Schizophrenia Nursing Care Plans Diagnosis and Interventions
Schizophrenia NCLEX Review and Nursing Care Plans
Schizophrenia is a serious mental disorder highly associated with psychosis or the disconnection from reality. It leads to a wide range of manifestations such as hallucinations, delusions, disorganized speech, and cognitive impairment.
It highly affects the person’s thoughts and emotions which then lead to the person’s inability to participate socially and maintain meaningful relationships.
Schizophrenia is a lifelong disorder which can occur in both men and women of any age.
There is still no cure for schizophrenia at present; however, there are treatments available to help manage the condition and control serious complications.
Signs and Symptoms of Schizophrenia
The clinical manifestations of schizophrenia are categorized into positive, negative, and cognitive.
- Positive Symptoms. These are the easily recognized signs and symptoms and are often referred to as behaviors not seen in healthy people.
- Delusions – delusions are beliefs that are not based in reality
- Hallucinations – these are experiences of seeing, hearing, feeling, or smelling something that does not exist
- Abnormal motor behavior – people with schizophrenia may display child-like silliness or any behavioral changes that include resistance to instructions, inappropriate posture, lack of response, or useless and excessive movements
- Negative Symptoms. These symptoms are sometimes more difficult to diagnose. They are related to the reduced ability to function normally and may include the following:
- Diminished emotional expression
- Anhedonia or the lack of ability to experience pleasure
- Social withdrawal
- Cognitive Symptoms. These symptoms are typically non-specific hence they tend to be severe enough to be noticed by another individual.
- Disorganized thinking or speech – schizophrenia can affect the person’s ability to communicate. It may be noted that people with schizophrenia may display the use of different words being put together without any meaning at all.
In teenagers, schizophrenia may be difficult to recognize since its signs and symptoms may overlap with typical teenage development. Signs and symptoms of schizophrenia in teenagers may include:
- Social withdrawal
- Changes in school performance
- Trouble getting sleep
- Depressed mood
- Lack of motivation
Causes of Schizophrenia
Despite extensive research on this condition, the exact cause of schizophrenia is still unknown.
However, it is generally accepted that several factors can precipitate the development of the disorder.
- In utero. Some studies suggest that schizophrenia starts due to fetal disturbances in utero. It has been linked to bleeding during pregnancy, gestational diabetes, having emergency caesarean section, asphyxia, and having low birth weight.
- Genetics. It is also believed that genetics plays a role in the occurrence of schizophrenia. It is found that the risk of developing the illness is high in people with family history of the disorder.
- Environmental factors. Environmental stressors are highly associated to the development of schizophrenia. It may include childhood trauma, social isolation, minority ethnicity, and having to live in an urban area.
- Changes in the brain chemistry. Although changes in brain structure is not evident in all cases of schizophrenia, some researchers believe that the imbalance of the neurotransmitters in the brain causes the condition to develop.
Complications of Schizophrenia
- Suicide. One of the common causes of deaths in people with schizophrenia is suicide. Having suicidal thoughts and committing suicide can be due to the hallucinations such as hearing voices to harm themselves, depression due to the diagnosis of schizophrenia, or substance abuse.
- Depression. This is seen in almost half of people with schizophrenia. It is not always identified and diagnosed hence it raises the risk of suicide in people suffering from the condition.
- Anxiety. Anxiety is quite common in people with schizophrenia. It is recorded that about 30-80% of cases have had anxiety at some point in their condition.
- Homelessness. Schizophrenia can greatly affect the person’s ability to function and hone social relationships. This may bring lack of support from friends and family and cause them to be socially isolated and disconnected. This often leads to them ending up in the streets and homeless.
- Self-injury. Hallucinations can predispose people with schizophrenia to injure themselves.
- Violence. Not all cases of schizophrenia are associated with violence. However, the condition involves several factors that can increase the risk of violent behaviors.
Diagnosis of Schizophrenia
The Diagnostic and Statistical Manual of Mental Disorder (DSM-5) suggests that the criteria for diagnosing schizophrenia should include the presence of 2 or more of the symptoms lasting for a month wherein one of the symptoms should include delusions, hallucinations, or disorganized speech.
