tag:blogger.com,1999:blog-47413785399585291752024-03-13T22:53:14.844-07:00Nursing process for Schizophrenia.EkaEka Komalasarihttp://www.blogger.com/profile/01067337300491408849noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-4741378539958529175.post-64962524033830468032009-12-17T19:33:00.000-08:002009-12-20T20:05:04.995-08:00Schizophrenia<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 12"><meta name="Originator" content="Microsoft Word 12"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CUser%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml"><link rel="themeData" href="file:///C:%5CDOCUME%7E1%5CUser%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx"><link rel="colorSchemeMapping" href="file:///C:%5CDOCUME%7E1%5CUser%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_colorschememapping.xml"><!--[if gte mso 9]><xml> <w:worddocument> 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font-stretch: normal;"> </span></span></span></b><!--[endif]--><b><span style="font-size: 14pt;" lang="EN-US">Schizophrenia <o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 28.5pt;"><span style="" lang="EN-US">Schizophrenia is a discussion that attracts attention to annual conference The American Psychiatric Association/APA in Miami, Florida, United States, May 1995 ago.<span style=""> </span>Because of in United States the rates of schizophrenia patients was quite high (lifetime prevalence rates) reached 1/100 citizens. As comparison, in Indonesia if to PJPT I the rates 1/1000 citizens if the projection to PJPT II, 3/1000 citizens even can higher again. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 28.5pt;"><span style="" lang="EN-US">Based on data in United States: <o:p></o:p></span></p> <ol style="margin-top: 0cm;" start="1" type="1"><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Annually there are 300.000 schizophrenia patients having acute episode; <o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Prevalence of schizophrenia<span style=""> </span>is higher than Alzheimer disease, multiple sclerosis, diabetic patient who uses insulin and muscular dystrophy); <o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">20% - 50% schizophrenia patients try to<span style=""> </span>commit suicide and 10% of them succeed (death because of suicide); <o:p></o:p></span></li></ol> <span style="font-size: 12pt; font-family: "Times New Roman","serif";" lang="EN-US">The rates of schizophrenia patients are 8 times higher than death rates of citizen in general.
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<![endif]--> <p class="MsoNormal" style="margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span style="font-size: 14pt;" lang="EN-US"><span style="">B.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b><span style="font-size: 14pt;" lang="EN-US">Causing Factors of Schizophrenia <o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 28.5pt;"><span style="" lang="EN-US">Until now has not found definite etiology why someone who suffers schizophrenia, although others don’t. In fact from the previous researches conducted has not found single factor. Causing factors of schizophrenia based on recent researches such as: <o:p></o:p></span></p> <ol style="margin-top: 0cm;" start="1" type="1"><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Genetic factor<o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Virus; <o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Auto antibody<o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Malnutrition <o:p></o:p></span></li></ol> <p class="MsoNormal" style="margin-left: 18pt; text-align: justify;"><span style="" lang="EN-US">How far the role of genetic to schizophrenia? From the research gained description as follows: <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 19.95pt; text-align: justify; text-indent: -19.95pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">A study to a family said that parents 5.6%, brother or sister 10.1%; children 12.8%; and citizen entirely 0.9%. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 19.95pt; text-align: justify; text-indent: -19.95pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">A study to twin people<span style=""> </span>said identical twin 59.20%; while fraternal twin 15.2%. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 19.95pt;"><span style="" lang="EN-US">Other researches said that disorder to fetus brain also has role for the emerging of schizophrenia someday. This disorder emerged, such as malnutrition, infection, trauma, toxin and hormonal disorder. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 19.95pt;"><span style="" lang="EN-US">Recent research said that although there is abnormal genetic schizophrenia will not emerge unless along with other factors named epigenetic factor. The conclusion is schizophrenia emerges if occur interaction between abnormal genetic with: <o:p></o:p></span></p> <ol style="margin-top: 0cm;" start="1" type="a"><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Virus or other infection during pregnancy<span style=""> </span>which can disturb<span style=""> </span>the development of fetus brain<o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Based on autoimmune which probably<span style=""> </span>caused by infection during pregnancy <o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Pregnancy complication <o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Quite serious malnutrition, particularly to trimester pregnancy <o:p></o:p></span></li></ol> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US"><o:p> </o:p></span></p> <span style="font-size: 12pt; font-family: "Times New Roman","serif";" lang="EN-US">Furthermore, pointed that people who have epigenetic factor, if having psychosocial stressor in life, thus the risk is higher to suffer schizophrenia than people who have not previous epigenetic factor.</span>
