Schizophrenia nursing care rehabilitation process. Caring for patients with schizophrenia. Text of the scientific work on the topic "Differentiated approaches to psychosocial therapy and rehabilitation of patients with schizophrenia recognized by the court as incompetent"

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State Autonomous Educational Institution of Secondary Vocational Education of the Arkhangelsk Region "Arkhangelsk Medical College"

TOPIC: “Schizophrenia, features of the nursing process in an adult department.”

Performed:

Pushkina Lidiya Vyacheslavovna

nurse, GBUZ JSC "Oktyabrsky"

psychoneurological boarding school"

Arkhangelsk, 2014

Introduction

Schizophrenia is a disease characterized by gradually increasing personality changes (autism, emotional impoverishment, the appearance of oddities and eccentricities), other negative changes (dissociation of mental activity, thinking disorders) and productive psychopathological manifestations of varying severity and severity (affective, neurosis- and psychopath-like, delusional , hallucinatory, hebephrenic, catatonic).

The risk of developing the disease ranges from 0.5 to 1%, and this indicator does not depend on nationality or race and does not accumulate in the population over time. Social status and cultural level of a person do not affect the incidence of schizophrenia. People suffering from schizophrenia have a higher mortality rate from somatic diseases, and about 10% of patients commit suicide. About 25% of people with schizophrenia abuse alcohol or drugs. The etiology and pathogenesis of schizophrenia are not well understood. Important role constitutional and genetic factors play a role, as well as the gender and age of patients. The genetic factor is involved in the formation of a predisposition to schizophrenia, and the risk of getting sick is directly proportional to the degree of relationship and the number of cases in the family. The most severe forms of the disease occur predominantly in men, while less progressive forms occur in women.

General clinical characteristics of schizophrenia

Schizophrenia as a separate disease was first identified by the German psychiatrist E. Kraepelin. He took groups of patients who had previously been described with diagnoses of hebephrenia (E. Hecker), catatonia (K. Kahlbaum) and paranoids (V. Magnan), and, having followed them catamnestically, found that in long term they had a kind of dementia. In this regard, E. Kraepelin combined these three groups of painful conditions and called them dementia praecox (dementia praecox). Having identified a separate disease based on the outcome in dementia, E. Kraepelin at the same time allowed for the possibility of recovery. This well-known contradiction and the principle of classification attracted attention and were critically assessed. Subsequently, the Swiss psychiatrist E. Bleuler (1911) proposed a new term for the name of this disease - “schizophrenia”. They were allocated primary and secondary signs diseases. He considered the primary causes to be the loss of social contacts by patients: autism), impoverishment of emotionality, splitting of the psyche (special thinking disorders, dissociation between different mental manifestations etc.). All these mental disorders were qualified as personality changes of the schizophrenic type. These changes were of decisive importance in the diagnosis of schizophrenia.

Other mental disorders, defined by E. Bleuler as secondary, additional, are manifested by senesthopathy, illusions and hallucinations, delusions, catatonic disorders, etc. He did not consider these disorders obligatory for schizophrenia, since they also occur in other diseases, although individual of these may be more characteristic of schizophrenia.

Certain forms of schizophrenia have been identified and described. By three classic forms: hebephrenic, catatonic and paranoid - a fourth form was added - simple. Subsequently, other forms were described: hypochondriacal, periodic, etc. The forms were identified on the basis of the leading syndrome. However, as clinical observations have shown, the psychopathological symptoms typical of one form or another of schizophrenia were not stable. The disease, which manifests itself in the first stages as a simple form, could subsequently exhibit psychopathological signs characteristic of paranoid and other forms.

The psychopathological manifestations of schizophrenia are very diverse. According to their characteristics, they are divided into negative and productive. Negative ones reflect loss or distortion of functions, productive ones - the identification of special psychopathological symptoms: hallucinations, delusions, affective tension, etc. Their ratio and representation in the patient’s mental state depend on the progression and form of the disease.

For schizophrenia, as noted, the most significant are the peculiar disorders that characterize changes in the patient’s personality. The severity of these changes reflects the malignancy of the disease process. These changes affect all mental properties of the individual. However, the most typical ones are intellectual and emotional.

Intellectual disorders manifest themselves in various types of thinking disorders: patients complain of an uncontrollable flow of thoughts, their blockage, parallelism, etc. It is difficult for them to comprehend the meaning of the text of books, textbooks, etc. they read. There is a tendency to capture special meaning in individual sentences, words, and create new ones words (neologisms). Thinking is often vague; statements seem to slip from one topic to another without a visible logical connection. Logical inconsistency in statements in a number of patients with advanced painful changes takes on the character of speech discontinuity (schizophasia).

Emotional disturbances begin with the loss of: moral and ethical properties, feelings of affection and compassion for loved ones, and sometimes this is accompanied by hostility and malice. Interest in what you love decreases and eventually disappears completely. Patients become sloppy and do not observe basic hygienic self-care. An essential sign of the disease is also the behavior of patients. An early sign of it may be the appearance of isolation, alienation from loved ones, and strange behavior: unusual behavior, a manner of behavior that was previously not characteristic of the individual and the motives of which cannot be associated with any circumstances. Various peculiar senestopathic manifestations are also typical for schizophrenia: unpleasant sensations in the head and other parts of the body. Senestopathies are fanciful in nature: patients complain of a feeling of distension of one hemisphere in the head, dry stomach, etc. The localization of senestopathic manifestations does not correspond to the painful sensations that can occur with somatic diseases.

Perceptual disorders manifest themselves predominantly auditory hallucinations and often various pseudohallucinations of various senses: visual, auditory, olfactory, etc. From delusional experiences it is also possible to observe various forms of delusion: paranoid, paranoid and paraphrenic, in the early stages - more often paranoid. Delusions of physical influence are very characteristic of schizophrenia, which is usually combined with pseudohallucinations and is called Kandinsky-Clerambault syndrome by the authors who described it.

Motor-volitional disorders are diverse in their manifestations. They are found in the form of a disorder of voluntary activity and in the form of a pathology of more complex volitional acts. One of the most striking types of disturbance of voluntary activity is catatonic syndrome. Catatonic syndrome includes states of catatonic stupor and agitation. Catatonic stupor itself can be of two types: lucid and oneiric. With lucid stupor, the patient retains elementary orientation in the environment and its assessment, while with oneiric stupor the patient’s consciousness is altered. Patients with lucid stupor, after emerging from this state, remember and talk about the events that took place around them during that period. Patients with oneiric conditions report fantastic visions and experiences that they were in the grip of during a stuporous state. Stuporous states, as well as catatonic excitations, are complex psychopathological formations, including various symptoms.

More complex volitional acts and volitional processes also undergo various disturbances under the influence of the disease. The most typical is an increasing decrease in volitional activity, ending in apathy and lethargy, and the severity volitional disorders, as a rule, correlates with the progression of the disease. However, some patients may experience an increase in activity associated with certain painful ideas and attitudes. For example, due to delusional ideas and attitudes, patients are able to overcome exceptional difficulties, show initiative and perseverance, and perform great work. The content of painful experiences of delusional ideas in patients may be different. At the same time, it reflects the spirit of the times, certain socially significant phenomena. Over time, the content of psychopathological manifestations of the disease changes. If in the past evil spirits, religious motives, and witchcraft often appeared in the statements of patients, now new achievements of science and technology.