The following are the procedures that can be performed to help achieve a diagnosis:
- Physical exam – a thorough physical examination can be done to rule out other relevant problems and assess for possible complications.
- Tests and screenings – blood and urine tests may be performed to identify the presence of alcohol and drugs, or any other medical conditions that can cause the symptoms. An imaging study of the brain may also need to be performed such as an CT scan or an MRI scan of the brain.
- Psychiatric evaluation – since schizophrenia is a mental health disorder, a psychiatric evaluation may be needed to assess mental health status.
Treatment of Schizophrenia
Unfortunately, the treatment for schizophrenia is life-long. It includes the use of medications and therapies.
- Medications. Certain drugs are often helpful in controlling the effects of the condition and in the prevention of possible complications.
- Second generation antipsychotics – these drugs are preferred due to their lower risk of side effects.
- First generation antipsychotics – these drugs carry higher risks of having neurological side effects which may not be reversible.
- Long-acting injectable antipsychotics – some drugs may be given true intramuscular or subcutaneous injection every 2-4 weeks. These may be the drug of choice if daily intake of pills is a concern.
- Psychosocial interventions
- Individual therapy
- Social skills training
- Family therapy
- Vocational rehabilitation and supportive employment
- Electroconvulsive therapy (ECT) – this can be considered if the person does not respond to other treatments. ECT involves the delivery of electrical shocks to the person’s brain to induce seizure in an attempt to relieve schizophrenic symptoms.
Nursing Diagnosis for Schizophrenia
Nursing Care Plan for Schizophrenia 1
Nursing Diagnosis: Impaired Verbal Communication related to altered perceptions due to biochemical alterations in the brain secondary to schizophrenia as evidenced by difficulty of establishing verbal communication, inability to discern usual or normal communication patterns, cognitive disturbances such as thought blocks, hallucinations/ delusions, and poverty of speech
Desired Outcome: The patient will be able to establish reality-based thought process and effective verbal communication.
|Nursing Interventions for Schizophrenia||Rationales|
|Assess and monitor the patient’s coherence of speech and cognitive ability.||To help establish baseline, as well as short-term and long-term goals.|
|Ensure that the patient receives anti-psychotic medications on time, with the right dosage and route. Have the patient take the medication in front of you.||Correct administration of anti-psychotic mediations helps the patient have clear thinking and a more functional cognitive ability. Patients with mental health problems such as having schizophrenia may not take medications correctly, or at all, so it is crucial for the nurse or carer to ensure that the patient has swallowed the oral medication completely.|
|Create an environment that is calm, quiet, well-lit, and conducive to effective communication.||Having an environment that is free from disturbing stimuli helps in preventing confusion or hallucination in a patient with schizophrenia.|
|Speak slowly, keep voice in low volume, and use clear and simple words when communicating with the patient.||Loud or high-pitched voice may trigger anxiety, agitation, or confusion in a patient with schizophrenia. Using simple words and speaking clearly can help the patient understand what is being said.|
|Educate the patient on ways to improve verbal communication, such as: |
Focusing on important activities of daily living and meaningful tasks
Replacing irrational thoughts with rational thoughts
Performing deep breathing exercises and calming techniques
Seeking support from staff, carer, family, or other supportive people
|To gradually help the patient achieve effective cognitive thinking and functional speech.|
Nursing Care Plan for Schizophrenia 2
Nursing Diagnosis: Disturbed Thought Process related to cognitive impairment secondary to schizophrenia as evidenced by problems with coordination and motor functions, difficulty handling complex tasks, confusion and disorientation, and inability to do activities of daily living (ADLs) as normal
Desired Outcome: The patient will be able to establish optimal mental and physical functioning.
