CNA742 - Nursing Interventions for Paranoid Schizophrenia Report

This report details nursing interventions for a patient, Julie, diagnosed with paranoid schizophrenia. It includes a mental status examination, interventions addressing visual sensory perceptions and interrupted family processes, and the rationale behind them. The intervention plan involves pharmacotherapy with olanzapine and diazepam, alongside cognitive behavioral therapy. The report further outlines a discharge plan, focusing on living arrangements, financial needs, daily activities, medication, and community treatment to ensure a smooth transition for the patient.

Running head: NURSING INTERVENTIONS FOR PARANOID SCHIZOPHRENIA 1
Nursing Interventions for Paranoid Schizophrenia
Name
Institution

NURSING INTERVENTIONS FOR PARANOID SCHIZOPHRENIA 2
Nursing Interventions for Paranoid Schizophrenia
The Mental Status Examination conducted on Julie led to the conclusion that the patient
under consideration is psychotic. The fact that Julie depicts the attributes of being anxious and
guarded plays a role in demystifying the fact that she is suffering from paranoid schizophrenia.
Based on this analysis, the current study seeks to suggest the most effective interventions, the
rationale for these interventions, an intervention plan, and a discharge plan for Julie.
Interventions and Rationale
Julie presents visual sensory perceptions. The patient confesses that she sees people
following her in cars and even imagines that they could be following her at the healthcare
facility. According to McDougal and Sanderson (2016 p.165) visual sensory impressions
among patients with paranoid schizophrenia are as a result of psychological stresses, changes in
the neurological setup of the patient, biochemical factors and altered sensory perceptions. The
first nursing intervention for Julie will be aimed at acknowledging the reality of the sightings on
the side of the patient while stating that such visualizations do not exist. Tham et al. (2016
p.798) explain that such an approach is aimed at ensuring that the patient becomes uncertain of
the soundness of what she purports to see. To achieve this intervention, Giunta et al. (2018 p.27)
explain that there is need for the caregiver to he/she does not sense the said visualizations.
Second, McDougal and Sanderson (2016 p.165) propose that when dealing with patients
with paranoid schizophrenia, the caregiver is faced with the obligation of ensuring that the
conversations embrace a simplistic fashion, are basic and based on realities. As such, any move
to bombard the patient with multiple ideas must always be avoided. Instead, the caregiver must
aim at ensuring that the client concentrates on a single idea at a time. The rationale for this
intervention is to avoid all factors that may disorganize Julie’s thought processes. According to

NURSING INTERVENTIONS FOR PARANOID SCHIZOPHRENIA 3
Rus-Calafell et al. (2018 p.364), incorporation of reality-based conversations plays a critical role
in enhancing the patient’s ability to concentrate.
Julie presents some aspects of interrupted family processes. According to Mubin et al.
(2018 p.2), interrupted family processes among patients with paranoid schizophrenia could be as
a consequence of developmental crises, situational crises and shifts in the family role. On the
other hand, Bighelli et al. (2018 p.317) explain that this symptom is evidenced by lack of mutual
support and knowledge deficits on the condition and community support. To intervene, Julie’s
father will be taken through a counseling session as a way of determining his coping abilities
while discouraging him from using demeanor terms such as “useless” when addressing his
daughter. The rationale for this intervention is to help in the processes of stabilizing the patient’s
family unit. Further, the counseling process will help Julie’s father to appreciate the efficacy of
using positive phrases in preventing relapses and minimizing paranoia on the side of the patient.
Intervention Plan
Upon C.T brain examination, Julie did not reveal extra axial, parenchymal, or ventricular
abnormalities. Further, no form of abnormality was evident in Julie’s renal, thyroid and liver
functions. The patient’s mean corpuscular volume was slightly elevated even though nothing
abnormal was detected. Similarly, the client’s full blood count was within the normal limits.
Considering the symptoms presented by Julie, the treatment plan will constitute
pharmacotherapy and supportive psychological interventions.
Olanzapine and diazepam will be adopted as the primary antipsychotics for Julie. Bighelli
et al. (2018 p.317) identify olanzapine and diazepam as the standard treatments for paranoid
schizophrenia based on their greater capabilities in fostering effective management of the
symptoms associated with this condition. Further, González-Pando and Alonso-Pérez (2018