The question of the prevalence of schizophrenia in the population is an important issue, both scientifically and practically. The difficulty in answering this question lies in the fact that it is not yet possible to fully identify these patients among the population. This is due, first of all, to the lack of reliable data for understanding the essence of schizophrenia and diagnostic criteria for its definition. Available statistical data and the results of epidemiological studies allow us to conclude that its distribution rates are almost identical in all countries and amount to 1–2% of general population. The initial assumption that schizophrenia is less common in developing countries has not been confirmed. The results of studies specifically conducted in developing countries revealed a similar number of patients with schizophrenia per 1000 population with the number of patients with schizophrenia in European countries. There is only a difference in the representativeness of certain types of clinical manifestations of the disease. Thus, among patients living in developing countries, acute conditions with confusion, catatonic, etc. are more common.

Schizophrenia can begin at any age. However, the most typical age period for the onset of development of schizophrenia is 20–25 years. At the same time, for individual initial clinical manifestations schizophrenia has its own optimal timing. Thus, schizophrenia with paranoid manifestations begins more often at the age of over 30 years, with neurosis-like symptoms and thinking disorders - in adolescence and young adulthood. In males, the disease begins earlier than in females. In addition, there are differences in the clinical picture of the disease depending on the gender of the patients. In women, the disease is more acute, and various affective pathologies are more common and more pronounced.

Nursing process in schizophrenia

Nursing process (NP) is now the basis nursing care. SP is a method for nurses to scientifically validate and practice their responsibilities in providing patient care. SP brings a new understanding of the role of the nurse in practical healthcare, requiring from her not only good technical training, but also the ability to be creative in caring for patients, the ability to work with the patient as an individual, and not as a nosological unit, an object of “manipulation techniques.” "

Constant presence and contact with the patient makes the nurse the main link between the patient and the outside world; the outcome of the disease often depends on the relationship between the nurse and the patient and their mutual understanding. What does the nursing process provide for practice, what goals does it set?

The nursing process first identifies the patient's specific nursing needs. Secondly, it helps to identify care priorities and expected care outcomes from a number of existing needs, and also predicts its consequences. Third, it determines the nurse's plan of action, a strategy aimed at meeting the patient's needs. Fourthly, with its help the effectiveness of the work carried out by the nurse and the professionalism of nursing intervention are assessed. And most importantly, it guarantees the quality of care that can be controlled.

The organizational structure of the nursing process consists of five main stages:

nursing examination of the patient;
diagnosing his condition (identifying needs and identifying problems);
planning assistance aimed at meeting identified needs (problems);
implementation of the plan for necessary nursing interventions;
assessment of the results obtained with their correction if necessary.

A negative prejudice has formed in society regarding psychiatry. There are large differences between mental and physical illnesses, which is why patients and their relatives often feel ashamed of the disease. This attitude can hinder the nursing process at all stages.

Caregivers should not perceive the patient's personality with its needs, desires and fears only from the point of view of the diagnosis of the disease.

Holistic care encompasses the individual, family, and relationships. The care process is carried out in stages. Quality care is possible through a partnership between the patient and the caregiver. Such interaction can only be achieved by establishing a relationship of trust between the patient and the caring staff. General care caring for elderly and senile mentally ill patients is more complex and requires more attention and time from medical personnel. The main principle of care is respect for his personality, acceptance of him as he is, with all his shortcomings, physical and mental: irritability, talkativeness, and in many cases dementia. For medical personnel in their work with such patients, traits such as patience, a sense of tact, and a sense of compassion are important. Consistent with the five stages of the nursing process, the nurse has a framework for making decisions and solving problems when the nurse provides care.

2.1. Collection of information

Patients suffering from schizophrenia are often immersed in their experiences, fenced off from the outside world, and attempts to collect information, much less penetrate into their inner world, can cause resistance and even aggression in them. This is especially possible in patients with paranoid schizophrenia.

Therefore, the duration of the conversation with patients should be short. Several short conversations throughout the day, separated by intervals, are recommended.

In conversations with patients, general expressions and abstract constructions should be avoided in every possible way: facts and judgments communicated to the patient must be extremely specific. Otherwise, due to thinking disorders and delusional constructs, the meaning of the conversation in the patient’s mind may be distorted.

The autism of patients suffering from schizophrenia, inaccessibility and resistance to communication require the collection of information not only from patients, but also from their relatives and loved ones. It should be taken into account that among the relatives of patients with schizophrenia there are many strange people, with personality deviations, full contact with whom may also not be possible.

Therefore, if possible, it is advisable to ask several people about the patient’s problems.

Short description

Schizophrenia is a mental illness of unknown etiology, prone to a chronic course, manifested by typical changes in the patient’s personality and other mental disorders of varying severity, often leading to persistent impairments in social adaptation and ability to work.
Schizophrenia is a disease characterized by gradually increasing personality changes (autism, emotional impoverishment, the appearance of oddities and eccentricities), other negative changes (dissociation of mental activity, thinking disorders) and productive psychopathological manifestations of varying severity and severity (affective, neurosis- and psychopath-like, delusional , hallucinatory, hebephrenic, catatonic).

News of psychiatry and psychology

Features of caring for patients diagnosed with schizophrenia

Caring for patients diagnosed with schizophrenia has a number of features and challenges. Features of the disease make it difficult to perform daily hygiene procedures such as washing, changing clothes and eating. In some cases, patients refuse to eat, in which case it is necessary to use tube feeding.

When caring for patients, nurses and nursing staff must consider the following aspects:

Constant monitoring of the patient’s behavior, as well as the manifestation of psychopathological symptoms of the disease. Psychopathological manifestations can be in the form of hallucinations, inexplicable fears, the patient can run and hide, or suddenly scream. In such situations, patients usually do not notice the people around them and what is happening around them. The patient may also be delirious and run away from medical personnel, be afraid of any objects, refuse food, and so on;

If necessary, medical staff provides care for patients at home. Usually in such cases a nurse is assigned to the patient;

Medical personnel must monitor the patient around the clock, because his behavior is unpredictable, he can cause physical harm to himself or other people at any time;

During the process of eating, medical staff must monitor the patient, as well as promote compliance with hygiene standards;

The patient should spend the allotted time in the fresh air;

During a meeting between a patient and his relatives, medical personnel must observe the patient’s behavior and enter data about his behavior into a journal. Does the patient recognize his loved ones, what emotions they evoke, joy, anger, aggression;

Monitoring the patient while taking medications and conducting therapy. The medical staff needs to make sure that the patient has taken the medicine, for this they need to check his oral cavity.

Schizophrenia, features of the nursing process in the adult department

abstract on psychiatry SCHIZOPHRENIA.doc

State Autonomous Educational Institution of Secondary Vocational Education of the Arkhangelsk Region "Arkhangelsk Medical College"

TOPIC: “Schizophrenia, features of the nursing process in an adult department.”

Pushkina Lidiya Vyacheslavovna

nurse, GBUZ JSC "Oktyabrsky"

The risk of developing the disease ranges from 0.5 to 1%, and this indicator does not depend on nationality or race and does not accumulate in the population over time. Social status and cultural level of a person do not affect the incidence of schizophrenia. People suffering from schizophrenia have a higher mortality rate from somatic diseases, and about 10% of patients commit suicide. About 25% of people with schizophrenia abuse alcohol or drugs. The etiology and pathogenesis of schizophrenia are not well understood. An important role is played by constitutional and genetic factors, as well as the gender and age of patients. The genetic factor is involved in the formation of a predisposition to schizophrenia, and the risk of getting sick is directly proportional to the degree of relationship and the number of cases in the family. The most severe forms of the disease occur predominantly in men, while less progressive forms occur in women.

