Schizophrenia Q 3
Upon Sam’s admission for acute psychiatric hospitalization, Nurse Jona documents the following: Client refuses to bathe or dress, remains in the room most of the day, speaks infrequently to peers or staff. Which nursing diagnosis would be the priority at this time?
A. Anxiety
B. Decisional conflict
C. Self-care deficit
D. Social isolation
Correct Answer: D. Social isolation
These behaviors indicate the client’s withdrawal from others and possible fear or mistrust of relationships. If a client is found to be very paranoid, solitary or one-on-one activities that require concentration are appropriate. The client is free to choose his level of interaction; however, concentration can help minimize distressing paranoid thoughts or voices. If a client is unable to respond verbally or in a coherent manner, spend a frequent, short period with clients. An interested presence can provide a sense of being worthwhile.
Option A: Keep the client in an environment as free of stimuli (loud noises, crowding) as possible. The client might respond to noises and crowding with agitation, anxiety, and increased inability to concentrate on outside events. Identify with client symptoms he experiences when he or she begins to feel anxious around others. Increased anxiety can intensify agitation, aggressiveness, and suspiciousness.
Option B: There is no indication of a Decisional conflict in the information provided. Structure times each day to include planned times for brief interactions and activities with the client on a one-on-one basis; helps the client to develop a sense of safety in a non-threatening environment. If the client is very withdrawn, one-on-one activities with a “safe” person initially should be planned. Learn to feel safe with one person, then gradually might participate in a structured group activity.
Option C: Although the client refuses to bathe or dress, Self-care deficit would not be the priority nursing diagnosis in this situation. Try to incorporate the strengths and interests the client had when not as impaired into the activities planned. Increase the likelihood of client’s participation and enjoyment. Remember to give acknowledgment and recognition for positive steps the client takes in increasing social skills and appropriate interactions with others. Recognition and appreciation go a long way to sustaining and increasing a specific behavior.