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font-size:10.0pt; font-family:"Calibri","sans-serif";} </style> <![endif]--> <p class="MsoNormal" style="margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b><span style="" lang="EN-US"><span style="">C.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b><span style="font-size: 14pt;" lang="EN-US">General Causing of Mental Disorder</span><span style="" lang="EN-US"><o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 28.5pt;"><span style="" lang="EN-US">Human reacts entirely, wholly, or can be said also somato-psycho-social. In searching the causing of mental disorder, thus these three elements should be pay attention. Mental disorder is a pathologic dominant symptom from physic elements. This case is not means that other element is not disturbed. Once again, who sick and suffer is human wholly and not only his or her body, mental but also environment. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 28.5pt;"><span style="" lang="EN-US"><span style=""> </span>The cases that can influence<span style=""> </span>human behavior are inherit and constitution,<span style=""> </span>age and sex, physical condition, psychological condition, family, custom, culture and belief, job, married and pregnancy, losing and death of someone who loved, aggression, hostility feeling, relationship between human etc. Table below is raw estimation the sum of patients some mental disorder type in one year in Indonesia with citizens 130 millions people. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 28.5pt;"><span style="" lang="EN-US"><span style=""> </span><b>Table 4.1. </b><span style=""> </span>Sum of Mental Disorder Client in Indonesia<o:p></o:p></span></p> <table class="MsoNormalTable" style="border: medium none ; border-collapse: collapse;" border="1" cellpadding="0" cellspacing="0"> <tbody><tr style=""> <td style="border: 1pt solid windowtext; padding: 0cm 5.4pt; width: 203.85pt;" valign="top" width="272"> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Psycho functional <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Syndrome of acute organic brain<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Syndrome of yearly organic brain<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Mental retradation <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Neuron<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Psychosomatic<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Personal disorder<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Drugs addiction<o:p></o:p></span></p> </td> <td style="border-style: solid solid solid none; border-color: windowtext windowtext windowtext -moz-use-text-color; border-width: 1pt 1pt 1pt medium; padding: 0cm 5.4pt; width: 97.95pt;" valign="top" width="131"> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">520.000<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">65.000<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">130.000<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">2.600.000<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">6.500.000<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">6500.000<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">1.300.000<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">1.000<o:p></o:p></span></p> </td> </tr> <tr style=""> <td style="border-style: none solid solid; border-color: -moz-use-text-color windowtext windowtext; border-width: medium 1pt 1pt; padding: 0cm 5.4pt; width: 203.85pt;" valign="top" width="272"> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US"><o:p> </o:p></span></p> </td> <td style="border-style: none solid solid none; border-color: -moz-use-text-color windowtext windowtext -moz-use-text-color; border-width: medium 1pt 1pt medium; padding: 0cm 5.4pt; width: 97.95pt;" valign="top" width="131"> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">17.616.000<o:p></o:p></span></p> </td> </tr> </tbody></table> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US"><span style=""> </span>Although, general symptoms or prominent symptoms are in the mental components, however the main causes<span style=""> </span>probably in the body (somatogenetic), in<span style=""> </span>social environment (sociogenic) or dipsike (psychogenic). Usually there is no single cause, but there are some causes directly from some components that influence each other or coincidence occur at the same time, then emerge<span style=""> </span>physic or mental disorder. For instance someone who depression, because lack of eating and sleep his or her immune become decreases thus having throat inflammation or someone with mania got accident. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US"><span style=""> </span>Vise versa someone with physic illness for instance inflammation that weaken, thus psychological immune also decrease thus he or she having depression. It is been known also, that illness to brain often causing mental disorder. Another example is a child who has brain disorder (because in birth, inflammation etc) then become hyperkinetic and hard to care. He or she influences environment, particularly parents and other families in the same home. They react one another and they influence each other. <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US"><span style=""> </span>The causing source of mental disorder influenced by factors to three components that persistently influence each other, those are: <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -36pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Somatic factors (somatogenetic) or Organ biological<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 39.9pt; text-align: justify; text-indent: -17.1pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">a.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Neuron anatomy <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 39.9pt; text-align: justify; text-indent: -17.1pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">b.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Neuron physiology<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 39.9pt; text-align: justify; text-indent: -17.1pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">c.