General clinical characteristics of schizophrenia

Schizophrenia as a separate disease was first identified by the German psychiatrist E. Kraepelin. He took groups of patients who had previously been described with diagnoses of hebephrenia (E. Hecker), catatonia (K. Kahlbaum) and paranoids (V. Magnan), and, following them follow-up, found that in the long-term period they had a kind of dementia. In this regard, E. Kraepelin combined these three groups of painful conditions and called them dementia praecox (dementia praecox). Having identified a separate disease based on the outcome in dementia, E. Kraepelin at the same time allowed for the possibility of recovery. This well-known contradiction and the principle of classification attracted attention and were critically assessed. Subsequently, the Swiss psychiatrist E. Bleuler (1911) proposed a new term for the name of this disease - “schizophrenia”. They identified primary and secondary signs of the disease. He considered the primary causes to be the loss of social contacts in patients: autism), impoverishment of emotionality, splitting of the psyche (special thinking disorders, dissociation between various mental manifestations, etc.). All these mental disorders were qualified as personality changes of the schizophrenic type. These changes were of decisive importance in the diagnosis of schizophrenia.

Certain forms of schizophrenia have been identified and described. To the three classic forms: hebephrenic, catatonic and paranoid, a fourth form was added - simple. Subsequently, other forms were described: hypochondriacal, periodic, etc. The forms were identified on the basis of the leading syndrome. However, as clinical observations have shown, the psychopathological symptoms typical of one form or another of schizophrenia were not stable. The disease, which manifests itself in the first stages as a simple form, could subsequently exhibit psychopathological signs characteristic of paranoid and other forms.

Intellectual disorders manifest themselves in various options thinking disorders: patients complain of an uncontrollable flow of thoughts, their blockage, parallelism, etc. It is difficult for them to comprehend the meaning of the text of books, textbooks, etc. they read. There is a tendency to capture a special meaning in individual sentences, words, and create new words (neologisms). Thinking is often vague; statements seem to slip from one topic to another without a visible logical connection. Logical inconsistency in statements in a number of patients with advanced painful changes takes on the character of speech discontinuity (schizophasia).

Emotional disturbances begin with the loss of: moral and ethical properties, feelings of affection and compassion for loved ones, and sometimes this is accompanied by hostility and malice. Interest in what you love decreases and eventually disappears completely. Patients become sloppy and do not comply with basic hygiene care behind you. An essential sign of the disease is also the behavior of patients. An early sign of it may be the emergence of isolation, alienation from loved ones, oddities in behavior: unusual actions, a manner of behavior that were previously unusual for the individual and the motives of which cannot be associated with any circumstances. Various peculiar senestopathic manifestations are also typical for schizophrenia: discomfort in the head and other parts of the body. Senestopathies are fanciful in nature: patients complain of a feeling of distension of one hemisphere in the head, dry stomach, etc. The localization of senestopathic manifestations does not correspond to the painful sensations that can occur with somatic diseases.

Perception disorders are manifested mainly by auditory hallucinations and often by various pseudohallucinations of various sense organs: visual, auditory, olfactory, etc. From delusional experiences it is also possible to observe various forms of delusion: paranoid, paranoid and paraphrenic, in the early stages - more often paranoid. Delusions of physical influence are very characteristic of schizophrenia, which is usually combined with pseudohallucinations and is called Kandinsky-Clerambault syndrome by the authors who described it.

More complex volitional acts and volitional processes also undergo various disturbances under the influence of the disease. The most typical is an increasing decrease in volitional activity, ending in apathy and lethargy, and the severity of volitional disorders, as a rule, correlates with the progression of the disease. However, some patients may experience an increase in activity associated with certain painful ideas and attitudes. For example, due to delusional ideas and attitudes, patients are able to overcome exceptional difficulties, show initiative and perseverance, and perform great work. The content of painful experiences of delusional ideas in patients may be different. At the same time, it reflects the spirit of the times, certain socially significant phenomena. Over time, the content of psychopathological manifestations of the disease changes. If in the past evil spirits, religious motives, and witchcraft often appeared in the statements of patients, now new achievements of science and technology.

The question of the prevalence of schizophrenia among the population is important question, both scientifically and practically. The difficulty in answering this question lies in the fact that it is not yet possible to fully identify these patients among the population. This is due, first of all, to the lack of reliable data for understanding the essence of schizophrenia and diagnostic criteria for its definition. Available statistical data and the results of epidemiological studies allow us to conclude that its distribution rates are almost identical in all countries and amount to 1–2% of the total population. The initial assumption that schizophrenia is less common in developing countries has not been confirmed. The results of studies specifically conducted in developing countries revealed a similar number of patients with schizophrenia per 1000 population with the number of patients with schizophrenia in European countries. There is only a difference in the representativeness of certain types of clinical manifestations of the disease. Thus, among patients living in developing countries, acute conditions with confusion, catatonic, etc. are more common.

Schizophrenia can begin at any age. However, the most typical age period for the onset of schizophrenia is 20–25 years. At the same time, certain initial clinical manifestations of schizophrenia have their own optimal timing. Thus, schizophrenia with paranoid manifestations begins more often at the age of over 30 years, with neurosis-like symptoms and thinking disorders - in adolescence and young adulthood. In males, the disease begins earlier than in females. In addition, there are differences in the clinical picture of the disease depending on the gender of the patients. In women, the disease is more acute, and various affective pathologies are more common and more pronounced.

The nursing process (NP) is currently the basis of nursing care. SP is a method for nurses to scientifically validate and practice their responsibilities in providing patient care. SP brings a new understanding of the role of the nurse in practical healthcare, requiring from her not only good technical training, but also the ability to be creative in caring for patients, the ability to work with the patient as an individual, and not as a nosological unit, an object of “manipulation techniques.” "

The organizational structure of the nursing process consists of five main stages:

nursing examination of the patient;

diagnosing his condition (identifying needs and identifying problems);

planning assistance aimed at meeting identified needs (problems);

implementation of the plan for necessary nursing interventions;

assessment of the results obtained with their correction if necessary.

Caregivers should not perceive the patient's personality with its needs, desires and fears only from the point of view of the diagnosis of the disease.

Holistic care encompasses the individual, family, and relationships. The care process is carried out in stages. Quality care is possible through a partnership between the patient and the caregiver. Such interaction can only be achieved by establishing a relationship of trust between the patient and the caring staff. General care for elderly and senile mentally ill patients is more complex and requires more attention and time from medical personnel. The main principle of care is respect for his personality, acceptance of him as he is, with all his shortcomings, physical and mental: irritability, talkativeness, and in many cases dementia. For medical personnel in their work with such patients, traits such as patience, a sense of tact, and a sense of compassion are important. Consistent with the five stages of the nursing process, the nurse has a framework for making decisions and solving problems when the nurse provides care.

2.1. Collection of information

Therefore, the duration of the conversation with patients should be short. Several short conversations throughout the day, separated by intervals, are recommended.

