HOLY NAME UNIVERSITY

COLLEGE OF HEALTH SCIENCES

DEPARTMENT OF NURSING
TAGBILARAN CITY

Care of Clients with Maladaptive Patterns of Behavior ( NCM 117 )

Assignment 7

CLINICAL VIGNETTE: SCHIZOPHRENIA

INSTRUCTION:
Please read the scenarios given and answer the following questions below.

Ricky was staying with his father for a few weeks on a visit. During the first week,
things had gone pretty well, but Ricky forgot to take his medication for a few days. His
father knew Ricky wasn’t sleeping well at night, and he could hear Ricky talking to
himself in the next room.

One day while his father was at work, Ricky began to hear some voices outside
the apartment. The voices grew louder, saying, “You’re no good; you can’t do anything
right. You can’t take care of yourself or protect your dad. We’re going to get you both.”
Ricky grew more frightened and went to the closet where his dad kept his tools. He
grabbed a hammer and ran outside. When his father came home from work, Ricky
wasn’t in the apartment though his coat and wallet were still there. Ricky’s father called
a neighbor, and they drove around the apartment complex looking for Ricky. They finally
found Ricky bent his knees behind some bushes, wearing a T-shirt, shorts and no
slippers/shoes. Ricky’s neighbor called emergency services. Meanwhile Ricky’s father
tried to draw Ricky into the car, but Ricky wouldn’t come. The voices had grown louder,
and Ricky was convinced that the devil had kidnapped his father and was coming for
him too. He saw someone else in the car with his dad. The voices said they would crash
the car if he got in. They were laughing at him! He couldn’t get into the car; it was only a
trap. His dad had tried his best, but he was trapped, too. The voices told Ricky to use

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 the hammer and to destroy the car to kill the devil. He began to swing the hammer into
the windshield, but someone held him back.

The emergency services staff arrived and spoke quietly and firmly as they
removed the hammer from Ricky’s hands. They told Ricky they were taking him to the
hospital where he and his father would be safe. They gently put him on a stretcher with
restraints, and his father rode in the emergency van with him to the hospital.

1. The client’s behavior is most likely indicating what particular positive symptoms
of Schizophrenia? Describe the behaviors that helped you determine the
symptom. (5 points)

 AMBIVALENCE
 DELUSIONS
 HALUCINATIONS
 IDEAS OF REFERENCE
 PRESEVERATION
 BIZARRE BEHAVIOR
Ricky began to hear voices outside their apartment, the voices even grew louder,
saying that he is not good, that he can’t do anything right. That he can’t take care of his
self and his dad. The voice that he heard also told him that they will get them both. He
was very frightened and got a tool from his dad’s closet which is the hammer and ran
after outside. He was found in the bushes with his knees bended. During that time the
voices that he heard started to get louder and says that the devil had kidnapped his
father and it was coming for him too. He also saw someone else in the car with his dad,
the voice told him they would crash the car if he gets in. The voices started to laugh at
him that he couldn’t get into the car. He was told to use the hammer to destroy the car
so that the devil can be killed. He began to swing his hammer into the windshield. All the
voices he heard were hallucinations and the things he saw were delusions.

2. As a Nurse, what action you would take in caring Ricky and help him cope with
the situation? (10 points)

1. Recognize schizophrenia. Note characteristic signs and symptoms of

schizophrenia (e.g., speech abnormalities, thought distortions, poor social
interactions).

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 2. Establish trust and rapport. Don’t tease or joke with patients. Expect that
patient is going to put you through rigorous testing periods. Introduce yourself
and explain your purpose.
3. Maximize level of functioning. Assess patient’s ability to carry out activities
of daily living (ADLs).
4. Assess positive symptoms. Assess for command hallucinations; explore
answers. Assess if the client has fragmented, poorly organized, well-
organized, systematized, or extensive system of beliefs that are not
supported by reality. Assess for pervasive suspiciousness about everyone
and their actions (e.g., vigilant, blames others for consequences of own
behavior, argumentative, threatening).
5. Assess negative symptoms. Assess for the negative symptoms of
schizophrenia (as mentioned above).
6. Assess medical history. Assess if the client is on medications, what these
are, and adherence to therapy.
7. Assess support system. Determine whether the family is well informed
about the disease. Does the family understand the need for medication
adherence?

3. Psychosocial strategies and antipsychotic drugs may both be an important part of

the patient’s treatment. Give at least 3 examples each treatment (Psychosocial
therapy and antipsychotic drugs) with some nursing considerations. (5 point
each)

SOCIAL SKILLS TRAINING

 Eye contact with others during conversation. Smiling when greeting people.
Shaking hands when meeting someone
COGNITIVE BEHAVIORAL THERAPY (CBT)
 someone with social anxiety might start by simply imagining anxiety-
provoking social situations. Next, they might start practicing conversations
with friends, family, and acquaintances.
COGNITIVE REMEDIATION
 a behavioural training based intervention that aims to improve cognitive
processes (attention, memory, executive function, social cognition or
metacognition) with the goal of durability and generalisation”
SOCIAL COGNITION TRAINING AMONG OTHERS
 territoriality in animals, dominance and subordination within the social
structure and the complexities of living in a group leading to social pressures
and stress.

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 Medications
Medications are the cornerstone of schizophrenia treatment, and antipsychotic
medications are the most commonly prescribed drugs. They're thought to control
symptoms by affecting the brain neurotransmitter dopamine.
The goal of treatment with antipsychotic medications is to effectively manage
signs and symptoms at the lowest possible dose. The psychiatrist may try different
drugs, different doses or combinations over time to achieve the desired result. Other
medications also may help, such as antidepressants or anti-anxiety drugs. It can take
several weeks to notice an improvement in symptoms.
Because medications for schizophrenia can cause serious side effects, people
with schizophrenia may be reluctant to take them. Willingness to cooperate with
treatment may affect drug choice. For example, someone who is resistant to taking
medication consistently may need to be given injections instead of taking a pill.
Ask your doctor about the benefits and side effects of any medication that's
prescribed.

 Aripiprazole (Abilify)
Be alert for suicidal thoughts and ideology. Notify physician immediately if patient
exhibits signs of depression or other changes in mood and behavior such as
nervousness, restlessness, hostility, confusion, or manic reactions. Assess levels of
drowsiness or lightheadedness, especially in older adults.

 Asenapine (Saphris)
Client is instructed not to abruptly stand to prevent fall due to orthostatic
hypotension. Check vital signs before and after medication. Client is instructed to take
sips of water frequently for avoiding of dry mouth; application of glycerine is also
recommended

 Brexpiprazole (Rexulti)
Advise patient to make position changes slowly to minimize orthostatic
hypotension. Protect from falls. Medication may cause drowsiness and
lightheadedness. Caution patient to avoid driving or other activities requiring alertness
until response to medication is known.

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