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Neuron chemical <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 39.9pt; text-align: justify; text-indent: -17.1pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">d.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Maturation<span style=""> </span>level and organic development<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 39.9pt; text-align: justify; text-indent: -17.1pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">e.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Pre and peri-natal factors<span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -36pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Psychological factors (psychogenic) or psychoeducative <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -16.05pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">a.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Interaction of mother-child: normal (confidence and safety<span style=""> </span>feeling) or abnormal based on the lack, distortion and break condition (unconfident<span style=""> </span>and doubt feeling)<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -16.05pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">b.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Father’s role<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -16.05pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">c.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Competition between brother or sister<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -16.05pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">d.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Intelligence<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -16.05pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">e.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Relationship in family, job,<span style=""> </span>playing and public. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -16.05pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">f.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Loss that cause worried, depression, shame or guilty feeling<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -16.05pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">g.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Self concept; self identity understanding against indefinite role<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -16.05pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">h.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Skills, talent and creativeness <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -16.05pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">i.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Adaptation pattern and defense as reaction toward danger. <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -16.05pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">j.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Emotional development level<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 36pt; text-align: justify; text-indent: -36pt;"><!--[if !supportLists]--><span style="" lang="EN-US"><span style="">3.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="" lang="EN-US">Social culture factors (sociogenic)<o:p></o:p></span></p> <ol style="margin-top: 0cm;" start="1" type="a"><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Family stability<o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">The pattern of caring child <o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Economy level <o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Housing: cities against villages <o:p></o:p></span></li><li class="MsoNormal" style="text-align: justify;"><span style="" lang="EN-US">Minority group problem which covers prejudice and health facilities, education and welfare which are not appropriate<o:p></o:p></span></li></ol> <span style="font-size: 12pt; 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class="MsoListParagraphCxSpFirst" style="margin-left: 21.3pt; text-align: justify; text-indent: -18pt;"><!--[if !supportLists]--><b style=""><span style="font-size: 14pt;"><span style="">D.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span></b><!--[endif]--><b style=""><span style="font-size: 14pt;">Etiology<o:p></o:p></span></b></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span style="">Detailed knowledge of the cause or causes of schizophrenia is lacking. Genetic factors are important in some (perhaps all) cases, but it is not yet clear which genes are deviant, how they contribute to pathophysiology, or whether the same or different genes are invilved in all cases that have a genetic etiology.<o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span style="">Other early influences, variously marked by gestational and birth complications and winter birth excess, must be involved in the causal pathways for schizophrenia, but the pathophysilogical mechanisms underlying the involvement of those factors are not yet know. Various versions of viral and immun theories of causation are plausible, but no virus or immune mechanis has yet been established as an etiological factors<span style=""> </span>in schizophrenia.<o:p></o:p></span></p> <p class="MsoListParagraphCxSpMiddle" style="margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span style="">For about a decade a cntral question underlying the investigation of etiology of schizophrenia has been whether schzophrenia ia a neurodevelopmental or neuropathological disorder. Is the causes of schizophrenia to be found in failure of the brain to develop nomally, or is it to be found in a disease process that alters a normally developed brain? Both causes, of course, may be true,for the schizophrenia syndrome probably represent more than one etiological and disease proses, and a developmental abnormality may increase the risk for subsequent disease pathogeneity. However, although there are sporadic reports of a disease process and subsequent neuropathological response, the preponderance of evidence is consistent with the hypothesis that schizophrenia is a neurodevelopmental disorder. The consistency with which the know data point to early deviations in the development of the central nervous system (CNS) has been useful in focusing theory and investigative work.