real to the client, cast “Doubt” on the
• (+) but explain that validity of his voices.
Auditory Short Term you do not hear
distortion Goal: the voices.
s After Five • Clients can sometimes
hours nurse learn to push voices
• With
patient • Stay with clients aside when given
inappropr
interaction, the when they are repeated instruction,
iate
client will able starting to especially within the
responses
demonstrate one hallucinate, and framework of a trusting
• Lack of stress reduction
cooperati direct them to tell relationship.
technique. the “Voices they
on
hear” to go away.
Repeat often in a
matter of fact
manner.

• Clients thinking might

• Keep simple, be confused and
basic, reality- disorganized; this
based topics of intervention helps
conversation. client focus and
Help client to comprehend reality-
focus on one idea based issues.
 at a time.
• Exploring the
• Explore how the hallucination and
hallucinations are sharing the experience
experienced by can help give the
the client. person a sense of
power that he might be
able to manage the
hallucinatory voices.

• Help the client to • Hallucination might

identify times that reflect needs for:
might underlie the A. Power
hallucinations. B. Self-esteem
C. Anger
D. Sexuality

• Help client to • Helps both nurse and

identify times that client identify
the hallucinations situations and times
are most prevalent that might be most
and frightening. anxiety producing and
threatening to client.
• Engage client in
simple physical • Redirecting client’s
activities or tasks energies to acceptable
that channel activities can decrease
energy.(Writing, the possibility of acting
drawing, crafts on hallucinations and
and help distract from
noncompetitive voices.
sports.
• Work with the
client to find • If clients stress triggers
which activities hallucinatory activity,
help reduce they might be more
anxiety and motivated to find ways
distract the client to remove themselves
from from a stressful
hallucinatory environment or try
material. Practice distraction techniques.
new skills with
client.

• Be alert for signs • Might herald

of increasing fear, hallucinatory activity,
anxiety or which can be very
agitation. frightening to client
and client might act
upon command
hallucinations.(Harm
self or others)
• Intervene before
• Intervene with anxiety begins to
one-on-one, escalate.
seclusion or PRN
medication when
appropriate.