Pathophysiology: Schizoaffective Disorder

There is no known cause. It is diagnosed when the client has the psychotic symptoms of schizophrenia and meets the criteria for a major affect or mood disorder.

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The client has depressive disorder (non-specified), generalized anxiety disorder, and has had hallucinations, disorganized thoughts, feels like people are talking about him, and has a flat affect. Client has had this illness since he was young. Neurotransmitters affected are dopamine and glutamate. Videbeck p. 252-253

DSM IV Criteria includes:

An uninterrupted period of illness, delusions and hallucinations are present for at least 2 weeks in the absence of a major mood episode, a major mood episode is present majority of the duration, and disturbance is not due to direct physiological effects of a substance or general medical condition.

DSM IV TR p. 319-323

Pathophysiology: Schizoaffective Disorder

There is no known cause. It is diagnosed when the client has the psychotic symptoms of schizophrenia and meets the criteria for a major affect or mood disorder. The client has depressive disorder (non-specified), generalized anxiety disorder, and has had hallucinations, disorganized thoughts, feels like people are talking about him, and has a flat affect. Client has had this illness since he was young. Neurotransmitters affected are dopamine and glutamate. Videbeck p. 252-253

DSM IV Criteria includes:

An uninterrupted period of illness, delusions and hallucinations are present for at least 2 weeks in the absence of a major mood episode, a major mood episode is present majority of the duration, and disturbance is not due to direct physiological effects of a substance or general medical condition. DSM IV TR p. 319-323

Concept Map

Goal: Client will verbalize and demonstrate techniques to control anxiety by 9/18/2012. 1. Nurse will monitor the client for depression each shift by 9/17/2012. 2. Nurse will observe for adverse changes if anti-anxiety drugs are taken each shift 9/17/2012. 3. Nurse will encourage a quiet environment with diversion each shift by 9/17/2012. Goal: Client will verbalize and demonstrate techniques to control anxiety by 9/18/2012. 4. Nurse will monitor the client for depression each shift by 9/17/2012. 5. Nurse will observe for adverse changes if anti-anxiety drugs are taken each shift 9/17/2012. 6. Nurse will encourage a quiet environment with diversion each shift by 9/17/2012. Goal: Client will discuss feelings that accompany impaired social interactions by 9/18/2012.

1. Nurse will monitor the clients’ use of defense mechanisms, and support healthy defenses by 9/17/2012. 2. Nurse will spend time with client each shift by 9/17/2012. 3. Nurse will encourage physical participation in activities by 9/17/2012. Goal: Client will discuss feelings that accompany impaired social interactions by 9/18/2012. 4. Nurse will monitor the clients’ use of defense mechanisms, and support healthy defenses by 9/17/2012. 5. Nurse will spend time with client each shift by 9/17/2012. 6. Nurse will encourage physical participation in activities by 9/17/2012. Impaired social interaction r/t impaired communication patterns AEB discomfort in social situations. Ackley p. 763-766

Impaired social interaction r/t impaired communication patterns AEB discomfort in social situations. Ackley p. 763-766
Axis I:Schizoaffective Disorder, Anxiety NOS, Depressive Disorder NOS Axis II:none
Axis III: Hyperlipidemia, Chronic Constipation, Hypothyroidism, Vitamin D insufficiency Axis IV:unavailable
Axis V: unavailable
Axis I:Schizoaffective Disorder, Anxiety NOS, Depressive Disorder NOS Axis II:none
Axis III: Hyperlipidemia, Chronic Constipation, Hypothyroidism, Vitamin D insufficiency Axis IV:unavailable
Axis V: unavailable

Goal: Client will recognize need for medications and understand by 9/18/2012. 1. Nurse will observe clients ability to learn and previous knowledge of medications by 9/11/2012. 2. Nurse will provide information to support self-efficacy, self-regulations, and self-management by 9/11/2012. 3. Nurse will provide visual aids to enhance learning by 9/11/2012. Goal: Client will recognize need for medications and understand by 9/18/2012. 4. Nurse will observe clients ability to learn and previous knowledge of medications by 9/11/2012. 5. Nurse will provide information to support self-efficacy, self-regulations, and self-management by 9/11/2012. 6. Nurse will provide visual aids to enhance learning by 9/11/2012. Anxiety r/t unconscious conflict with reality AEB feeling constant worry. Ackley p. 139-141