<o:p></o:p></span></p> <p class="MsoListParagraphCxSpLast" style="margin-left: 0cm; text-align: justify; text-indent: 36pt;"><span style="">Increasing information on the neurobiology of brain development has led to considerable new knowledge of the mechanism of pathogenic influences. It is now clear taht subtle deviations in brain development could create dysfunctions associated with specific behaviors. Postmortem findings of abnomalities in pyramidal cell density and aligment, although not always replicated, support the proposition that the developmental process of cell migration underlying the establishment of normal brain cytoarchitecture may go awryin schizophrenia. Alternatively, it is known that the braiin has extensive redundancy during the developing years, and that the fine-tuning necessary for efficient funtioning involves eliminating certain nerve cells and many of the synapses connecting cells. Inadequate pruning of nerve cells and synapses or errors in selection for pruning could, in theory, underlie dysfunctions that later lead to schizophrenia symptoms.<o:p></o:p></span></p> <span style="font-size: 12pt; font-family: "Times New Roman","serif";">Principal hypothese regarding causesation include the altered expression of genes, neoroimmunovirology factors, and hypoxic damage during gestation and birth.</span>
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mso-fareast-font-family:Calibri; mso-hansi-font-family:Calibri;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 72.0pt 72.0pt 72.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif";} </style> <![endif]--> <p class="MsoNormal"><b style=""><span style="font-size: 14pt;" lang="EN-US">Nursing Diagnosis<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-indent: 36pt;"><span lang="EN-US">As indicated by the assessment, a person with schizophrenia may have a variety of symptoms. Although there may be many clients on a unit with schizophrenia, each may present with different personal needs and defensive behaviors. Each client requires a nursing care plan that reflects individual needs and strategies appropriate to the client’s behaviors and level of functioning. Some nursing diagnoses that are appropriate to nurses’ work with schizophrenic clients are discussed.</span></p> <p class="MsoNormal" style="text-indent: 36pt;"><span lang="EN-US">During the course of schizophrenia, a client is likely to experience positive (hallucinations, delusions) and negative (withdrawal, poor social functioning) symptoms. During this time, impairment in thought processes may be evident in the client’s ability to reason, problem-solve, make decisions, and concentrate. These distortions alter the client’s ability to perceive reality accurately (hallucinations or delusions) and usually impair the client’s judgment. A nursing diagnosis of altered thought process is appropriate. Altered thought process may be related to alteration in biochemical compounds, panic,<span style=""> </span>levels of anxiety, emotional trauma, and so forth.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>With alteration in thought process come changes in language and speech. Therefore, impaired verbal communication may be a problem to varying degrees. When looseness of communicate needs or feelings. The nurse interacts in a variety of ways to try to understand and help reduce the client’s anxiety. Use of neologisms, echolalia, clang associations, and word salad contribute to the client’s impaired verbal communication.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>When a person is unable to interpret the world accurately his or her ability to cope with environment is also impaired. Therefore, ineffective individual coping is most always present. A person’s ineffective individual coping may be evidenced by inappropriate use of defenses mechanisms and inability to meet role expectations. Symptoms may include withdrawal or excitability, disorganized or regressive behaviors, paranoid or disorganized thinking, and inability to meet basic needs.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>A person who is extremely paranoid may have special problems. For example, if the person is refusing to eat because he or she thinks the food is poisoned then altered nutrition: less than body requirements is used.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>“Voices” that tell the person to harm others or himself or herself can result in bodily harm or even death to the client or others. High risk for violence directed at others or self-directed would take priority (refer to section on paranoia).</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>During the excited phase of catatonia, a client may be highly agitated and can exhaust himself or herself to a dangerous level if rest and high-calorie fluid replacement are not immediately provided. Extreme hyperactivity can lead to cardiac or respiratory collapse and indicates a nursing diagnosis of activity intolerance.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>During extreme withdrawal, attention to physical care is vital. Some useful nursing diagnoses might be (1) constipation/incontinence, (2) impaired physical mobility, or (3) self-care deficit: feeding, bathing, dressing/grooming, and toileting.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span><span style=""> </span>When the disease becomes chronic, it is not uncommon to note multiple admissions to a unit. Problems with compliance with medications is thought to be a major factor. Families with schizophrenic members may have their own confused patterns of communication and insufficient knowledge of the client’s problems or may feel powerless in coping with the client at home. Ineffective family coping: compromised or disabling may be an important area for intervention by members of the health care team, especially in relation to discharge planning.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>Most people with schizophrenia suffer from a low self-concept. There is often confusion of sexual identity, as well as unrealistic and confuses the person’s perception of body image. Disturbance in self-esteem is usually present.</span></p><p class="MsoNormal">
