Nursing Care Management

for a Patient
with Schizophrenia and
Generalized Anxiety
 INTRODUCTION
Schizophrenia is a serious mental disorder in which people interpret reality
abnormally. Schizophrenia may result in some combination of hallucinations,
delusions, and extremely disordered thinking and behavior that impairs daily
functioning, and can be disabling.

Schizophrenia affects approximately 24 million people or 1 in 300 people (0.32%)

worldwide. This rate is 1 in 222 people (0.45%) among adults. It is not as common as
many other mental disorders. Onset is most often during late adolescence and the
twenties, and onset tends to happen earlier among men than among women.
Schizophrenia is frequently associated with significant distress and impairment in
personal, family, social, educational, occupational, and other important areas of life.
People with schizophrenia are 2 to 3 times more likely to die early than the general
population. This is often due to physical illnesses, such as cardiovascular, metabolic,
and infectious diseases.
People with schizophrenia often experience human rights violations both inside mental
health institutions and in community settings. Stigma against people with this condition
is intense and widespread, causing social exclusion, and impacting their relationships
with others, including family and friends. This contributes to discrimination, which in
turn can limit access to general health care, education, housing, and employment.

Schizophrenia involves a range of problems with thinking (cognition), behavior and

emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations
or disorganized speech, and reflect an impaired ability to function. Symptoms can vary
in type and severity over time, with periods of worsening and remission of symptoms.
Some symptoms may always be present.

In men, schizophrenia symptoms typic the early to mid-20s. In women, symptoms

typically begin in the late 20s. It's uncommon for children to be diagnosed with
schizophrenia and rare for those older than age 45.
 CASE SCENARIO
Patient S.K was a retired military army who served the Philippines in a war in
Marawi City. During the war pt S.K was cornered by the terrorist and luckily
escaped the situation. After pt S.K retired a few years after he experienced seeing
and hearing things like explosions and gunshots, he was also hearing footsteps.
Prior to admission the patient was experiencing severe hallucinations and he kept
on hiding in the back of the door whenever he heard a loud bang noise, the patient
also having a difficulty in performing in his daily lives.

CHIEF COMPLAINT
Episodes of hallucination and delusions
 PATIENT'S PROFILE

NAME S.K NATIONALITY Filipino

AGE 65 RELIGION Roman Catholic

BIRTHDAY January 2, 1958 ADDRESS Quezon City

ADMITTING
STATUS Married Dr. M.A.C
PHYSICIAN
 PATIENT’S HISTORY OF PRESENT ILLNESS

The patient had trauma after captivated and escaped from terrorist. On September 24,
2022, the patient started to experience mild to severe hallucinations and delusions by
seeing and hearing things like footsteps, explosions and gunshots.

PAST MEDICAL HISTORY

Patient had neurological/psychological assessment after the traumatic incident.

FAMILY HISTORY

The patient is an retired Filipino military army and lives with his two children.
The patient does drink alcohol beverages and does smoke.
 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Subjective: Short term goal: Established Rapport To giant the trust of Goals Met
Defensive
“Andyan na ang mga After 3-7 days, of proper the client
coping
kalaban sa labas, nursing intervention the Short term goal:
related to
kailangan ko na patient will: Explain to the patient Prepares the patient After 3-7 days of
magtago” as suspicion of Interact with others the activity. to minimize proper nursing
verbalized by the the motive of appropriately; misinterpretation intervention the
patient. others Avoid high-risk patient:
environments and Interacted with his
Objective: situations. Use a non- Less chance for the family, friends
Fearful judgemental, patient to misinterpret normally
Agitate Long term goal: respectful, and neutral the actions Avoided high-risk
Aggression After 3-4 weeks of proper approach. environments and
Suspicious look in nursing intervention the situations for a
the eyes patient will: Use clear and simple Minimize while
Delusions Demonstrate ways in language. miscommunication or
Unable to dealing stress and misconstructing the Long term goal:
maintain/ establish feeling of meaning of the After 3-4 weeks of
relationship powerlessness; message proper nursing
 Be honest and Honesty and
Decrease in intervention the
suspicious behaviors; consistent regarding consistency provides
patient:
Apply a variety of outcomes and an environment in
Demonstrate
stress/anxiety enforcing rules. which trust can grow
ways in dealing
reducing techniques. stress and
Keep Chaotic environment
feeling of
environmental,quiet can be perceived as
powerlessness;
and free of stimuli. threatening
Decrease in
suspicious
Provide patient with To help the patient eat
packed meals or with ease behaviors;