Therefore, if possible, it is advisable to ask several people about the patient’s problems.

Nursing process in schizophrenia

Patients with dementia are radically different from other patients. Therefore, a special nursing process is required for schizophrenia. A difficult task falls on the shoulders of the medical staff, since patients often psychiatric clinics do not understand the seriousness of their illness, and some refuse to consider themselves sick.

Dementia is very dangerous disease. In most cases, the first symptoms of the disease are difficult to notice. A sick person flatly refuses to believe in his oddities and, in most cases, tries to hide them. Exist different types mental disorders, among which completely innocent actions or life-threatening actions of both the patient and those around him are possible. But when a diagnosis has already been established, everyone would like to alleviate the condition of a loved one, for which innovative, effective techniques, as well as careful supervision. Plays an important role nursing care for schizophrenia, in which all aspects of care over the patient are clearly described. Special personnel are trained for this work, and every nurse must clearly understand their responsibilities.

Nursing process in psychiatry: schizophrenia

An integral part of treatment is the behavior of medical personnel. In the hands of the sister is the life of a patient who at any moment can harm himself or others.

Medical staff within the walls of a psychiatric clinic have to deal with people with completely different thinking and complex mental disorders. Workers must familiarize themselves with the patient’s data in detail - know the patient’s last name, first name, patronymic and the number of the room in which he is located. Treatment should be correct, affectionate and individual to each individual patient. The nurse is obliged to remember by heart what prescriptions the attending physician made for this or that patient and strictly follow them.

Many people mistakenly believe that mentally ill people do not notice a polite attitude. On the contrary, they have a very delicate sensitivity and will not miss the slightest change in intonation and highly value good nature. But at the same time, it is worth remembering that a “golden mean” is necessary; the staff should not be too rude, nor too soft, ingratiating. It is strictly forbidden to single out among patients those who would like to be given preference more often in help, care, and then immediately neglect others.

It is important to maintain a normal environment within the clinic; everyone should know their responsibilities. Loud talking, shouting, and knocking are not allowed, since the main condition in psychiatric clinics for the peace of mind of patients is peace and quiet.

Female staff should not wear shiny items: jewelry, earrings, beads, rings, as patients can tear them off. This is especially true in departments where patients with serious forms of the disease are treated.

If there is a sudden change in the patient’s condition or changes in his speech, the nurse must immediately notify the attending or duty doctor about this.

You cannot have conversations with colleagues in the presence of patients, especially discussing the condition of other patients. It is unacceptable to laugh or treat wards with even the slightest degree of irony or jokes.
In most psychiatric clinics, visits are prohibited during the acute phase of the disease. Therefore, relatives pass notes and letters to their loved ones, which should be read before handing them over. If they contain information that could aggravate the patient’s condition, transmission is prohibited, and a conversation with relatives will be required. When transferring things or products, you must carefully inspect each package: there should be no sharp, cutting, piercing objects, matches, alcohol, pens, or medications.

The duties of the nurse include supervising the orderlies. She must clearly set tasks to complete and monitor their implementation. Constant supervision in such institutions is an important condition. Thus, patients will not be able to injure themselves or their companions, commit suicide, escape, etc. Patients in psychiatric clinics should not be left alone for a minute and should not be out of sight of the staff. If the patient is covered with a blanket, you need to go up and uncover his face.
Temperature taking and medication administration must also be strictly supervised. For suicide purposes, the patient may injure himself with a thermometer or swallow a thermometer. Do not turn away or leave the room until the patient drinks them in front of the nurse.

Maintenance of wards in clinics

Often when complex forms diseases, patients cannot eat, make their bed, go to the toilet, or wash themselves. Light, liquid food is required that does not cause injury or pain when swallowing. When feeding through a tube, you must rinse your mouth after each meal.

The bed should always be clean, the patient needs to regularly place a bedpan, if necessary, use an enema, required water treatments after each act of defecation and urination. In a catatonic state, urinary retention is possible, so special catheters are used.

Important: the nurse must examine the patient’s body and skin twice a day to make sure there are no bedsores, diaper rash, redness, swelling, or rash.

How to deal with schizophrenia

The answer to this question has been sought for centuries. A medicine that would allow one to permanently get rid of mental illness has not yet been invented. But there are still achievements, thanks to which stable remission is maintained and two thirds of the total number of sufferers lead a normal lifestyle. The fight against schizophrenia includes a set of measures that must be strictly followed.

Taking medications causing a stop, stabilization and support of remission in the patient.
Regular visits to the attending physician, undergoing various types of procedures.
The house must be kept harmonious relationships, the patient should not be subjected to attacks due to quarrels, scandals, loud parties, conversations, etc.

An important point in the treatment of mental disorders is to contact only official specialized institutions. The specialist must have a certificate of compliance with the standards of the Ministry of Health, accreditation, and qualification documents. It is best if relatives collect information through forums, where reviews of leading doctors in psychiatric clinics are always reflected.

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Treatment of schizophrenia

Problems in treating schizophrenia

Unpredictability of the flow
Low effectiveness of therapy
Difficulty in identifying the target syndrome
Combination of schizophrenia and substance use
Severe side effects of psychopharmacological drugs

When determining the indications for psychopharmacotherapy in each specific case, it is necessary to take into account the entire set of indicators that influence the success of treatment

Indicators determining therapy

The severity of the mental state ( dangerous actions, incl. in past)
The severity of the somatic condition, the possibility of its aggravation
Clinical picture (symptoms, syndromes)
Experience of previous therapy (data on tolerability, effect in relatives)
Form of the course and stage of the disease

Types of therapy for schizophrenia

Active, stopping
Supportive
Preventive, anti-relapse
Anti-resistant

Febrile schizophrenia

Assistance is provided in intensive care conditions
Differentiate from ZNS
Antipsychotic therapy
Benzodiazepines
Fighting hyperthermia, cerebral edema
Support of vital functions, restorative therapy

Continuously ongoing malignant

Catatonic-hebephrenic, catatonic-hallucinatory, catatonic-paranoid
The goal is to achieve out-of-hospital remission at home
Method – maximum reduction of psychopathological disorders

Treatment of continuous malignant forms consists of:

Use of incesive antipsychotics, often in very high doses: clopixol up to 150 mg per day, risplept, haloperidol
Immunomodulators icaris
Plasmapheresis
Hemodialysis
Upon achieving out-of-hospital remission - prolongations, rehabilitation measures in HDPE (LTM)

Progressive paranoid schizophrenia

treatment involves the use of high doses of antipsychotics
To combat agitation and aggression, the use of sedative antipsychotics
To overcome resistance - ECT
Greater efficiency of prolongs

Paroxysmal-progressive schizophrenia

It is necessary to strive for the interrupting effect of clopixol, haloperidol, triftazine in medium doses
For chronic delirium, combination therapy of triftazine with azaleptin
Rehabilitation activities

Recurrent and schizoaffective

Treatment with drugs that have a significant sedative effect: clopixol, a combination of triftazine with tizercin or haloperidol with aminazine
If necessary, combination with antidepressants
Normotimics

Sluggish

It represents a gradual decrease in emotional-volitional potential.