Anxiety r/t unconscious conflict with reality AEB feeling constant worry. Ackley p. 139-141
Deficient Knowledge: Medication r/t lack of interest in learning AEB anxious behaviors. Ackley p. 520-523

Deficient Knowledge: Medication r/t lack of interest in learning AEB anxious behaviors. Ackley p. 520-523

9/20/2012

Deficient Knowledge: Medication r/t lack of interest in learning AEB anxious behaviors. Ackley p. 520-523 7. Nurse will observe clients ability to learn and previous knowledge of medications by 9/11/2012. Finding how the client learns best will help increase retention of the material. They will be more motivated. Ackley p.521 8. Nurse will provide information to support self-efficacy, self-regulations, and self-management by 9/11/2012. By providing information it allows the client to focus on problem solving and decision making. Ackley p.521 9. Nurse will provide visual aids to enhance learning by 9/11/2012. Pictures and simple word captions can help highlight important information. Ackley p.521 Impaired social interaction r/t impaired communication patterns AEB discomfort in social situations. Ackley p. 763-766 7. Nurse will monitor the clients’ use of defense mechanisms, and support healthy defenses by 9/17/2012.

By focusing on techniques, the client will be more aware of when they are using defense mechanisms and can try to avoid them. Ackley p. 764 8. Nurse will spend time with client each shift by 9/17/2012. Being present demonstrates that you care. Ackley p.764 9. Nurse will encourage physical participation in activities by 9/17/2012. By encouraging physical participation, the client learns to become more comfortable in social situations. Ackley p. 765 Anxiety r/t unconscious conflict with reality AEB feeling constant worry. Ackley p. 139-141 7. Nurse will monitor the client for depression each shift by 9/17/2012. Anxiety sometimes masks depression.

Clients who have anxiety and depression are socially isolated. Ackley p.140 8. Nurse will observe for adverse changes if anti-anxiety drugs are taken each shift by 9/17/2012. Age renders clients more sensitive to both the clinical and toxic effects of many agents. Ackley p.140 9. Nurse will encourage a quiet environment with diversion each shift by 9/17/2012. Excessive noise increases anxiety, involvement in a quiet activity can be soothing. Ackley p. 140 EVALUATION: This nursing student was unable to evaluate some of the interventions due to being ill one day. I assessed the client’s ability to learn. He didn’t seem to want to participate in learning about his medications, so I asked him what he knew about his medications. He was knowledgeable about what they were for, but not why he was taking them.

I used my Kindle fire to provide information about the 2 medications he was taking. There were pictures and information about them. The client seemed uninterested but did look at the pictures. He was able to explain to me why he was taking the medications. I felt the education was beneficial to the client, but it is hard to assess him for what he actually retained. I monitored the clients’ defense mechanism daily. The client would not talk a lot to me, have his arms crossed with poor eye contact at times. This nursing student spent time with the client each day (except for 9/18/2012 due to illness). The client seemed much closed off and didn’t want to participate in activities.

Each day I approached the client to participate in an activity such as Yahtzee, decorating the unit for fall, and going to the canteen for ice cream. The client did not participate in the activities. More time is needed to gain trust with this client. I believe that the client would participate if he and a therapeutic relationship with me. It is hard to get a therapeutic relationship established in a short amount of time. Client was monitored for depression each day. Client wanted to be alone in his room most of the day. He came out for meals, but he didn’t talk a lot. It was hard to assess for depression as this seems to be the daily behaviors for this client according to most of the staff.

I tried to encourage participation in activities and explained that it would be a quiet environment, but the client didn’t want to participate. He was very verbal with his feelings. I didn’t pressure him. Overall, this client likes to be alone in his room. He is afraid that people are talking about him. His room is the only place where he feels comfortable and that people aren’t talking about him. He said he feels like people are always staring at him. Great experience overall, I really had to try to use many different therapeutic techniques to talk and get information from my client. It was very hard, but it was a great learning experience.