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name="Bibliography"> <w:lsdexception locked="false" priority="39" qformat="true" name="TOC Heading"> </w:LatentStyles> </xml><![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:-1610611985 1107304683 0 0 159 0;} @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-1610611985 1073750139 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman","serif"; mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US; mso-fareast-language:EN-US;} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-size:10.0pt; mso-ansi-font-size:10.0pt; mso-bidi-font-size:10.0pt; mso-ascii-font-family:Calibri; mso-fareast-font-family:Calibri; mso-hansi-font-family:Calibri;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 72.0pt 72.0pt 72.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif";} </style> <![endif]--> </p><p class="MsoNormal"><b style=""><span style="font-size: 14pt;" lang="EN-US">Planning<o:p></o:p></span></b></p> <span style="font-size: 12pt; font-family: "Times New Roman","serif";" lang="EN-US"><span style=""> </span>Planning involves more than the identification of measurable and attainable goals. Identification of personal reactions and feelings regarding the client is necessary if the interventions in the nursing care plan are to be carried out effectively. Therefore, planning involves (1) content level-planning goals and (2) process level-nurses’ reactions and feelings.</span><p></p><p class="MsoNormal">
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mso-fareast-language:EN-US;} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-size:10.0pt; mso-ansi-font-size:10.0pt; mso-bidi-font-size:10.0pt; mso-ascii-font-family:Calibri; mso-fareast-font-family:Calibri; mso-hansi-font-family:Calibri;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 72.0pt 72.0pt 72.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif";} </style> <![endif]--> </p><p class="MsoNormal"><b style=""><span style="font-size: 14pt;" lang="EN-US">C</span></b><b style=""><span style="font-size: 14pt;">ontent </span></b><b style=""><span style="font-size: 14pt;" lang="EN-US">L</span></b><b style=""><span style="font-size: 14pt;">evel </span></b><b style=""><span style="font-size: 14pt;" lang="EN-US">– P</span></b><b style=""><span style="font-size: 14pt;">lanning</span></b><b style=""><span style="font-size: 14pt;" lang="EN-US"> G</span></b><b style=""><span style="font-size: 14pt;">oals<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-indent: 36pt;"><span style="">I</span><span lang="EN-US">t is important that goals be both meaningful and attainable by nursing action. The goals are usually directed toward the “related to” component of the nursing diagnosis. Therefore, altered thought process related to isolation and altered thought process related to unclear communications would have different short term and long term goals. The goals listed subsequently are offered as examples and guidelines for nursing actions.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>Altered thought process related to panic levels of anxiety, as evidenced by hallucinations or delusions (positive symptoms).<span style="font-weight: bold;">
<br /></span></span></p><p class="MsoNormal">
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to severe levels of anxiety with the aid of medication and nursing intervention.<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">Client will meet with nurse once a day for 15 minutes in an activity in which the client feels comfortable.<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">By (date), client will state that “the voices” or “the thoughts” are less frequent with the aid of medication and nursing intervention.<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">By (date), client will engage in one unit activity per day that provides reality testing.<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">By (date), client will identify personal interventions that lower hallucinations.<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">By (date), client will talk about concrete happenings without talking about delusions or hallucinations for short periods.<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">By (date), client will make needs and wants clearer with the aid of medication and nursing interventions.<b style=""><o:p></o:p></b></span></li></ul><p class="MsoNormal"></p><p class="MsoNormal"> </p><p class="MsoNormal"><span lang="EN-US">Ineffective individual coping related to lack of motivation to respond, as evidenced by alteration in social participation (negative symptoms)</span><span style="">.<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 18pt;"><b style=""><span lang="EN-US"><o:p> </o:p></span></b></p> <p class="MsoNormal"><b style=""><span lang="EN-US">Long and Short Term Goals</span></b><b style=""><span style=""><o:p></o:p></span></b></p> <p class="MsoNormal"><b style=""><span style=""><o:p> </o:p></span></b></p> <p></p><p></p><ul><li><span lang="EN-US">By (date), client will meet with nurse for 10 minutes two times a day in a activity in which the client feels safe<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">By (date), client will meet with the nurse and one other client in a simple activity<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">Client will sate that he or she feels more comfortable with nurse by (date)<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">Client will sate that he or she feels more comfortable with one other client or staff member by (date)<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">Client will attend one simple group activity each day by (date).