Treatment is carried out with disinhibiting antipsychotics: sulpiride, amisulpiride, atypical

It is a condition reminiscent of OCD, but with an increasingly complex plot

Therapy is carried out with atypical antipsychotics in combination with serotonergic antidepressants (anafranil, remeron), if necessary, benzodiazepines are added

sisternskij-process24.ru

Nursing process in schizophrenia. Part 1

The role of the nurse in the organization healing process and care for patients suffering from various mental disorders

Medical care for patients with mental disorders

The role of the nurse in organizing the treatment process and care for mental patients is difficult to overestimate, since her activities include a wide range of issues, without which it would be impossible to self-implement a therapeutic approach to patients and, ultimately, a state of remission or recovery.

This is not the mechanical implementation of medical prescriptions and recommendations, but the solution of everyday issues, which include the direct implementation of treatment processes (distribution of drugs, parenteral administration of drugs, implementation of a number of procedures), carried out taking into account and knowledge of possible side effects and complications.

The Greek word “psychiatry” literally means “the science of treatment, the healing of the soul.” Over time, the meaning of this term has expanded and deepened, and currently psychiatry is the science of mental illness in the broad sense of the word, including a description of the causes and mechanisms of development, as well as the clinical picture, methods of treatment, prevention, maintenance and rehabilitation of mentally ill patients.

In Kazakhstan, provision psychiatric care The population is provided by a number of medical institutions. Patients can receive outpatient care in psychoneurological dispensaries. Depending on the nature of the disease and its severity, the patient is treated on an outpatient basis, in day hospital or in the hospital. All procedures and rules of the psychoneurological hospital are aimed at improving the health of patients.

Caring for psychiatric patients is very difficult and unique due to unsociability, lack of contact, and isolation in some cases and extreme agitation and anxiety in others. In addition, mental patients may have fear, depression, obsession and delusions. The staff is required to have endurance and patience, a gentle and at the same time vigilant attitude towards patients.

Responsibilities of the nurse in caring for patients with mental disorders

Ultimately, it is also taking responsibility for a number of activities:

1. Prepare the patient for a particular procedure or event, which sometimes requires a lot of effort, skill, knowledge of the patient’s psychology and the nature of the existing psychotic disorders from the nurse.

2. Convincing the patient of the need to take medicine and undergo this or that procedure is often difficult due to its painful products, when, due to ideological and delusional motives of hallucinatory experiences or emotional disorders resists medical treatment. In this case, knowledge of the clinical picture of the disease helps to correctly solve the therapeutic problem, making a positive treatment solution possible.

3. To this day, the care and supervision of mentally ill people carried out by a nurse remains relevant. This includes feeding patients, changing linen, carrying out sanitary and hygienic measures, etc. Monitoring an entire contingent of patients is especially difficult. This applies to depressed patients, patients with catatonic symptoms, patients with acute psychotic disorders and behavioral disorders.

Care and supervision are undoubtedly important links in in general terms treatment of patients, since carrying out therapeutic measures without these important hospital factors is impossible. Information about patients, the dynamics of their diseases, changes in the treatment process, etc. is invaluable during the complex treatment process that is carried out by mental patients in psychiatric hospitals.

Only a nurse can detect the appearance of a number of delirious symptoms in the evening, prevent the implementation of suicidal tendencies, establish daily mood swings in patients based on indirect, objective characteristics, and predict their socially dangerous impulses.

Great value for successful treatment has a sister process to schizophrenia. Patients with this diagnosis require special care. It is provided by the medical staff of the medical institution where the patient is located. A difficult task is entrusted to him. Health care providers must cope with patients who do not recognize that they truly need treatment. This is the main difficulty of a nurse's work.

The nurse should ensure that the patient takes all prescribed medications.

Nursing care for a patient diagnosed with schizophrenia is based on a set of important principles. Every nurse who will be caring for a person with a mental disorder should be familiar with them.

Important! Medical personnel who are familiar with the specifics of working with patients with this diagnosis are allowed to care for a schizophrenic.

First of all, the nurse who will look after the patient needs to study his data. She must know the patient's last name, first name and patronymic, his diagnosis and room number. She needs to try to gain the trust of the schizophrenic. To do this, you will need to find a special approach to the patient. Only a professional can achieve such a result.

The success of performing work duties and providing care to a patient with schizophrenia depends on whether the nurse fulfills the following requirements:

When visiting the ward, medical staff must remove any jewelry from themselves, as patients may unknowingly try to rip them off;
It is necessary to pay attention to the appearance of new symptoms that indicate a deterioration in the person’s condition. These cases should be reported to your doctor immediately;
It is prohibited to have personal conversations with colleagues in the presence of patients. It is also unacceptable to discuss other patients in front of them, even if they do not know each other;
The nurse should protect the patient from visitors if he is in the acute phase of a mental disorder. If relatives or friends ask to give notes to a person, then she is obliged to personally familiarize herself with them;
Medical staff must inspect all transfers to the patient. If prohibited products or items are found, they are immediately returned to the sender;
Constant monitoring of patients with schizophrenia is required. Compliance with this rule helps minimize the likelihood of patients being injured or committing suicide.

The nurse's responsibilities include monitoring the patient's actions during procedures. She must ensure that the patient takes his medications on time. She should also check the correct use of a thermometer and other items that are used to assess the current state of a person’s health.

Nursing process

Nursing care for patients with schizophrenia includes a number of tasks that must be performed by medical staff. The patient’s well-being and increased chances of achieving remission depend on the correctness and quality of these operations.

Correct nurse behavior

Only truly dedicated people should work with schizophrenics

The nurse is required to observe the behavior of her patient. She should become familiar with his emotional-volitional sphere, intellectual abilities and level of attention. She is also entrusted with the task of introducing the person to other patients who will be his neighbors in the ward.

The nurse should establish close contact with the patient. This will allow her to better assess his health and immediately learn about symptoms that were not previously identified by the doctor.

A person with schizophrenia has difficulty navigating places where he has never been before. Complicating the situation is short-term memory loss, which is not so rare in patients with this diagnosis. Therefore, the nurse needs to introduce the person in detail to the department and the ward in which his bed is located. It is possible that this action will have to be repeated several times. In about 2-3 weeks, schizophrenics finally remember their place and stop getting lost in the department if they accidentally leave the ward.

The behavior of a nurse when caring for a schizophrenic must meet the following requirements:

It is necessary to address the patient by his first name and patronymic and only as “you”. When speaking, you should be friendly in order to quickly gain the patient’s trust.
You cannot discuss his diagnosis with a person. The same applies to the doctor’s decisions regarding the treatment of the patient and conversations about personal life other patients.
Before performing any procedure, you need to explain to the patient its meaning and significance for health. A casual conversation will allow him to relax and avoid unnecessary stress.
When communicating with close relatives of a schizophrenic, you should remain calm and friendly. The nurse has the right to tell them only the information that the attending physician has authorized.
It is the responsibility of the medical staff to explain to the patient’s relatives the principles of caring for him at home.

A good nurse performs her professional duties efficiently, even regardless of how she treats her patient. Relatives of the patient may offer various gifts and monetary rewards for their care. Medical staff are obliged to refuse this. Such “thanks” are unacceptable.

Comfortable environment in the rooms

Nurses are responsible for ensuring a comfortable environment in the wards of a patient with schizophrenia. Ideally, they should accommodate no more than two people. By following this rule, it is possible to provide each patient with sufficient free space.

Medical staff must ensure the cleanliness of the wards. They are responsible for timely cleaning and ventilation of these premises. They are also tasked with monitoring the provision of clean bed linen to patients.