sealed foods. Apply a variety

of
Introduce patient to Helps patient to lower stress/anxiety
strategies that anxiety levels reducing
minimize anxiety, techniques.
such as deep
breathing exercise
and counting 1o 10.
Provide solitary, non
competitive activities
that take some
concentration.
 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Subjective: Short term goal: encourage same staff To promote Short term:
Disturbed
Patient verbalized “I After 4 hours of nursing to work with the client development of Patient was able to
Sensory
can hear someone’s intervention, the nurse will as much as possible. trusting relationships. recognize that
Perception
calling me”. be able to present reality avoid physical Suspicious clients may hallucinations occur
related to to the patient. contact perceive touch as a at times of extreme
Objective: Auditory threatening gesture. anxiety
Looks fearful Hallucinations Long term goal: be honest and keep This honesty and

Irritability noted After 3 days of nursing all promises dependability promote

Long term:
Talkativeness intervention, the patient trusting relationships.
Patient and family
Hyperactivity will be able to verbalize mouth checks may be To verify that the client
will be able to
Agitation understanding that the necessary after is swallowing the
recognize signs of
Hostile behavior voices are the result of his medication tablets or capsules.
increasing anxiety
Threatened toward illness and demonstrate administration Suspicious clients may
and employed
self ways to interrupt believe they are being
techniques to
Restlessness hallucinations. poisoned with their
interrupt the
Hears voices medication and
responses
attempt to discard the
pills.
encourage client to Verbalization of
verbalize true feelings. feelings in a non
The nurse should threatening
avoid becoming environment may help
defensive when angry clients come to terms
feelings are directed with long-unresolved
at him or her. issues.

an assertive matter - The suspicious client

off -fact yet genuine does not have the
approach is the least capacity to relate to
threatening to the an overly friendly,
suspicious person. overly cheerful
attitude.
 INTRODUCTION

Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive

worry about a number of different things. People with GAD may anticipate disaster
and may be overly concerned about money, health, family, work, or other issues.
Individuals with GAD find it difficult to control their worry. They may worry more than
seems warranted about actual events or may expect the worst even when there is no
apparent reason for concern.

GAD is diagnosed when a person finds it difficult to control worry on more days than
not for at least six months and has three or more symptoms. This differentiates GAD
from worry that may be specific to a set stressor or for a more limited period of time.
Generalized Anxiety Disorder affects 6.8 million adults, or 3.1% of the U.S population.
GAD is characterized by constant and excessive worrying, for at least six months or
more. GAD can be considered a primary or secondary disorder, depending on the
time of onset. Diagnosis at a young age is considered a primary disorder, and
secondary is normally diagnosed later in life and is associated with other disorders.

GAD is most often associated with other disorders that involve anxiety and
depression and can lead to or worsen pre-existing conditions. Many of the bodies
systems can be affected by GAD, including: Cardiopulmonary, Musculoskeletal,
Gastrointestinal and Neurological systems. This disorder can manifest in several
ways, incorporating physical, behavioral, and cognitive characteristics.
CASE SCENARIO
A 26 year-old patient K.F presents to the clinic with complaints of trouble falling asleep
at night, headache and is unable to get a good night’s rest. She often feels "restless" or
"on edge", which she associates with not sleeping. She states she constantly worries
about her performance in school, her family, and her mother’s health, who has recently
been diagnosed with Stage IV Small Cell Carcinoma. Patient also states she wakes up
at night with throbbing headaches that last for a couple hours. She feels tense the
majority of the day, causing her to feel stiff. She also has difficulty paying attention in
class and finishing her homework.