|Nursing Interventions for Schizophrenia||Rationales|
|Assess the patient’s level of confusion.||To monitor effectiveness of treatment and therapy.|
|Assist the patient performing activities of daily living. Consider one-to-one nursing.||To maintain a good quality of life and promote dignity by allowing the patient to perform their ADLs while maintaining safety.|
|Simplify tasks for the patients by using simple words and instructions. Label the drawers with simple words and big letters, and use written notes when necessary.||Schizophrenia patients may have difficulty handling complex tasks.|
|Provide opportunities for the patient to have meaningful social interaction, but never force any interaction.||To prevent feelings of isolation. However, forced interaction can make the patient agitated or hostile due to confusion.|
|Allow the patient to display abnormal behaviors within acceptable limits and while maintaining patient safety.||To prevent agitation and increase the sense of security while allowing the patient to perform activities that are difficult to stop for him/her.|
Nursing Care Plan for Schizophrenia 3
Nursing Diagnosis: Defensive coping related to perceived threat to self as evidenced by agitation/ aggression, anxiety, suspiciousness, confusion, irritability, hallucinations/delusions, difficulty establishing relationships, and verbalization of powerlessness
Desired Outcome: The patient will demonstrate effective coping with the disorder as evidenced by being able to establish relationship, seeking support and help as needed, staying calm and oriented, and verbalization of being in control of his/her life.
|Nursing Interventions for Schizophrenia||Rationale|
|Assess the current cognitive level / mental status of the patient, anxiety triggers and symptoms by asking open-ended questions.||To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding suspicions, hallucinations, and delusions.|
|Initially, support the patient by meeting dependency needs if deemed necessary.||The patient can become more anxious if the avenues for dependency are suddenly and/or complete eliminated.|
|Encourage the patient to be independent and provide positive reinforcement for being able to do self-care and other independent behaviors.||To enhance the patient’s self-esteem and encourage him/her to repeat desired behaviors.|
|Discuss with the patient and significant other/s the available treatments for schizophrenia, such as anxiolytics and anti-psychotic medications.||Psychotherapy involves speaking with a licensed therapist and going through how to gradually cope with the symptoms. Medication such as anxiolytics and anti-psychotics can help the patient cope with his/her condition.|
|Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation. Promote a calm, noise-free, and well-lit environment.||To promote relaxation and reduce stress levels.|
Nursing Care Plan for Schizophrenia 4
Impaired Social Interaction
Nursing Diagnosis: Impaired Social Interaction is related to an exaggerated response to alerting stimuli secondary to schizophrenia as manifested by dysfunctional communication with others; looking bothered, flustered, or troubled when others come in close contact or try to take her part in an activity; Observed usage of ineffective social communications behaviors.
- The patient will improve social connections with family members, friends, and acquaintances.
- The patient will demonstrate suitably social interpersonal skills.
- The patient will participate in one or two activities with lesser stimulation from the healthcare team or family members.
- The patient will sustain connection with other patients while performing activities. (example: simple board games, drawing).
- The patient will verbalize comfort in participating in at least three designed activities that are goal-oriented.
- The patient will look for supportive social connections.
|Nursing Interventions for Schizophrenia||Rationale|
|Evaluate if the medication has made it to the level of effectiveness.||Most of the positive manifestations of schizophrenia such as hallucinations, delusions, and racing ideation will decrease with drug therapy which will make interactions easier.|
|Associate with the patient symptoms he or she encounters when he or she started to experience anxiety around others.||Increased anxiety can aggravate distress, hostility, and distress.|
|3. Maintain the patient’s environment free of stimuli such as loud noises, and big crowds as possible.||The patient might react to the noises and crowds with nervous excitement, uneasiness, and increased incapacity to focus on outside events.|
|4. Avoid physical contact with the patient.||Touch by an unknown person can be interpreted wrongly as a sexual or threatening action. This is specifically true for paranoid patients.|
|5. Establish goals that are set realistic; either in the hospital or community.||Refrain from pressure on the client and a sense of disappointment on part of the nurse and family members. This feeling of failure can result in mutual disengagement.|
|6. Design activities that will work both based on the patient’s pace and interest.||The patient can lose enthusiasm for activities that are too aggressive, which can increase a sense of disappointment.|
|7. Schedule times each day to incorporate planned times to make short interactions and activities with the patient on an individual basis.||Helps patients to experience a non-threatening environment and build a sense of well-being.|