Sleep and diet

Maintaining a clear and balanced schedule for people with mental disabilities is extremely important

By learning all the ins and outs of caring for people with schizophrenia, nurses will be prepared to provide comprehensive health care to their patients. Their responsibilities include monitoring sleep patterns, nutrition and physical activity schizophrenics.

The regime of rest, sleep and nutrition allows you to develop a number of conditioned reflexes that benefit patients. Thanks to proper organization time, the problem of sudden overwork of a person or the influence of factors on him that can provoke an exacerbation of a mental disorder is solved.

Nurses should carefully prepare the patient for sleep. They should ventilate the room and ensure that the patient takes care of personal hygiene. A certain time is allocated for these procedures, which is indicated in the daily routine.

If the patient is worried about anxiety or another painful condition, the nurse should reassure him. As prescribed by the doctor, he may be prescribed a sedative or sleeping pill.

Patients being treated for schizophrenia also eat according to the regimen. If the patient has no desire to eat, the nurse should try to persuade him to do so.

Symptoms that require drug therapy

Patients cannot cope without medications if they have an acute course of schizophrenia.

The medical staff performs the function of monitoring that the patient takes the medications prescribed by the doctor at the prescribed time and in the correct dosage.

It will not be possible to avoid drug therapy if a patient with schizophrenia exhibits the following signs of the disease:

sudden change in behavior;
unreasonable isolation;
the appearance of hallucinations;
frequent mood changes;
aggressiveness towards others;
severe anxiety;
sleep disturbance;
speech activity even in the absence of an interlocutor.

Bright severe symptoms schizophrenia negatively affects a person’s overall well-being. In this state, he can pose a danger to himself and those around him. Therefore, he is prescribed treatment with drugs that reduce the intensity of painful symptoms.

Features of communication with the patient and his family

In unfavorable stages of a mental disorder, a nurse may be the only link connecting relatives and the patient

The medical staff conducts conversations not only with the patient, but also with his close relatives. It is he who should talk about the peculiarities of behavior next to the patient during periods of exacerbation of the disease and its remission.

Most patients who experience severe schizophrenia experience withdrawal from the world and aggressive behavior towards others. In such cases, nurses try to avoid long conversations with them, as this may cause them to become overly irritable. Ideally, you should limit yourself to a couple of conversations throughout the day, with intervals between them.

When communicating with patients, nurses should avoid general phrases. Specifics must be used in a conversation, otherwise a person may misunderstand the information that they are trying to convey to him.

The nurse must, through her actions, create the most comfortable conditions for the patient who is under her temporary care. She should avoid actions that are not provided for by the norms of behavior with patients diagnosed with schizophrenia.

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Introduction

1. Paranoid form

2. Hebephrenic form

3. Catatonic form

4. Treatment

Conclusion

Literature

Introduction

Schizophrenia is a disease characterized by gradually increasing personality changes (autism, emotional impoverishment, the appearance of oddities and eccentricities), other negative changes (dissociation of mental activity, thinking disorders, drop in energy potential) and productive psychopathological manifestations of varying severity and severity (affective, neurotic). and psychopathic, delusional, hallucinatory, hebephrenic, catatonic).

The etiology and pathogenesis of schizophrenia are not well understood. An important role is played by constitutional and genetic factors, as well as the gender and age of patients. The genetic factor is involved in the formation of a predisposition to schizophrenia, and the risk of getting sick is directly proportional to the degree of relationship and the number of cases in the family. The most severe forms of the disease occur predominantly in men, while less progressive forms occur in women.

Schizophrenia that begins in adolescence is more malignant than in adults. According to the type of course of the schizophrenic process, they are divided into: continuous (psychotic symptoms are present almost continuously - 20%), episodic with progressive development of the defect (in the intervals between psychotic episodes there is an increase in negative symptoms - 20-25%), episodic with a stable defect (without increase negative symptoms in remissions - 5-10%) and remitting (with full remissions between episodes - 30%); about 20% of patients recover after the first episode. There are also several main diagnostic forms of schizophrenia: paranoid, hebephrenic, catatonic, simple, etc.

1. Paranoid form

Paranoid form. The most common form of schizophrenia. Typically, the paranoid form begins after the age of 20 and is manifested by thinking disorders such as delusions of influence, persecution and relationships. Hallucinations are often auditory (sound of voice); Urgent hallucinations are also typical, which can make the patient dangerous to himself or others. Olfactory hallucinations rare, visually uncharacteristic. Kandinsky-Clerambault syndrome is often encountered - a combination of mental automatisms, pseudohallucinations and delusions of influence. As the disease progresses, phenomena of emotional-volitional personality defect arise and intensify.

The course of paranoid schizophrenia can be episodic (paroxysmal) or chronic (continuous).

The paranoid form usually occurs at a later age than hebephrenic or catatonic schizophrenia. At differential diagnosis it is necessary to exclude epileptic and drug-induced psychoses. It should also be borne in mind that persecutory delusions do not always have a leading diagnostic value in other countries and under other cultural conditions. In case of pronounced productive psychotic symptoms that disrupt the patient’s social and labor adaptation, therapy is carried out only in a hospital. Antipsychotics with a pronounced effect on delusional and hallucinatory syndromes are used: haloperidol, zuclopenthixol, triftazine, piportil.

2. Hebephrenic form

Hebephrenic (hebephrenic) form. Begins in adolescence or young adulthood. Such patients are often shy and lonely.

The clinical picture is characterized by absurd foolishness, gross antics, and exaggerated grimaces. At times, motor excitement flares up; patients tend to shamelessly expose themselves in front of strangers, masturbate in front of everyone, and are unclean and unkempt. Delusional statements are fragmentary and unstable, hallucinations are episodic. This form is characterized by a malignant course and quickly (within 1-2 years) a schizophrenic mental defect develops in the form of apatoabulic syndrome (a combination of lack of will with indifference and loss of desires). The unfavorable course and severity of the clinical picture require the prescription of antipsychotics with a powerful general antipsychotic effect reaching average or high level doses, and continuation of therapy on an outpatient basis is advisable using long-acting drugs. The rapid increase in negative symptoms leads to the use of atypical antipsychotics (azaleptin, olanzapine, risperidone).

3. Catatonic form

Catatonic form. It manifests itself as an alternation of catatonic excitement with a state of immobility and complete silence. Consciousness during stupor can be fully preserved in the future; when the stupor passes, patients talk in detail about everything that happened around them. Catatonic disorders can be combined with hallucinatory-delusional experiences, and in the case of acute course Oneiric syndrome develops. Important clinical sign There may be episodes of aggressive behavior. In respect of differential diagnosis It should be remembered that catatonic symptoms do not have a decisive diagnostic value for schizophrenia and can sometimes be provoked organic diseases brain, metabolic disorders, alcohol intoxication or medications, and can also occur with affective disorders. When treating, neuroleptics with a powerful general antipsychotic effect (mazeptil) or atypical antipsychotics are preferred. The prognosis of attacks of the disease that occur acutely and occur with violent psychotic symptoms is more favorable than during a protracted course with increasing apathy and a drop in energy potential, with a predominance in the clinical picture of systematized delirium, persistent hallucinosis, and catatonic hebephrenic disorders.

