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Schizoaffective Disorder Nursing Care Plan (NCP)

This disorder emphasizes the temporal relationship of schizophrenic and mood symptoms and is used for conditions that meet the criteria for both schizophrenia and a mood disorder with psychotic symptoms lasting a minimum of 1 month. The clinical features must occur within a single uninterrupted period of illness (for some, this may be years or even decades) that is judged to last until the individual is completely recovered for a significant period of time, free of any significant symptoms of the disorder. In comparison with schizophrenia, schizoaffective disorder occurs more commonly in women than in men.

DSM-IV
295.70 Schizoaffective disorder

ETIOLOGICAL THEORIES
Psychodynamics
Refer to CPs: Schizophrenia, Major Depression, and Bipolar Disorder.

Biological 
Refer to CPs: Schizophrenia, Major Depression, and Bipolar Disorder.
Recent studies suggest that schizoaffective disorder is a distinct syndrome resulting from a high genetic liability to both mood disorders and schizophrenia.

Family Dynamics 
Refer to CPs: Schizophrenia, Major Depression, and Bipolar Disorder.

NURSING PRIORITIES
1. Provide protective environment; prevent injury.
2. Assist with self-care.
3. Promote interaction with others.
4. Identify resources available for assistance.
5. Support family involvement in therapy.

DISCHARGE GOALS
1. Signs of physical agitation are abating and no physical injury occurs.
2. Improved sense of self-esteem, lessened depression, and elevated mood are noted.
3. Approaches and socializes appropriately with others, individually and in group activities.
4. Adequate nutritional intake is achieved/maintained.
5. Client/family displays effective coping skills and appropriate use of resources.
6. Plan in place to meet needs after discharge.
(Refer to CPs: Schizophrenia, Major Depression, and Bipolar Disorder for other NDs that apply, in addition to the following.)

Nursing diagnosis for Schizoaffective Disorder: Risk for Violence, directed at self/others may be related to Depressed mood; feelings of worthlessness; hopelessness; Unsatisfactory parent/child relationship; feelings of abandonment by significant other(s); Anger turned inward/directed at the environment; Punitive superego and irrational feelings of guilt; Numerous failures (learned helplessness); Misinterpretation of reality; and Extreme hyperactivity possibly evidenced by History of previous suicide attempts; making direct/indirect statements indicating a desire to kill self/having a plan; Hallucinations; delusional thinking; Self-destructive behavior (hitting body parts against wall/furniture); destruction of inanimate objects; Temper tantrums/aggressive behavior; increased agitation and lack of control over purposeless movements; and Vulnerable self-esteem.

Desired Outcomes
1. Express improved sense of well-being/self- concept.
2. Manage behavior and deal with anger appropriately.
3. Demonstrate self-control without harm to self or others.

Nursing intervention with rationale:
1. Note direct statements of a desire to kill self; also note indirect actions indicating suicidal wish, (e.g., putting affairs in order, writing a will, giving away prized possessions; presence of hallucinations and delusional thinking; history of previous suicidal behavior/acts; statements of hopelessness regarding life situation).
Rationale: Direct and indirect indicators of suicidal intent need to be attended to and addressed as being potentially acted on.

2. Ask client directly if suicide has been considered/ planned and if the means are available to carry out the plan.
Rationale: The risk of suicide is greatly increased if the client has developed a plan, and particularly if means exist to execute the plan.

3. Provide a safe environment for client by removing potentially harmful objects from access (e.g., sharp objects; straps, belts, ties; glass items; smoking materials).
Rationale: Provides protection while treatment is being undertaken to deal with existing situation. Client’s rationality is impaired, she or he may harm self inadvertently.

4. Assign to quiet unit, if possible.
Rationale: Unit milieu may be too distracting, increasing agitation and potential for loss of control.

5. Reduce environmental stimuli (e.g., private room, soft lighting, low noise level, and simple room decor).
Rationale: In hyperactive state, client is extremely distractible, and responses to even the slightest stimuli are exaggerated.

6. Formulate a short-term verbal contract with the client stating that he or she will not harm self during specified period of time. Renegotiate contract as necessary.
Rationale: An attitude of acceptance of the client as a worthwhile individual is conveyed. Dis cussion of suicidal feelings with a trusted individual provides a degree of relief to the client. A contract gets the subject out in the open and places some of the responsibility for own safety on the client.

7. Encourage verbalization of honest feelings. Explore and discuss symbols of hope client can identify in own life.
Rationale: Because of elevated anxiety, client may need assistance to recognize presence of hope in life situations.

8. Promote expression of angry feelings within appropriate limits. Provide safe method(s) of hostility release. Help client identify true source of anger, and work on adaptive coping skills for continued use.
Rationale: Depression and suicidal behaviors may be viewed as anger turned inward on the self, or anger may be expressed as hostile acting-out toward others. If this anger can be verbalized and/or released in a nonthreatening environment, the client may be able to resolve these feelings, regardless of the discomfort involved.

9. Orient client to reality, as required. Point out sensory/environmental misperceptions, taking care not to belittle client’s fears or indicate disapproval of verbal expressions.
Rationale: Elevated level of anxiety may contribute to distortions in reality. Client may need help distinguishing between reality and misperceptions of the environment.

10. Prepare for/assist with electroconvulsive therapy (ECT).
Rationale: May be indicated to alter mood until neuroleptics or antidepressants become effective. Note: Some research suggests this is the most effective treatment for some clients.
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