CHIEF COMPLAINT
Having sleep problems such as trouble falling asleep, headache, feeling restless and on-
edge, constant worrying and difficulty concentrating.
 PATIENT'S PROFILE

RELIGION Roman Catholic

NAME K.F
OCCUPATION None
AGE 26
ROOM NUMBER 509
GENDER Female
ADMITTING DATE &
March 19, 2023 - 11:37 AM
BIRTHDAY January 5, 1997 TIME

STATUS Single ADMITTING Generalized Anxiety

DIAGNOSIS Disorder
NATIONALITY Filipino
ADMITTING
Dr. D
PHYSICIAN
 PATIENT’S HISTORY OF PRESENT ILLNESS

Patient started having difficulty sleeping and paying attention for almost a year
because of her school.
However, constant worrying and feeling restless started when the pt’s mom was
diagnosed with stage IV small cell carcinoma four months ago.
Patient was diagnosed with PTSD in May of 2004 and was treated with CBT by
a clinical psychologist following a car crash which caused the death of her eldest
sister.
PERSONAL HISTORY

Patient does not smoke but drinks alcoholic beverages regularly.

Patient is currently taking his second year as a graduate student.

FAMILY HISTORY

Patient does not have a family history of any mental illness

 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Subjective: Anxiety Related Short term goal: Independent: Goals Met

“Iniisip ko yung to situational After 8 hours of nursing Establish trust with Especially when a Short term goal
situation ko ngayon, crisis intervention the patient the patient patient has a high Goals Partially Met:
lalo na sa mother ko will be able to: 1. Listen to her level of anxiety, After 8 hours of
na may sakit at sa pag Relax and report concerns. establishing trust can nursing intervention
aaral ko, ano na ang anxiety reduced to a 2. Avoid giving help the patient calm the patient was able
gagawin ko” as manageable level. immediate down. to:
verbalized by the Verbalize awareness suggestions Relax and report
patient of feelings of anxiety. 3. Be respectful of anxiety reduced
patient’s space to a manageable
Objective: Long term goal: Provide opportunities Allowing the patient level.
Persistent worry After 48 hours of nursing for patients to assist to help make minor Verbalized
Inability to relax intervention the patient with decision making, decisions can help awareness of
will be able to: but avoid decisions them regain control of feelings of
Express relief from that may require their emotions. anxiety.
anxiety. concentrated thought
or maybe life-
changing.
 The nurse can offer Long term goal
Identify healthy ways Provide stress
available options Goals Partially Met:
to deal and express relieving and
such as books, After 48 hours of
anxiety relaxation techniques
music, and nursing intervention
Knows how to cope
distraction. the patient was able
up with her situation
Dependent: to:

Give sedatives as order Express relief

from anxiety.
Identify healthy

Collaborative: ways to deal and

Refer to counseling express anxiety

or support group Knows how to

. cope up with her

situation.
 NURSING CARE PLAN
NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

Subjective: Disturbed Short term goal: Independent: Short term goal:

“Hindi ako makatulog sleeping pattern After 1-2 hours of nursing 1. Establish rapport 1. To gain the patient’s Goals Met:
ng maayos tuwing r/t generalized intervention the patient with the patient cooperation. After 1-2 hours of
gabi, lalo na’t anxiety as will be able to: Listen to their nursing intervention
sumasakit pa ang ulo evidenced by: Determine patterns of concerns the patient was able
ko ng ilang oras” as Verbalized sleep in the past in a Avoid giving to:
verbalized by the complaint of normal environment: immediate Determine the
patient “Hindi ako bedtime routines, suggestions patterns of
makatulog depth, length, Be respectful of sleeping in the
Objective: ng maayos positions, aids, and patient’s space past in a normal
Restless or on tuwing gabi, other interfering environment:
edge lalo na’t factors. 2. Introduce relaxing 2. These activities bedtime routines,
Frequent yawning sumasakit Note physical or activities such as warm provide relaxation and depth, length,
with apparent pa ang ulo psychological baths, calm music, distraction to prepare the positions. aids,
eyebags ko ng ilang circumstances that reading a book, and mind and body for sleep. and other
Throbbing oras” hinder sleep such as meditation before interfering
headache that last noise, fear, and bedtime. factors.
for a couple hours anxiety.
 Apply non 3. Minimize sleep- 3. To promote readiness Apply non
pharmacologic disruption (e.g. turn off for sleep and improve pharmacologic
management on phone ringtone and duration and quality management on
headache adjust room headache
temperature)
Long term goal:
Long term goal: 4. Evaluate the patient’s 4. The patient may have Goals Partially Met:
After 1-2 days of nursing knowledge of the cause insights about the After 1-2 days of
intervention the patient of sleep problems and existing problems (e.g., nursing intervention
will be able to: potential relief measures anxiety or fear about a the patient was able
Report improvement to facilitate treatment. certain situation in life). to:
in sleep/ rest pattern This data will determine Have an
and increase sense of the appropriate therapy. improvement with
well-being and feeling her sleep/rest
rested. 5. Advice patient to 5. As your brain shrinks, pattern but was
increase oral fluid intake it pulls away from the not able to
especially water skull, puts pressure on achieve an
nerves and causes pain. increased sense
When you drink water of well-being and
and other fluids, the feeling rested.
brain plumps up to its
previous size and the
pain goes away.
 Apply non 6. Advice patient to have 6. Menthol has been
pharmacologic inhalants such as Vapor used for the treatment of
management on Rub, Katinko or white various pain conditions
headache flower including headache.

Dependent:
Long term goal: Cognitive behavioral Helps with learning to
After 1-2 days of nursing therapy and recognize and change
intervention the patient relaxation therapy thought patterns and
will be able to: behaviors that lead to
Report improvement anxious feelings. This
in sleep/ rest pattern type of therapy helps
and increase sense of limit distorted thinking by
well-being and feeling looking at worries more
rested. realistically.

Collaborative:
Refer to psychiatrist Specializes in
diagnosing and
treatment.
REFERENCES:

ADAA. (2022). Generalized Anxiety Disorder (GAD). Retrieved March 19, 2023 from https://adaa.org/understanding-
anxiety/generalized-anxiety-disorder-gad

Krishnan, P., & Hawranik, P. (2008). Diagnosis and management of geriatric insomnia: a guide for nurse practitioners. Journal of
the American Academy of Nurse Practitioners, 20(12), 590-599.

MOORER, D., & HOCKER, K. (n.d.). Generalized Anxiety Disorder Case Study 2017. Retrieved March 19, 2023 from
https://www.physio-pedia.com/Generalized_Anxiety_Disorder_Case_Study_2017

Mayo Foundation for Medical Education and Research. (2020, January 7). Schizophrenia. Mayo Clinic. Retrieved March 19, 2023,
from https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-
20354443#:~:text=Schizophrenia%20is%20a%20serious%20mental,with%20schizophrenia%20require%20lifelong%20treatment.

World Health Organization. (n.d.). Schizophrenia. World Health Organization. Retrieved March 19, 2023, from
https://www.who.int/news-room/fact-
sheets/detail/schizophrenia#:~:text=Some%20people%20with%20schizophrenia%20experience,worsening%20of%20symptoms%2
0over%20time.&text=Schizophrenia%20affects%20approximately%2024%20million,%25)
Nursing Care Management for a Patient
with Schizophrenia and Generalized
Anxiety

GROUP 2: Geriosa, Shekinah Angela Marie E.

Abdulbasher, Rayan T. Kanneh, Fatu
Boricano, Kimberly Ann T. Lucila, Kristina Cazandra
Cayetano, Keena Jan G. Mendoza, Samantha Kaye
Dolota, Alexis Claire A. Pascua, Ma. Nhelvie
Ferrer, Celin Jones Santa Teresa, Mikaela Luisa B.
Garcia, Caselyn T. Sebastian, Klareyn