4. Treatment

Treatment, depending on the patient’s condition, is carried out on an outpatient or inpatient basis. Out-of-hospital care is provided in a psychoneurological dispensary (psychoneurological consultation), where patients are treated during minor exacerbations, and are also observed during remission. At dispensaries, occupational therapy workshops are usually created, in which patients with II and III disability groups can work.

This helps them adapt in life and benefit society. If the condition worsens significantly, it is advisable to hospitalize the patient. Most patients are admitted to the hospital for at will due to their awareness of the need for treatment. However, there are cases of involuntary hospitalization, when a patient is hospitalized without his consent or the consent of his relatives.

There are active therapy that stops the manifestations of the disease during its manifestation, attack, exacerbation; maintenance therapy aimed at maintaining the achieved improvement and stabilizing the condition; preventive therapy, the purpose of which is to prevent relapses of the disease and prolong remissions.

A new generation of so-called atypical antipsychotics (leponex, risperidone, olanzapine and Seroquel), which do not have the disadvantages of classical antipsychotics and can even affect negative symptoms, is increasingly used. With maintenance therapy with psychotropic drugs, prophylactic use of lithium salts and finlepsin, and implementation of measures for social and labor adaptation, the prognosis improves.

Effective treatment of schizophrenia requires physiotherapy, hydrotherapy, massage, and regular exercise therapy in the pool and gym. The patient's passivity leads to a chronic course of the disease and contributes to the increase in negative symptoms.

Of particular importance in the treatment of schizophrenia is therapy aimed at preventing relapse of the disease. IN Lately For this purpose, drugs with a prolonged effect are actively used: rispolept - consta, fluanxol - depot, and less often due to their insignificant effect on negative symptoms, clopixol - depot. As a rule, maintenance treatment for schizophrenia should be long-term and include a long period of monitoring the patient’s condition, taking into account the dynamics of hormonal, neurophysiological and biochemical parameters, and systematic psychotherapy with the patient. It is necessary to teach the patient’s relatives the correct tactics of behavior to prevent the occurrence of a relapse of schizophrenia.

Modern psychiatry has a variety of quite effective means of treating patients with schizophrenia. Suffice it to say that about 40% of patients who undergo treatment are discharged in good condition and return to their previous place of work.

If psychotropic therapy is ineffective, they resort to such treatment methods as insulin comatose therapy and electroconvulsive therapy - ECT. Insulin comatose therapy can also be used in patients with the first attack of the disease who were not treated before admission to the hospital.

In these cases, good results can be obtained with fairly deep and long-lasting remission. ECT is performed in patients with long-term depressive states with obsessive, hypochondriacal ideas and ineffective treatment with antidepressants and antipsychotics.

schizophrenia paranoid hebephrenic catatonic

5. Nursing process in schizophrenia

The nursing process in schizophrenia differs from that in other hospitals and has a number of features. These features are mainly due to the fact that many mentally ill people do not understand their painful condition, and some do not consider themselves sick at all.

In addition, patients with upset consciousness may experience severe motor agitation. In this regard, special requirements are placed on medical personnel in psychiatric hospitals: constant vigilance, endurance and patience, resourcefulness, sensitive, affectionate attitude and a strictly individual approach to patients. Consistency in the work of the entire team of department and hospital employees is of great importance.

Knowledge of all the details of the care and supervision of the mentally ill is an absolutely necessary condition for working as a nurse in a psychiatric hospital. First of all, we should dwell on what should be the behavior of medical personnel in the department of a psychiatric hospital and their attitude towards the mentally ill.

Firstly, the nurse must know well not only all the patients in the department by last name, first name and patronymic, but also in which ward everyone is, what is his mental state for the current day, know the total number of patients in the department and the reason for the absence of some of them in department. It is necessary to pay special attention to patients who require special monitoring and care. Secondly, it is necessary to accurately find out all the prescriptions made by the doctor and strictly follow them at the specified time.

All patients should be treated seriously, politely, kindly and sympathetically. To think that patients do not understand and do not appreciate this is a deep misconception. However, one should not go to the other extreme: be overly affectionate, sweet in dealing with patients, or talk to them in an ingratiating tone. This may irritate and worry them. You cannot give obvious preference and pay special attention to one of the patients and neglect others. This also does not go unnoticed and causes fair discontent.

It is necessary to monitor the business situation in the department, ensure compliance with the established daily routine, and avoid loud conversations between staff and patients, since silence is an important and necessary condition in the treatment of neuropsychiatric patients.

Female staff of the restless department should not wear beads, earrings, brooches, etc. while working, as all this interferes with holding an excited patient and can be torn off by him.

In cases where patients begin to experience motor or speech agitation or a sudden change in condition generally occurs, the nurse is obliged to immediately notify the attending or duty doctor about this. Nursing staff are not allowed to independently prescribe medications or procedures, or move patients from one room to another or even within the same room.

Extraneous conversations in the presence of the patient are prohibited, even if the patient is completely indifferent to everything around him. In the presence of patients, one cannot discuss the health status of any of them, talk about his illness, or make judgments about the prognosis. It is strictly forbidden to laugh at the sick or conduct a conversation in an ironic, playful tone.

Letters and notes received by the department must also be read before being distributed to patients. This is done to protect the patient from certain traumatic news that could worsen his health. Transfers to patients (products and things) should be carefully reviewed so that relatives and friends do not intentionally or unintentionally transfer to the patient something that may be contraindicated for him or even dangerous for him, for example, medicines (especially drugs), alcoholic beverages, needles, razor blades , pens, matches.

The nurse must know in detail the duties of the orderlies and monitor their work, remembering the inadmissibility of removing the sanitary post without providing a replacement. The nurse must give instructions to the new shift of orderlies entering the post which patients need strict supervision, especially nursing care. The most vigilant supervision and observation of such patients is the best way to avoid accidents (suicides, self-torture, escapes, attacks on others). These patients should not disappear from the sight of the orderlies for a minute. If a patient with thoughts of suicide covers his head with a blanket, it is necessary to approach him and open his face, since there are cases of attempts to commit suicide under the blanket. When measuring temperature, care must be taken to ensure that the patient does not harm himself with the thermometer or swallow it for the purpose of suicide.

When dispensing medications, you should not leave the patient until he takes them.

In the departments, as a rule, there are helpless patients who require the most careful systematic care. They often cannot eat on their own; they need to be fed and watered by hand. Physically weak patients, as well as in cases of swallowing disorders, should be given mostly liquid food, in small portions, slowly, as patients can easily choke. It is necessary to monitor the cleanliness of linen and bed. Periodically, for this purpose, a bed should be placed on the patient. Cleansing enemas are used to empty the intestines. Patients who are allowed to stand must be taken to the toilet. In case of urinary retention (more often observed with catatonia), it must be released using a catheter. It is important to carefully examine (at least 1-2 times a week) the skin of patients, as they easily develop bedsores and diaper rash. Particular attention should be paid to the area of the sacrum and buttocks. When the first signs of bedsores appear - persistent redness of the skin - the patient should be placed on a rubber circle and the skin should be systematically wiped with camphor alcohol. Oral cavity, especially if the patient does not drink or eat and is fed through a tube, you should periodically rinse

Much attention service personnel required by patients who refuse to eat. Refusals to eat can have different origins: catatonic stupor, negativism, delusional attitudes (ideas of poisoning, self-blame), imperative hallucinations that prohibit the patient from eating. In each case, you must try to find out the reason for refusing to eat. Sometimes, after persuasion, the patient begins to eat on his own. Some patients trust only one of the employees or a relative to feed themselves. Patients with symptoms of negativism sometimes eat if you leave food near them and move away. Injecting 4-16 units of insulin on an empty stomach often helps, resulting in an increased feeling of hunger.