<b style=""><o:p></o:p></b></span></li></ul><p class="MsoNormal"></p><p class="MsoNormal"> </p><p class="MsoNormal"><span lang="EN-US">High risk for violence directed at others related to misperceived messages from others, as evidenced by persecutory delusions and hallucinations.</span></p> <p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p> <p class="MsoNormal"><b style=""><span lang="EN-US">Long and Short Term Goals</span></b><b style=""><span style=""><o:p></o:p></span></b></p> <p class="MsoNormal"><b style=""><span style=""><o:p> </o:p></span></b></p> <p></p><p></p><ul><li><span lang="EN-US">By (date), client will state that the voices are less angry, with the aid of medication.<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">By (date), client will identify helping behaviors of nurses and staff.<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">Client will join the nurse for one activity per day in which he states that he feels safe.<b style=""><o:p></o:p></b></span></li><li><span lang="EN-US">By (date), client will state that he feels safe on the unit with the staff.<b style=""><o:p></o:p></b></span></li></ul><p class="MsoNormal"></p><p class="MsoNormal"> </p><p class="MsoNormal" style="margin-left: 18pt;"><span lang="EN-US">Activity intolerance related to extreme physical activity, as evidenced by constant physical agitation and increased respiration and pulse</span></p> <p class="MsoNormal" style="margin-left: 18pt;"><span lang="EN-US"><o:p> 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</w:LatentStyles> </xml><![endif]--><style> <!-- /* Font Definitions */ @font-face {font-family:"Cambria Math"; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:roman; mso-font-pitch:variable; mso-font-signature:-1610611985 1107304683 0 0 159 0;} @font-face {font-family:Calibri; panose-1:2 15 5 2 2 2 4 3 2 4; mso-font-charset:0; mso-generic-font-family:swiss; mso-font-pitch:variable; mso-font-signature:-1610611985 1073750139 0 0 159 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-unhide:no; mso-style-qformat:yes; mso-style-parent:""; margin:0cm; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman","serif"; mso-fareast-font-family:"Times New Roman"; mso-ansi-language:EN-US; mso-fareast-language:EN-US;} .MsoChpDefault {mso-style-type:export-only; mso-default-props:yes; font-size:10.0pt; mso-ansi-font-size:10.0pt; mso-bidi-font-size:10.0pt; mso-ascii-font-family:Calibri; mso-fareast-font-family:Calibri; mso-hansi-font-family:Calibri;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 72.0pt 72.0pt 72.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif";} </style> <![endif]--> <p class="MsoNormal"><b style=""><span style="font-size: 14pt;" lang="EN-US">P</span></b><b style=""><span style="font-size: 14pt;">rocess</span></b><b style=""><span style="font-size: 14pt;" lang="EN-US"> L</span></b><b style=""><span style="font-size: 14pt;">evel</span></b><b style=""><span style="font-size: 14pt;" lang="EN-US"> – N</span></b><b style=""><span style="font-size: 14pt;">urses</span></b><b style=""><span style="font-size: 14pt;" lang="EN-US">’ R</span></b><b style=""><span style="font-size: 14pt;">eactions</span></b><b style=""><span style="font-size: 14pt;"> </span></b><b style=""><span style="font-size: 14pt;">and</span></b><b style=""><span style="font-size: 14pt;" lang="EN-US"> F</span></b><b style=""><span style="font-size: 14pt;">eelings<o:p></o:p></span></b></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>Working with individuals diagnosed as schizophrenic is bound to bring up strong emotional reactions from health care worker. The psychotic client is intensely anxious, lonely, dependent, and distrustful. The intensity of these emotions can stir up intense, uncomfortable, and frightening emotions in all health care workers. The identification of transference and countertransference phenomena is an important part of the work of the therapeutic process.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>If personal countertransferential reactions are ignored by the nurse, feelings of helplessness follow increased feelings of helplessness escalate anxiety. Without the support, opportunity, and willingness to explore these reactions with more experienced nursing staff, defensive behaviors emerge. Defensive behaviors in the nurse, such as denial, withdrawal, and avoidance, thwart the client’s progress and undermine the nurse’s self-esteem. These behaviors are associated with staff burnout. Statements such as “These clients are hopeless”, “You can’t understand these people.” and “You waste your time with them” are examples of unexamined or unrecognized emotional reactions to client’s behaviors or feelings.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>For new nurses introduced into the psychiatric setting, especially for student nurses, the availability of supportive supervision is a must if learning is to take place. The student’s part in the supervisory process is a willingness to discuss and identify personal feelings as well as to identify problem behaviors. This can be and often is done in group supervision. Experienced psychiatric nurses call this process peer group supervision.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>Individual supervision provides the greatest opportunity for a better understanding of the interpersonal issues involved in establishing a working relationship with the client. Individual supervision can increase the learner’s understanding of the client and the client’s situation, competence with therapeutic skills, and self-confidence. Unfortunately, many schools of nursing do not have the time or faculty to provide this learning opportunity for students. Some psychiatric settings encourage the practice of supervision and provide time and personnel for psychiatric nurses and other staff.