|8. If the patient is not able to respond verbally or in a reasonable method, allot time with the patient more often even in a short period.||Building companionship with the patient can provide a feeling of being worthwhile.|
|9. If the patient is observed to be very paranoid, withdrawn, or doing solo activities that need concentration is applicable.||The patient is at liberty to select the level of interaction they can make. However, keeping the patient concentrated can help reduce distressing paranoid ideas or voices.|
|10. If the patient is having problems concentrating or experiencing delusion or hallucination, prepare simple and compact activities with them. Some examples are painting and looking at a picture.||A simple activity can help in taking out the patient from delusional thoughts to the real environment.|
|11. If the patient is very withdrawn, plan an initial one-on-one activity with a safe person.||To develop a safe environment with one person, and eventually grow into a structured group activity.|
|12. Try to integrate the patient’s strengths and interests when the planned activity is not effective.||It will increase the patient’s cooperation and enjoyment.|
|13. Advise the patient to withdraw himself immediately from any activities when feeling agitated and go through some anxiety relief activities like meditations, rhythmic exercises, and deep breathing exercises.||Train client abilities in handling anxiety and promote a sense of self-control.|
|14. Teach functional coping skills that the patient will need to involve conversational and self-assured skills.||These are basic skills for dealing with the public, which all the people use every day close to skill.|
|15. Make sure to give appreciation and merit for the positive steps the patient does in improving social skills and suitable interactions with others.||Recognizing and acknowledging their development sustain and increase improved behavior.|
|16. As the patient goes forward, coping skills training should be available to them. The process includes: Outline the skills to be learned.Demonstrate the skill.Practice skills in a safe environment, then in the community. Provide corrective feedback on the execution of skills.||Enhance the patient’s capacity to acquire social support and decrease feelings of loneliness.|
Nursing Care Plan for Schizophrenia 5
Nursing Diagnosis: Fear related to suspicion of the motives of others secondary to schizophrenia as evidenced by fearful feelings.
- The patient will continue everyday activities.
- The patient will verbalize understanding and recognition of fears.
- The patient will make use of coping methods to control fear.
- The patient will exhibit effective coping strategies to improve psychological and physical comfort.
|Nursing Interventions for Schizophrenia||Rationale|
|Identify the type of fear the patient has by detailed and logical questioning and actively listening/||The outside source of fear can be identified. Patients who see it unacceptable to reveal fear may find it helpful to know that someone is willing to listen if they share their thoughts and feeling in the future.|
|Evaluate the expression of fear by behavior and verbal communication.||These findings provide a foundation for outlining interventions to support the patient’s coping plan of action.|
|Assess the course of action the patient practice to cope with that fear.||These details help identify the effectiveness of coping techniques used by the patient.|
|Determine to what degree the patient’s fears may affect their ability to function.||Medications to treat anxiety or recommendation for particularly designed treatment programs is necessary for continuous, disabling fears. The safety of the patient must always be put first.|
|Talk about your recognition of the patient’s fear.||Recognizing the patient’s fear validates the feelings the patient is carrying and shows acknowledgment of those feelings|
|Explain the situation with the patient and help characterize the difference between real and imagined threats to the patient’s welfare.||This method helps the patient how properly deal with fear.|
|Discuss to the patient that fear is a normal and appropriate reaction to situations in which pain, danger, or loss of control is expected or felt.||This reassurance puts fear within the normal field of human experiences.|
|Spend time with the patient to promote safety, mostly during uneasy procedures or treatment.||It gives the feeling of security and safety during a time of fear when there is a physical connection between a trusted person and a patient.|
|Keep a relaxed and gracious attitude while communicating with the patient.||A peaceful and non-threatening surrounding develops the patient’s feeling of security.|
|Acquaint the patient with the environment as necessary.||Awareness of the surroundings builds up comfort and eases fear.|
|Give precise information if unreasonable fears of mistaken information are present.||Cutting out inaccurate information and changing to accurate knowledge reduces anxiety.|
|Understand the patient’s fear if it is based on a reasonable response. Always be truthful and avoid negative reassurance.||Encourage patients that asking for help is both a proof of strength and progress toward resolution of the problem.|
|Speak using simple language and terminologies easier to understand regarding diagnostic procedures.||During extreme fear, the patient may have difficulties understanding any given explanation. The use of simple, but clear and brief statements is important.|
