SHARANDEEP KAUR a/p MOHINDER SINGH

880605235274001
JAN/2013
Schizophrenia is an illness, a medical condition.
It affects the normal functioning of the brain,
interfering with a persons ability to think, feel
and act. Some do recover completely, and, with
time, most find that their symptoms improve.
However, for many, it is a prolonged illness
which can involve years of distressing symptoms
and disability.
People affected by schizophrenia have one
personality, just like everyone else. It is a myth
and totally untrue that those affected have a so-
called split personality.

Mr. I - 39 years
-Male
-Chinese /Islam
-Single
-Salesman
-Rumah Perlindungan Saudara Baru,Rumah
Jabatan Agama, Bukit Pasir, Batu Pahat.
Johor
-Schizophrenia

Outpatient department in Hospital Permai on
6/3/13 at 1pm with his foster father by HSI
ambulance
Abnormal behavior - Disturbed sleep for few
days.
-Hearing voices
-Violence
Know case of depression since more than 10
years ago.
f/up under psychiatric department Kedah GH
He was given alprazolam, midazolam,
dothiapine and fluvoxamine but had stop
taking these medication about 5 years ago.




Mother (pass away 2003) Father (pass away 1988)















Patient Married Married Married Married
Married
(Single) Salesman



Born on 13/4/1974 at Kedah Hospital.
Normal delivery with the birth weight 2.7kg.
Converted to Islam in year 1995
Finished his study until UPSR
Working history - to work as a salesman and
subcontractor more than 10
years ago.
Sexual / Marital History single
- have a history of
sexual promiscuity++.

Financial Support - Received RM 300
from Nursing Home and
RM 100 from Jabatan
Agama Johor .
Religion - Chinese but he has converted to
Muslim
Habits - consume alcohol
-taking substance abused drugs
-smoking 1 pack per days
-EX IVDU.
Medical / Surgical History - HIV positive for
more than 10
years.
-asthma and gastritis
Records of Past Admission.
Year 2003 First contact to psychiatric
Year 2010 ( 1
st
adm) Referred from Kedah
GH and admitted HSIJB
for depression
-Tab. Alprazolam 5mg ON
-Tab. Midazolam 10mg PRN
-Tab. Dothiapine 25mg PRN.
-Tab. Fluvoxamine 50mg PRN
-Tab. Sod valproate 400mg BD

Year 2012(2
nd
adm) - brought by caretaker to
Hospital Permai Johor Bahru
-wondering around for 1 week
and naked in public
-stole money from public to buy
alcohol and fought with another
inmate for 1 week
-having homosexual activity with
the other patient for 2 month
-took alcohol half a bottle of
seven sea daily to feel better
-Tab. Risperidone 2mg ON
-Tab. Valium 10mg PRN
-Tab Haloperidol 10mg PRN
Year 2013 (3
rd
adm) - brought to the
outpatient department
in Hospital Permai on
6/3/13
-alleged assaulted by the
villagers
-Tab. Risperidone 2mg ON
-Tab. Valium 10mg PRN
-Inj. Haloperidol 10mg PRN.
-Tab. Midazolam 10mg PRN


Disturbances in General Appearance
- well-groomed and appears calm
Disturbances in Perception
- having auditory hallucination
- hears voices commanding him to hurt
himself and tohurt other people
Disturbance in Speech
- a good complete sentence
Disturbances in General Behaviour and Activity
- sometimes lethargic and catatonic stupor
during interactions
- sometimes restless where he cant remain
still
Disturbances in Orientation
- well oriented on date, time, place and reality.
- relate to past experiences and able to organized ideas
- aware that he was at the Permai Hospital Johor Bahru
- able to differentiate day and night.
Disturbances in Affect and Mood
- show appropriate affect with regards to a certain situation
Disturbances in Memory, Present and Remote
- good memory but sometimes he had relapses
- remember his past experiences and important events and
people in his life
Disturbances in Physiological
- able to sleep well sometimes and his appetite was good



Disturbances in Consciousness
- alert and conscious
Insight
- good
Physical Examination
- Vital Signs stable
- thin Malay guy
- calm, comfortable and cooperative
- looks well-nourished and not overweight
- short hair, finger nails are short and clean
- CVS, GI, Urinary & Respiratory system -
Normal
Family Therapy impossible
Individual Therapy - Established good
relationship and rapport
with Mr I (gain his respect and trust)
Group Therapy - divisional therapy together with
other patient
- interact and share their experiences
Social Skill Training - become socially competent
- more confidence when
interacting with others
through working and
socializing with the society
Explain to Mr I about the process of his illness
and the sign of relapse.
The important of regular follow-up according to
the appointment date.
The important of taking his medication regularly
as prescribed by doctor.
The functions and side effect of antipsychotic
drugs.
Management of hallucination
Advice Mr I to keep himself occupied by
preparing himself going back to work.
NO NURSING DIAGNOSIS GOALS NURSING INTERVENTION EVALUATION
1 Risk of harming self or
violence towards
others related to
hallucination
Mr I will not harm
himself or other
1. Observe patients behaviour
frequently and closely while carrying out
routine activities.
2. Ensure patients bed is near to nurses
station if it is in an open ward so that
patient is directly under nurses close
supervision.
3. Maintain safe and therapeutic
environment in the ward by removing all
dangerous object from the patient.
4. Keep all sharp objects or tools under
locked and key and keep and inventory
on it.
5. Remove the patient from the group if
hes become violence or disturbing
others.
Patient did not harm
himself or harm
others.
2 Risk of non-
compliance with
medication
Patient will be able
to take the
medication as
prescribe by
doctors
1. Establish rapport and develop
therapeutic patient nurses relationship
2. Make sure medication is served
according to the schedule so that
patients symptom can be controlled.
3. Ensure patient swallow the medication in
front of the nurses.
4. Provide health teaching to patient
regarding the side effects of the drug
and how to overcome it.
Patient understands
the important of
taking his
medication regularly
according to the
instruction.
NO NURSING DIAGNOSIS GOALS NURSING INTERVENTION EVALUATION
3 Disturbed sleep pattern Patients able to
adjust sleep
pattern
1. The patient will resume appropriate rest and
activity patterns.
2. More activities during day times.
3. Allowed only for 2 hours sleep during
afternoon time
Patient able to sleep
well during night
time
4. Disturbed thought
process related
inability to trust
evidenced by
delusional thinking
The patient will
eliminate pattern
of delusional
thinking
1. Be honest and keep all the promises.
2. Avoid physical contact in the form of
touching the patient.
3. Avoid laughing, whispering or talking
quietly where the patient can see but
cannot hear what is being said
Patient manage to
eliminate pattern of
delusional thinking
Schizophrenia is a chronic and profoundly
disabling psychiatric disorder.
Depressed mood, poor adherence, and
medication side-effects were the factors to
increase the risk of relapse in schizophrenia
patients.
Risk of relapse may be reduces when the
treating psychiatrist identifies and addresses
these factors

Kazadi, Moosa, & Jeenah (2008)