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>Kahn (1984) identifies three strong tree strong transferences on the part of schizophrenic clients that can trigger equally strong counterstransference reactions among mental health care workers. These three transferences are (1) the dependent transference, (2) the angry transference and (3) the eroticized transference. These issues are best dealt with during supervision. During this time, the transference phenomena are identified, personal reactions of the nurse are explored, and appropriate intervention strategies are suggested and evaluated.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>For example, in dealing with dependency issues, decisions need to be made about when to gratify modest dependency needs without hindering the development of the client’s autonomy. What feelings does the nurse experience in relationship to the client’s exhaustive dependency needs? Which responses are rational and which irrational? Do the irrational feelings toward the client block effective therapeutic work?</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>During supervision of the angry transference feelings, the nurse learn to inhibit the urge to act on angry personal responses, to provide alternative experiences for the client to deal with anger, and to understand the function the anger serves for the client (e.g., maintaining distance).</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>Eroticized transference may be anxiety producing to both the client and the nurse. Supervision may explore with the nurse-clinician ways for setting clear limits while maintaining effective contact with the client (Kahn 1984).</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>Menninger (1984) discusses the extreme frustration that staff have with the slow progress of schizophrenic clients. This sense of frustration and feelings of helplessness can lead to burnout. Periodic reassessment of treatment goals and scaling down of expectations can benefit both staff and client.</span></p> <span style="font-size: 12pt; font-family: "Times New Roman","serif";" lang="EN-US"><span style=""> </span>These are some but by ni means all of the kinds of issues that may surface in dealing with a schizophrenic client. Clinical practice with adequate supervision increases the nurse’s skills, lowers personal anxiety, increases confidence, and can improve the quality of interpersonal relationships with clients as well as relationships with others.</span>
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mso-fareast-font-family:Calibri; mso-hansi-font-family:Calibri;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 72.0pt 72.0pt 72.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif";} </style> <![endif]--> <p class="MsoNormal"><b style=""><span style="font-size: 14pt;" lang="EN-US">Intervention<o:p></o:p></span></b></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>The detrimental effect of stress on a schizophrenic person’s environment has been long observed by clinicians. Environmental stress can result in an exacerbation of schizophrenic symptoms. Much of the work with schizophrenic clients involves decreasing waxing levels of environmental stress, thereby lowering the client’s level of anxiety and improving the client’s perceptions and adaptive responses lowered anxiety levels can decrease the intensity of schizophrenic symptoms and make the client more amenable to engagement in activities and relationships with health professionals, improved family interactions, and involvement in nonthreatening activities. Lowered anxiety levels make it possible for all people, including people with schizophrenia, to define problems and focus on issues.</span></p> <span style="font-size: 12pt; font-family: "Times New Roman","serif";" lang="EN-US"><span style=""> </span>For planning interventions, it is important not to overlook the adaptive skills of a psychotic client. Attention should bi given to the client’s assets and healthy functioning as well as to areas of deficiencies</span>.
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mso-fareast-font-family:Calibri; mso-hansi-font-family:Calibri;} @page Section1 {size:612.0pt 792.0pt; margin:72.0pt 72.0pt 72.0pt 72.0pt; mso-header-margin:36.0pt; mso-footer-margin:36.0pt; mso-paper-source:0;} div.Section1 {page:Section1;} --> </style><!--[if gte mso 10]> <style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif";} </style> <![endif]--> <p class="MsoNormal"><b style=""><span style="font-size: 14pt;" lang="EN-US">P</span></b><b style=""><span style="font-size: 14pt;">sychotherapeutic</span></b><b style=""><span style="font-size: 14pt;" lang="EN-US"> I</span></b><b style=""><span style="font-size: 14pt;">nterventions</span></b><b style=""><span style="font-size: 14pt;" lang="EN-US"><o:p></o:p></span></b></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>Therapeutic strategies for working with schizophrenic clients often involve interventions that address specific behaviors. Psychotherapeutic interventions are aimed at lowering the client’s anxiety, decreasing defensive patterns, encouraging participation in the environment and raising the client’s level of self- esteem. Refer strategies for paranoid, withdrawn, excitable, and regressed behaviors.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>All nurses should be familiar with the principles of dealing with phenomena that are certain to arise with most schizophrenic clients. These are the phenomena of (1) hallucination, (2) delusion, and (3) looseness of association.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span><b style="">HALLUCINATION.</b> Understanding the process of hallucinations offers useful guidelines for working with clients who are actively hallucinating. The hallucinatory process starts out in a painfully lonely and isolated person under stress. Hallucinations are a means to allay the terrorizing feelings of alienation and the resulting panic levels of anxiety.