|Keep a noise-free environment at home or in a hospital. Clear any inessential items around the patient.||An unsafe environment is not a conducive place to stay for the patient. The patient’s fear is not lessened and fixed if the surroundings are high-risk.|
|Prepare safety pieces of equipment within the home when recommended. These include alarm systems and safety devices in showers and bathtubs.||To provide an immediate response during emergency situations.|
|Assist the patient in recognizing techniques used before to handle fearful situations.||This procedure allows the patient to understand that fear is a natural element of life and can be overcome successfully.|
|Permit the patient to have rest periods.||The patient’s coping abilities improve during relaxation. As a nurse, proper pacing of activities must be done, especially for older patients to conserve their energy.|
|Recommend the patient to have comforting items when away from home.||To enhance the feeling of security when in a new environment.|
|When designing a treatment plan, allow the patient to participate actively in the process of decision-making.||The patient’s active participation and involvement in decision-making strengthen up self-integrity in the patient’s treatment.|
|Discuss alternative, non-medical techniques. Include verbal and nonverbal comfort of safety if within control.||Alternative, non-medical techniques such as meditation, prayer, music, and therapeutic touch help lighten fear.|
Nursing Care Plan for Schizophrenia 6
Nursing Diagnosis: Disturbed sensory perception related to biochemical factors such as manifested by inability to concentrate secondary to schizophrenia as manifested by changes in communication patterns, disorientation to person, place, and time, auditory distortions, reported or measured change in sensory acuity, hallucinations, and mumbling to self, talking or laughing to self.
- The patient will get on new ways to avoid responding to hallucinations.
- The patient will verbalize, using a scale from 0 to 10, that “the voices” are not common and less threatening with the help of medication and nursing interventions.
- The patient will sustain role performance and social relationships.
- The patient will determine stressful events that precipitate hallucinations.
- The patient will recognize personalized interventions that reduce or lessen the intensity or persistency of hallucination. Examples are listening to music, wearing headphones, reading out loud, jogging, and socializing.
- The patient will be able to recognize the severity of the anxiety and exhibit techniques for stress reduction.
- The patient will display effective approaches that distracts him or her from auditory hallucinations.
|Nursing Interventions for Schizophrenia||Rationale|
|Acknowledge the fact that the voices are existing to the client, however, explain to them that you do not hear the voices. Pertain to the voices as “your voices” or “voices that you hear”.||Attesting to the truth that your reality does not include voices can help the client cast the doubt on the legitimacy of his or her voices.|
|Monitor any signs of increasing fear, uneasiness, or anxiety.||It can be an indicator of hallucinatory activity, which can be disturbing to the patient, and it may cause them to act upon the command hallucinations. An example is harming self or others.|
|Observe closely how the patient experiences hallucinations.||Explores the hallucinations and shares the experience can help the patient have a sense of power that they can manage the hallucinatory voices.|
|Assist the patient to determine times that the hallucinations are most common and disturbing.||Guides both nurse and patient to identify occurrence and frequency that are possibly most anxiety-producing and threatening to the patient.|
|If voices are commanding the patient to harm themself or others, provide needed environmental actions. Inform others and police, doctors, and administration following unit protocol.If admitted to the hospital, follow the unit protocol for suicidal, or threats of violence if the patient wants to act on commands. If living in the community, assess the necessity for hospitalization. Document everything the patient says, and if there is a threat to others. Take note of the person who was contacted and informed. Use the agency protocol as a guide.||Most of the time patients follow hallucinatory instructions to kill themselves or others. Immediate assessment and intervention can save lives.|
|Collaborate with the patient to identify which activities help decrease anxiety and divert the patient’s attention from the hallucinatory materials.||The patient might get more motivated to know new ways to remove themselves from stressful surroundings and look for distraction techniques.|
|Reduce environmental stimuli as much as possible. Examples are low volume noise and minimal activities.||Lessens the possibility of anxiety that might aggravate hallucinations.|
|Maintain conversation that is simple, basic, and reality-based topics. Guide the patient to focus on one idea at a time.||Patient way of thinking might be confused and disorganized; this intervention helps the patient concentrate and understand reality-based issues.|
|Involve the patient in reality-based activities like card playing, writing, drawing, doing simple art and craft works, or listening to music.||The use of acceptable activities in redirecting the patient’s attention can reduce the chance of doing the hallucinatory commands and distract them from hearing the voice.|
More Schizophrenia Nursing Diagnosis
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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