SCHIZOPHRENIA

A Case Study
Presented to The
Faculty of the College of Nursing
Of the St. Anthony’s College
San Jose, Antique

In Partial Fulfillment
Of the Requirements for the
Degree of Bachelor of Science in Nursing

Submitted By:
Toledo, John Carlo P.
Mosquera, Rainy Rose M.

BSN 3
 TABLE OF CONTENTS

I. INTRODUCTION --------------------------------------------------1

II. OBJECTIVES -------------------------------------------------------2

III. BASELINE DATA -------------------------------------------------3

IV. HISTORY OF PRESENT ILLNESS ---------------------------4

V. MENTAL STATUS EXAM --------------------------------------5

VI. PSYCHOPATHOLOGY ------------------------------------------6

VII. DRUG STUDY -----------------------------------------------------7

VIII. NURSING CARE PLAN ------------------------------------------8

IX. TREATMENT ------------------------------------------------------9

X. NURSE-PATIENT INTERACTION --------------------------10

XI. PROGRESS REPORT -------------------------------------------11

XII. RECOMMENDATION ------------------------------------------12

XIII. REFERENCES ----------------------------------------------------13

 I. INTRODUCTION
Schizophrenia

Patient L.L was 54 years old female, who started showing symptoms
of auditory hallucination. The patient stated that she worked for 2 years in
Hong Kong. After a series of event including violent behavior in her
household, she was admitted to PMHU on April 12, 2019. She was
diagnosed with Schizophrenia and complied with treatment.

BSN 3 was given the opportunity to go on a psychiatric exposure at

Pototan Mental Health Unit on April 22 – May 3, 2019. The students chose
this case study to present to the St. Anthony’s College of Nursing. The
student chose this case because it gave them the opportunity to expand their
learning on psychiatric nursing. This case provided the student nurses
motivation to gain better understanding on mental illness. Moreover, this
case study help the student nurses to enhance their ability to care for
patients with mental disorders, especially schizophrenia. Lastly, the student
nurses hope that this case study will be a bridge in order to stop the stigma
on mental illness.
VI.PSYCHOPATHOLOGY

Predisposing Factors: Precipitating Factors:

Age: 54 Occupation: housewife
Sex: Female Civil Status: Separated
Family history of schizophrenia Socioeconomic Status
Loss of mother figure Non-compliance to medication

Neurodevelopmental abnormalities and target features

Physical and Psychological changes

Imbalance in the neurotransmitters in the brain

High dopamine activity in the Mesolimbic System

Dysfunctional cortico-limbic Dopaminergic pathways

Increase Serotonin

Increase acetylcholine

Increase Gamma-Aminobutyric Acid

Pre-fontal Cortex deficits

Positive Signs and Symptoms Negative Signs and Symptoms

1. Delusion of Persecution 1. Manic Behavior

2. Delusion of Grandeur 2. Depressed mood
3. Auditory Hallucination 3. Anhedonia

Nursing Diagnosis:
 Psychosexual Theory by
Sigmund Freud
Infancy (Birth 1 year)
Oral Stage- Putting all sort of
things in the mouth to satisfy the
libido, and thus its id demands.
Which at this stage in life are oral,
or mouth oriented, such as
sucking, and breastfeeding.
Toddler (1-3 years)
Anal stage – Libido is now
becomes focused on the anus, and
child derives great pleasure from
defecating.
Preschool (3-6 years)
Phallic Stage – Sensitivity now
becomes concentrated in the
genitals and masturbation (in both
sexes) becomes a new source of
pleasure
OEDIPUS COMPLEX
Psychosocial Development by
Erik Erikson
Infancy: Trust vs. Mistrust
Value: Hope
The infant is uncertain about the
world in which they live. To
resolve these feelings of
uncertainty, the infant looks
towards their primary caregiver for
stability and consistency of care.
Toddler: Autonomy vs. shame
Value: Will
The child is discovering that he or
she has many skills and abilities
such as putting on clothes and
shoes, playing with toys. Such
skills illustrate the child’s growing
sense of independence.
Pre- school: Initiative vs. Guilt
Value: Purpose
The primary feature involves the
child regularly interacting with
other children at the school.
Interpersonal Theory Anamnesis
By Henry Sullivan
Infancy (Birth- 18 months):
Characteristics:
Gratification of needs
A time when the child receives
tenderness from mothering, one
while also learning anxiety
through an empathic linkage with
mother.
Childhood (18 mos.-6 yrs.):
Characteristics: Delayed
gratification
The need of playmates of equal
status is call childhood. The
child’s primary interpersonal
relationship continues to be with
the mother, who is now
differentiated from other persons
who nurture the child
Juvenile era (6-9 yrs.):
Characteristics: formation of a
peer group.
Begins with the need fro peers of
equal status and continues until the
child develops a need for an
intimate relationship with a single
best friend,
School age (6 years to puberty)
Latency Stage – The superego
continues to develop while id’s
energies are suppressed. Children
develop social skills, values and
relationship with peers and adults
outside of the family
School age: Industry vs Preadolescence (9-12 yrs.)
Inferiority Characteristics: Development of
Value: Competency relationship within the same
It is at this stage that the child’s gender.
peer group will gain greater
significance will become a major
source of the child’s self-esteem.
Puberty: Identity vs Role Early adolescence (12-14 yrs.)
Confusion Characteristics: Development of
Value: Fidelity an identity
This is a major stage of
development where the child has
to learn the roles he will occupy
as an adult.
Early Adulthood: Intimacy vs Late Adolescence (14-21 yrs.)
Isolation Characteristics: Formation of
Value: Love lasting, intimate relationships.
Once people have established
their identities, they are ready to
make long term commitments to
others. If they cannot, a sense of
isolation may result.
Adulthood: Generatively vs
Stagnation
Value: Care
Has broad application to family,
relationships, work and society.
 VII. DRUG STUDY

Name of Drug Dosage, Route, and Mechanism of Action Indication and Adverse Effect Nursing Responsibilities
Frequency Contraindication
Generic Name: Dosage: 10 mg Olanzapine’s antipsychotic Indication: CNS: Somnolence,
Olanzapine activity is likely due to a Treatment of acute mixed dizziness, nervousness,
Frequency: combination of antagonism D2 or manic episodes headache, akathisia,
Brand Name: ODT receptors in the mesolimbic associated with Bipolar I personality disorder.
Zyprexa pathway and 5HT2A receptors disorder and maintenance
Route: Oral in the frontal cortex. of Bipolar I disorder as CV: Orthostatic
Classification: Antagonism at D2 receptors monotherapy or combined hypotension, peripheral
Atypical relieves positive symptoms with Lithium or edema, tachycardia
Antipsychotics while antagonism at 5HT2A Valproate.
Dopamine blocker receptors relieves negative Respiratory: Cough,
symptoms of schizophrenia. Contraindication: Pharyngitis
 Contraindicated with
allergy to GIT: Constipation,
Olanzapine. Abdominal pain
 Severe CNS
depression. Other: Fever,
 Comatose states. development of Diabetes
 Lactation Mellitus