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>Voices are the most are the most common hallucinatory experience reported by schizophrenic clients. It is important initially to understand what the voices are saying or telling the person to do. The presence of suicidal or homicidal messages indicates priority measures for all members of the health care team.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>Peplau believes that an important perspective for nurses to have when working with a client who is hallucinating is to view hallucinations as evidence that loneliness might be a problem. Though hallucinations significant human contact is being sought (Smoyak 1994). The nurse might ask, “What is going on right now?” and follow up with dialogue that “keeps clear that what the person is experiencing can be differentiated from what others see and hear” (Smoyak 1994).</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>When the client is asked to give up something important, no matter how maladaptive, something more adaptive and useful should be available to take its place, namely, receptive and interested people in the client’s environment. Establishing a relationship that minimizes anxiety and is built on honesty, consistency of care, and genuine concern for the client is an important first step. Moller (1989) has outlined 12 steps nurses can take when working with a hallucinating client. These are part of a process that progresses over time and is shared with the hallucinating individual. Moller cautions that nurse may become frustrated at times, and is to be expected.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span><b style="">DELUSIONS</b>. Delusions are a result of misperception of cognitive stimuli. It is useful if the nurse attempts to see the world as it appears through the eyes of client. In that way, the nurse can better understand the client’s delusional experience. For example</span></p> <p class="MsoNormal"><span lang="EN-US">CLIENT:You people all alike …. All in on the CIA plot to destroy me.</span></p> <p class="MsoNormal" style="margin-left: 42.55pt; text-indent: -42.55pt;"><span lang="EN-US">NURSE :I do not want to hurt you, Tom. Thinking that people are out to destroy </span><span style="" lang="EN-US"><span style=""> </span></span><span lang="EN-US">you must be very frightening.</span></p> <p class="MsoNormal" style="margin-left: 72pt; text-indent: -72pt;"><span lang="EN-US"><o:p> </o:p></span></p> <p class="MsoNormal"><span lang="EN-US">First, the nurse clarifies the reality of his or her intent. Second, the nurse empathizes with the client’s apparent experience, the feelings of fear. The nurse does not get drawn into the conversation regarding the content of the delusion (CIA and plot to destroy) but looks for the feelings the person may be experiencing. Talking about the client’s feeling experience can be useful for the client; talking about delusional material is not.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>It is not useful to argue with the client regarding the content of the delusion. Doing so can intensify the client’s retention of irrational beliefs. Although the nurse does not argue with the client’s delusions, clarifying misinterpretations of the environment is useful. For example :</span></p> <p class="MsoNormal"><span lang="EN-US">CLIENT :<span style=""> </span>I see the doctor is here, and he is out to get me and destroy me.</span></p> <p class="MsoNormal" style="margin-left: 72pt; text-indent: -72pt;"><span lang="EN-US">NURSE :<span style=""> </span>It is true the doctor wants to see you, but he wants to talk to you about your treatment. Would you feel more comfortable talking to him in the day room?</span></p> <p class="MsoNormal"><span lang="EN-US"><o:p> </o:p></span></p> <span style="font-size: 12pt; font-family: "Times New Roman","serif";" lang="EN-US">Interacting with the client on concrete realities in the environment can be useful in minimizing the client’s time spent with delusional ruminations. 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The client’s autistic and disorganized ramblings may leave the nurse confused and frustrated. Increase in the client’s autistic speech patterns can indicate increased anxiety on the part of the client and reflect his or her difficulty responding to internal and external stimuli.</span></p> <p class="MsoNormal"><span lang="EN-US"><span style=""> </span>Decoding is a term used for interpreting the meaning of autistic communications. 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"Times New Roman","serif";">REFERENCES</span></u></b><span style="font-size: 14pt; line-height: 150%; font-family: "Times New Roman","serif";"><o:p></o:p></span></p> <p></p><p></p><p></p><ul><li><span style="font-size: 12pt; font-family: "Times New Roman","serif";">Fortinash, Haladay. 2007. <i>Psychiatric Nursing Care Plans</i>. 5th ed. Philadelphia: Mosby Elsevier.<o:p></o:p></span></li><li><span style="font-size: 12pt; font-family: "Times New Roman","serif";">Kaplan, Sadock, B. 1995. <i>Comprehensive Text Book of Psychiatry</i>. 6th ed,vol 1. Maryland: William & Wilkins.<o:p></o:p></span></li><li><span style="font-size: 12pt; font-family: "Times New Roman","serif";">Kozier, Barbara. 1979. <i>Fundamental of Nursing</i>. California: Wesley Publishing Company.<o:p></o:p></span></li><li><span style="font-size: 12pt; line-height: 115%; font-family: "Times New Roman","serif";">M Varcarolis, Elizabeth. 1994. <i style="">Foundations of Psychiatric:</i> Mental Health Nursing. Philadelphia: W.B Sounders Company<o:p></o:p></span></li><li><span style="font-size: 12pt; font-family: "Times New Roman","serif";">Yosep, Iyus. 2009. <i>Keperawatan Jiwa Edisi Revisi</i>. Bandung: Refika Aditama.<o:p></o:p></span></li></ul><p class="MsoNormal"></p><p class="MsoNormal"></p><p class="MsoNormal"> </p> <p></p> <p></p> <span style="font-size: 12pt; font-family: "Times New Roman","serif";" lang="EN-US"> </span>
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<br /></span></p>Eka Komalasarihttp://www.blogger.com/profile/01067337300491408849noreply@blogger.com0