If all measures taken do not lead to positive results, the patient has to be fed artificially through a tube. To carry out this activity, it is necessary to prepare: 1) a rubber probe (hole diameter is about 0.5 cm, one end is rounded, with two side holes, the other is open); 2) a funnel onto which the open end of the probe is placed; 3) petroleum jelly or glycerin to lubricate the probe before insertion; 4) nutritional mixture, which includes 500 grams of milk, 2 eggs, 50 grams of sugar, 20-30 grams butter, 5-10 grams of salt and vitamins (the nutritional mixture should be warm); 5) two glasses boiled water or tea; 6) clean rubber balloon; 7) matches; 8) mouth dilator. When everything is prepared, the patient is placed on the couch on his back. Usually the patient resists, so 2-3 orderlies have to restrain him. The end of the probe is lubricated with Vaseline or glycerin and inserted through the nose. Usually, the probe passes well without much effort through the nasal passage into the nasopharynx, then into the esophagus and reaches the stomach; for this, the probe must be inserted to a length of about 50 cm.

Feeding is done as follows. First, pour about half a glass of water or tea into the funnel. After this, they begin to pour the nutrient mixture. To prevent it from entering the stomach too quickly, the funnel should not be held high. Then pour 1-2 cups of boiled water or tea into the funnel. The probe must be removed quickly, but not with a sudden movement. At the end of feeding, the patient should be stopped in the same position for a few minutes, as sometimes he can induce vomiting. To prevent vomiting, atropine is used (subcutaneous injection 10-15 minutes before feeding).

Much attention should be paid to caring for agitated patients. Good results in case of excitement are obtained by the use of aminazine, which is used in the form of a 2.5% solution of 200-400 mg/day intramuscularly. For this purpose, triftazine, haloperidol, tizercin and other antipsychotic drugs can be used.

In some cases, chloral hydrate 2-3 grams, 10% hexenal solution 5-10 ml, 25% magnesium sulfate solution 5-10 ml, barbamyl 0.2-0.4 g per dose are indicated.

When caring for patients, it should be remembered that due to their unique character, they often enter into long-term conflicts with surrounding patients, which can lead to aggression. The nurse must be able to distract the patient in time and calm him down. However, if the patient still remains angry and tense, this must be brought to the attention of the doctor. During dysphoria (mood disorder), which can last for several hours or days, the patient does not need to be contacted often, or sought to be involved in any activities, since at this time he is extremely irritated and angry. It is better to give him complete rest.

Great difficulties arise when caring for patients, who often violate the department's rules and often get into quarrels with the patients around them. In such cases, you have to sternly talk to them and call them to order.

Only with clear and coordinated work of all department staff, with proper organization of care and treatment can it be achieved good results in providing assistance to a patient suffering from mental illness.

Patients who are suicidal sometimes collect pieces of glass, metal, and nails while walking in the garden, so orderlies must carefully monitor their behavior. The area must be systematically and thoroughly cleaned. Patients should not carry matches with them. In this case, it is necessary to carefully observe that the patient does not throw a burning cigarette on the bed or cause burns to himself, which is sometimes done by patients in a depressed or delirious state.

Patients should not have long pencils, penknives, hairpins or hairpins.

Patients are shaved by a hairdresser in the presence of an orderly; for this it is better to use a safety razor. These precautions are necessary because there are cases when a patient snatches a razor from the hands of staff and seriously injures himself.

Knives and forks are not given to patients during meals. Food is prepared in advance in such a way that it can be eaten using only a spoon. The cupboard where knives and other items are stored must always be locked. Sick people are not allowed to enter the pantry.

Conclusion

As with any mental disorder, the treatment of schizophrenia requires a comprehensive approach. It is impossible to treat a person’s soul in isolation from his body, just as it is impossible to treat schizophrenia only using biological methods, even with the most modern drugs; psychotherapeutic assistance is needed, training the patient’s relatives and the patient’s most necessary skills.

The timing of initiation of treatment for schizophrenia plays a huge role. It is generally accepted that treatment is especially effective if it is carried out within the next two years after the onset of the disease. But even if the disease has existed for a long time, you can significantly help a person suffering from schizophrenia and those close to him.

Of particular importance is the personality of the patient, his attitude to treatment, the stigma of the diagnosis of schizophrenia, and to medical personnel. The organization of patients' free time is of great importance - occupational therapy, satisfaction of cultural needs, walks. Psychotherapy, mainly of an explanatory nature, is provided to patients during the recovery period, before discharge, and also during outpatient follow-up.

It is also necessary to conduct conversations with relatives and family members of the patient in order to create a favorable climate in the family and readapt the patient after discharge from the hospital. Neither the patient nor relatives should be afraid of the maintenance therapy prescribed by the doctor, because Most medications have virtually no side effects, and if they exist, the doctor reports this and gives appropriate recommendations.

Literature

1. Abramova L.I. About some clinical features of remission in patients with paroxysmal schizophrenia // Neuropathology named after. S.S. Korsakov. 2001-94 pp.

2. Avrutsky G.Ya., Neduva A.A. Treatment of mentally ill patients. M. 1987 - 437 p.

3. Vovin R.Ya., Ivanov M.Ya. // Social and clinical psychiatry.; M. 1995-72 p.

4. Zavyalov V.Yu. Standards in psychotherapy. Current problems of modern psychiatry and psychotherapy. Collection of scientific papers. Novosibirsk, vol. 3, 1996 - 33

5. Zenevich G.V. Issues of clinical examination of mentally and neurologically ill people. M. 1999-234 p.

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Schizophrenia nursing care rehabilitation process. Caring for patients with schizophrenia. Text of the scientific work on the topic "Differentiated approaches to psychosocial therapy and rehabilitation of patients with schizophrenia recognized by the court as incompetent"

Attached files: 1 file

Introduction

General clinical characteristics of schizophrenia

Nursing process in schizophrenia

2.1. Collection of information

Short description

News of psychiatry and psychology

Features of caring for patients diagnosed with schizophrenia

Schizophrenia, features of the nursing process in the adult department

abstract on psychiatry SCHIZOPHRENIA.doc

General clinical characteristics of schizophrenia

2.1. Collection of information

Nursing process in schizophrenia

Nursing process in psychiatry: schizophrenia

Maintenance of wards in clinics

How to deal with schizophrenia

Medicine. Nursing.

Treatment of schizophrenia

Problems in treating schizophrenia

Indicators determining therapy

Types of therapy for schizophrenia

Febrile schizophrenia

Continuously ongoing malignant

Treatment of continuous malignant forms consists of:

Progressive paranoid schizophrenia

Paroxysmal-progressive schizophrenia

Recurrent and schizoaffective

Sluggish

Nursing process in schizophrenia. Part 1

Medical care for patients with mental disorders

Responsibilities of the nurse in caring for patients with mental disorders

Nursing process

Correct nurse behavior

Comfortable environment in the rooms

Sleep and diet

Symptoms that require drug therapy

Features of communication with the patient and his family

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