NURSING INTERVENTIONS FOR PARANOID SCHIZOPHRENIA 4
p.374) explain that antipsychotic medications play a significant role in restoring the natural
chemical functioning of the affected patient’s brain, minimizing psychotic symptoms, and
reducing drug addiction. A review of Julie’s medical profile reveals critical psychiatric issues
such as social isolation, paranoid ideas, reluctance when leaving the house, smoking, accessional
alcoholism, and low self esteem. As a consequence, olanzapine (10 mgs Stat in ED) and
diazepam (5 mgs Stat in ED) will be adopted.
Cognitive behavioral therapy (CBT) will be implemented as the primary psychosocial
intervention for Julie. According to Lang et al. (2016 p.78), CBT is a psychological intervention
that is implemented with the aim of fostering proper acknowledgement of the behavioral changes
depicted by the patient under consideration. As such, the intervention aims at recognizing the
warning signs and escalating symptoms depicted by the patient, normalizing the lapses
associated with drug addiction, coping up with personal cravings and incorporating healthy
alternatives through cognitive restructuring and counteraction of positive viewpoints concerning
drug use and abuse. Based on the initial intervention plan, Julie will attend counseling meetings
with the primary nurse, her grandmother and registrar with the aim of instilling an environment
that fosters motivation, positive mood change, cognitive repair, and enhancement of the patient’s
social skills. Further, Julie will be allowed the opportunities of watching favorite television
shows with her peers in the lounge area, being part of group counseling programs and using
about an hour off leave on a daily basis in the hospital’s grounds. Such activities will be of
critical significance in alienating attention deficits while boosting Julie’s ability to concentrate on
personal activities and foster abstract thought processes.

NURSING INTERVENTIONS FOR PARANOID SCHIZOPHRENIA 5
Discharge Plan
The institutionalization of Julie’s discharge plan commenced during hospital admission.
The caregiver played an essential role in creating a strong alliance between Julie’s grandmother,
the patient and other members of staff that were directly involved with this case. Table 1 gives a
summary of the discharge plan adopted for Julie.
Discharge plan for: Julie Date:
At hospital discharge
Living arrangements  Julie’s housing will be provided by her
grandmother.
 Other basic requirements such as food,
clothing, and transportation will be provided
by Julies family members (father and
grandmother)
Financial needs  Considering Julie’s position as a minor, all her
financial needs will be met by her father and
grandmother.
 The patient will be provided with social
support contacts to seek assistance.
Daily activities  In her position as a minor and a delicate
person, the patient’s grandmother and father
will face the obligation of meeting her daily
activities such as cooking, cleaning, and
budgeting. However, the patient will be

NURSING INTERVENTIONS FOR PARANOID SCHIZOPHRENIA 6
counseled on the importance of coping with
these chores.
Medication plan  Olanzapine (10 mgs Stat in ED)
 Diazepam (5 mgs Stat in ED)
Community treatment plan  Julie will be accorded 1/7 appointments with
the case manager.
 Follow-up psychiatric and rehabilitation
programs will be accorded for Julie when
necessary.

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References
Bighelli, I., Salanti, G., Huhn, M., Schneider‐Thoma, J., Krause, M., Reitmeir, C., Wallis, S.,
Schwermann, F., Pitschel‐Walz, G., Barbui, C. and Furukawa, T.A., 2018. Psychological
interventions to reduce positive symptoms in schizophrenia: systematic review and
network meta‐analysis. World psychiatry, 17(3), pp.316-329.
Giunta, S., La Fiura, G., Mannino, G. and Russo, S., 2018. Stigma and mental health: the
perception of the health professionals of the future and the feasible interventions.
International Journal of Psychoanalysis and Education, 10(1), pp.25-31.
González-Pando, D. and Alonso-Pérez, F., 2018. Integrated Care–‘Schizophrenia’: A Challenge
for Psychiatric/Mental Health Nursing. In European Psychiatric/Mental Health Nursing
in the 21st Century (pp. 371-383). Springer, Cham.
Lang, F.U., Müller-Stierlin, A.S., Walther, S., Schulze, T.G., Becker, T. and Jäger, M., 2016.
Psychopathological symptoms assessed by a system-specific approach are related to
global functioning in schizophrenic disorders. Psychopathology, 49(2), pp.77-82.
McDougall, Tim, and Sally Sanderson. "Nursing children and young people with psychosis and
schizophrenia." Children and Young People's Mental Health: Essentials for Nurses and
Other Professionals (2016): 165.
Mubin, M.F., Riwanto, I., Sakti, H. and Erawati, E., 2019. Psychoeducational therapy with
families of paranoid schizophrenia patients. Enfermería Clínica.
Rus-Calafell, M., Garety, P., Sason, E., Craig, T.J. and Valmaggia, L.R., 2018. Virtual reality in
the assessment and treatment of psychosis: a systematic review of its utility, acceptability
and effectiveness. Psychological medicine, 48(3), pp.362-391.

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Tham, X.C., Xie, H., Chng, C.M.L., Seah, X.Y., Lopez, V. and Klainin-Yobas, P., 2016. Factors
affecting medication adherence among adults with schizophrenia: a literature review.
Archives of psychiatric nursing, 30(6), pp.797-809.