H.

Evaluation of Interventions

BEFORE AFTER

March 5, 2018 March 7, 2018

R.L was reserved in sharing information and He is comfortable around student nurses
usually mumbles during conversation. The and is open with his expressions. His
conversation solely relied on the nurses. mumbling had stopped.

.
March 5, 2018 March 12, 2018
R.L was easily distracted on environmental R.L is no longer distracted on environmental
stimuli. stimuli and is attentive during interaction.

March 7, 2018 March 13, 2018

R.L was wearing the same clothes he was R.L. was observed to wear different clothes
wearing the day before. than yesterday.

March 5, 2018 March 14, 2018

R.L does not want to wander too far from his R.L. decides to choose a befitting place for
current position when making decisions for a place not only him but for the student nurses as well
for nurse-patient interaction. for the nurse-patient interaction
 I. Recommendations or Discharge Plans- Medical and Nursing
Management

1. Medical Management
Drug Therapy

ANTIPSYCHOTIC AGENTS

CONVENTIONAL/TYPICAL ANTIPSYCHOTICS
Haloperidol 20mg/tab, 1/4 tab HS
 Tell patient/SO (s) to take tablets with a full glass of water, with or
without food.
 Instruct patient/SO (s) to not get oral cocentration on skin or clothes
because contact dermatitis may occur.
 Use caution in hot weather, patient is at risk for heat stroke. Keep up
fluid intake and do not over exercise in hot climate.
 Inform client/SO (s) to that he may experience the following side effects:
drowsiness, (avoid driving or operating machinery, activities requiring
energy), sensitivity to the sun (avoid prolonged sun eposure), pink or
reddish brown urine, faintness, dizziness ( change position slowly)
 Patient or the patient’s guardian should be advised about possibility of
tardive dyskinesia
 Advice not to drink with alcohol
 As appropriate, review all significant and life-threatening adverse
reactions and reactions, especially those related to drugs or behaviours.

Chlorpromazine 200mg/tab HS
 Tell patient/SO (s) to take tablets with a full glass of water, with or
without food.
 Instruct patient/SO (s) to not get oral cocentration on skin or clothes
because contact dermatitis may occur.
 Use caution in hot weather, patient is at risk for heat stroke. Keep up
fluid intake and do not over exercise in hot climate.
 Inform client/SO (s) to that he may experience the following side effects:
 drowsiness, (avoid driving or operating machinery, activities requiring
energy), sensitivity to the sun (avoid prolonged sun eposure), pink or
reddish brown urine, faintness, dizziness ( change position slowly)
 Patient or the patient’s guardian should be advised about possibility of
tardive dyskinesia
 Advice not to drink with alcohol
 As appropriate, review all significant and life-threatening adverse
reactions and reactions, especially those related to drugs or behaviours.

Fluphenazine-Typical

ANTIPARKINSONIAN MEDICATION
Biperiden HCL 2g HS

 Tell significant others not to abruptly stop the drug to prevent withdrawal
symptoms (insomnia, involuntary movements, anxiety and tachycardia)
 Caution significant others to let patient rise from sitting or recumbent
position slowly to prevent orthostatic hypoten
 Inform significant others to teach patient to chew gum, or hard candy
and frequent sips of water to relieve dry mouth.
 Inform significant others to teach patient to avoid any hazardous
activites.
 Instruct significant others that patient’s doses ahould not be doubled, but
missed doses may be taken up to 2 hours b

OLANZAPINE (TYPICAL)

• Atypical Antipsychotics

Antipsychotics. Antipsychotics are drugs that are used to treat symptoms of

psychosis such as delusions (for example, hearing voices), hallucinations,
paranoia, or confused thoughts. They are used in the treatment of schizophrenia,
severe depression and severe anxiety. Antipsychotics are also useful at stabilizing
episodes of mania in people with Bipolar Disorder.

Their main action is on dopamine receptors, reducing levels of excess dopamine.

They may also affect levels of other neurotransmitters, namely acetylcholine,
noradrenaline, and serotonin.

If symptoms of depression or mania persist in spite of treatment with other

medications, adding an antipsychotic drug such as olanzapine (Zyprexa),
risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone
(Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may
prescribe some of these medications alone or along with a mood stabilizer.

Atypical antipsychotics. Atypical antipsychotics are newer antipsychotics, most of

which were approved in the 1990s. They may also be called second generation
antipsychotics.

Atypical antipsychotics are used in the treatment of schizophrenia and other

psychoses and work on a number of different receptors, including serotonin,
dopamine, adrenergic, cholinergic (muscarinic), and histamine receptors. They
are usually preferred over older-type antipsychotics (also called first generation
antipsychotics or typical antipsychotics) because they are less likely to produce
extrapyramidal side effects (these are drug-induced movement disorders and
include dystonia, Parkinson's-like symptoms, restlessness, rigidity, tardive
dyskinesia, tremor, and other unwanted movements). In addition, atypical
antipsychotics are more effective at treating the negative symptoms of
schizophrenia such as lack of motivation and social withdrawal, and are more
effective in treatment-resistant patients.

