Comprehensive Health History and Holistic Plan of Care
Schizophrenia is a mental illness that is difficult to diagnose. In the prodromal period people exhibit suspicion and withdrawal along with an increase of unusual thoughts. The exact causes of the disease are unknown, but genetics, brain chemistry, and a variety of environmental factors are thought to be contributing factors. Stress, malnutrition, and viruses are environmental factors that may play a part in the development of disease (National Institute of Mental Health, n.d.).
The patient is a 40 year old female who has experienced a schizophrenic episode including psychotic symptoms, (see psycho-social ...view middle of the document...
The patient denies mental illness, and is non-compliant with her medication, stating that: “the doctors are trying to make me fat and ugly, and I don’t need medicine, I am fine.”
The main concerns in this case include the fact that the patient is non-compliant with her medication, and that relapse is possible. Another concern is that the patient does not admit illness, and is hostile and suspicious of healthcare professionals, making treatment difficult. Due to the patient’s continuing negative symptoms, paranoia, flat affect, and lack of motivation, she is having difficulty in social situations, as well as in obtaining and keeping employment. Ann has a history of eating mainly junk food, and her nutritional health is poor, which may be a cause of her low energy level.
The priorities for this patient are nutritional support, development of a trusting therapeutic relationship that focuses on continuity of care, and the prevention of a relapse of positive schizophrenic symptoms, which in the past has led to dangerous impulsivity, and impaired judgement in the patient.
The patient’s major strength is her high level of intelligence. A supportive relationship with an assertive outreach team who understand the social stigma of being labeled schizophrenic will help to boost the patient’s self- esteem, without making her feel “disabled”. The patient is very aware of the stigma that accompanies a diagnosis of schizophrenia, and she is resistant to treatment due to embarrassment, and denial.
The patient’s weaknesses are impulsive behavior, lack of a strong support system, paranoia, and her secretive nature. These traits are inherent in many schizophrenic patients, but with consistent support it is possible to maintain a normal life.
The top three problems that I have identified are related to nutrition, non-compliance with medical advice, and denial of mental illness.
I chose knowledge deficit related to nutrition as my first nursing diagnosis, because it is the most urgent problem under Maslow’s hierarchy. A study published in the Journal of Research in Medical Sciences found that: “cobalamin and folate deficiencies may contribute to the pathogenesis of neuropsychiatric disorders such as mental confusion, memory changes, cognitive slowing, mood disorder, violent behavior, fatigue, delirium and paranoid psychosis” (Saedisomeolia et al., 2011).
1. Determine nutritional knowledge and motivation about health and eating.
This first step will help to determine what the client knows, and what she needs to learn.
2. Obtain a dietary consult to assist the client in selecting appealing foods that meet nutritional needs that the client can use as a guide after discharge.
By encouraging the client to eat things that she likes that are also healthy, there will be a better chance of compliance with the healthy eating plan.
3. Encourage family members to offer client reinforcement about healthy...