Schizophrenia Q 26
The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client’s plan of care?
A. Meeting all of the client’s physical needs.
B. Giving the client an opportunity to express concerns.
C. Administering lithium carbonate (Lithonate) as prescribed.
D. Providing a quiet environment where the client can be alone.
Correct Answer: A. Meeting all of the client’s physical needs
Because a client with catatonic schizophrenia can’t meet physical needs independently, the nurse must provide for all of these needs, including adequate food and fluid intake, exercise, and elimination. The initial management includes supportive measures such as IV fluids and even nasogastric tubes given that patients with catatonia are susceptible to malnutrition, dehydration, pneumonia, etc. The key is early identification of catatonia in a patient with schizophrenia and initiation of treatment.
Option B: This client is incapable of expressing concerns; however, the nurse should try to verbalize the message conveyed by the client’s nonverbal behavior. The treatment of catatonia in schizophrenia is with benzodiazepines as the first line of treatment and then electroconvulsive therapy (ECT). The Bush-Francis group has conducted a study where they have shown a reduction in the BCFRS by 60% by administrating 2 mg of lorazepam in 10 minutes. Multiple case reports, studies, and clinical evidence now points towards the use of benzodiazepines as the standard of treatment of catatonia.
Option C: Lithium is used to treat mania, not catatonic schizophrenia. Lithium has also been studied but has not been studied exclusively for catatonic schizophrenia. Rather its efficacy is seen in cases of recurrent catatonia mostly associated with mood disorders.
Option D: Despite the client’s mute, unresponsive state, the nurse should provide non-threatening stimulation and should spend time with the client, not leave the client alone all the time. Although aware of the environment, the client doesn’t interact with it actively; the nurse’s support and presence can be reassuring.