Olanzapine. Olanzapine is an antipsychotic medication that affects chemicals in

the brain. Olanzapine is used to treat the symptoms of psychotic conditions such
as schizophrenia and bipolar disorder (manic depression) in adults and children
who are at least 13 years old. Olanzapine is sometimes used together with other
antipsychotic medications or antidepressants.

2. Nursing Management

Promoting safety if client and others

- Instruct folks to observe for any signs of building agitation or escalating

behavior such as increased intensity of pacing, loud talking or yelling, and hitting
or kicking objects. This may cause patient to harm self or other people around
him so it is best to administer medications , or moving the client into a quite less
stimulating enviroment, and in extreme situations, temporary use of seclusions
and restraints may be imposed.

-Instruct the patient’s primary caregiver to observe measures to provide a safety

environment as necessary.

Establish a Trusting Interpersonal Relationship

- Initiate a nurse-patient relationship contract mutually agreed on by nurse and

patient.

- Establish mutual goals related to social interaction.

- Establish trust by consistently meeting the elements of the plan and engaging
in open and honest communication.

-If the student nurse is anxious or frightened, the patient will be anxious or
frightened too.

-SN should be patient, shows acceptance, and use an active listening skills.

-Maintain eye contact.

-Demonstrate attitude of caring or concern.

-Help patient identify and maximize strengths and positive characteristics.

-Give positive feedback when patient handles a situation well.

-Call the patient by name.

-Use touch as appropriate.

Give Information

-Provide information about causes of symptoms.

-Involve significant others in educational sessions.

-Discuss the advantages of engaging in a wellness lifestyle.

Focus on the Symptoms and Ask the Patient to Describe what is

Happening

-Empower patient by helping understand the symptoms experienced or

manifested.

Medication Regimen, Nutrition and ADLs (Activities of Daily Living)

- Emphasize importance of compliance with medication.

-Give health teachings on possible side effects of using antipsychotic medication.

-Teach client to avoid drinking alcohol when taking the medication.

-Help patient keep focused on a single task, one step at a time.

-Provide feedback regarding the patient’s general coping responses and activities
of daily living.

Assist Client in Making Decisions

-Help patient determine desired outcomes.

-Help patient prioritize goals and categorize them as short term or long term.

-Help patient establish a timeline for attainment of each goal.

-Help establish small, concrete steps to achieve desired goals.

-Ensure that these small steps are achievable by the patient and are congruent
with culture and values.

-Educate ton maintain healthy lifestyle.

-Inform patient to maintain a regular sleep pattern.

-Encourage patient to be active (hobbies, friends, groups, sports, job, special

interests)

-Encourage patient to learn ways to reduce stress.

Usage of Therapeutic Communication

-Orient the patient regularly

-Active listening

-Clarify feelings and statements when speech and thoughts are confused, unclear
or in doubt.

-Nurse must maintain nonverbal communication when verbal one is not effective.

Family Support

Family intervention is an evidence-based support program available in many

areas which helps to reduce the relapse rate of psychotic patients in both early
and late stages.

Stress Management

Environmental stress plays a key role, whether or not there is vulnerability.

Many people cite stress as the trigger of their psychotic episode. The nurse’s role
is to explore and identify stress factors (life events or crises, such as leaving
home, starting college, being bullied or taking drugs) that affect the patient.

Sensitivity, support and the provision of emotional space for reflection are crucial
when nursing people who are recovering.

-Educate interventions on enhancing sleep.

-Encourage relaxation techniques to help patient cope with stress and improve
frame of mind.

-Encourage patient in getting more exercise that helps in reducing stress,

improves relaxation and sleep patterns and improve mood. It will also help to
improve motivation and self-esteem.

-Encourage patient to talk to someon he trusted. Stressful events can become

much easier to cope with if you have someone close to you who you can discuss
them with.

-Encourage patient to keep active. Experts say that keeping yourself occupied
helps you become distracted from stressful thinking. Many people find this useful
and preferable to being at home all the time where they may simply dwell on
their problems. In addition physical activities such as gardening or conservation
work in the open air will help you to relax and improve your sleep pattern.

XIV. Bibliography

Shives, L.R. and Isaacs, A. (2002), Basic Concepts of Psychiatric-Mental Health Nursing.
(5th Edition). Philippines: Lippincott Williams and Wilkins.

Doenges et. al. (2008). Nurse's Pocket Guide: Diagnoses, Prioritized Interventions, and
Rationales (11th Edition). Philadelphia: Lippincott Williams and Wilkins

Videbeck, Shiela L. (2011). Psychiatric-Mental Health Nursing. (5th edition).

Philadelphia: Lippincott Williams and Wilkins.

Varcarolis, E. (2007). Manual of Psychiatric Nursing Care Plans: Diagnoses, Clinical

Tools, and Psychopharmacology (3rd Edition). Philadelphia: Lippincott Williams and
Wilkins