It is likely that the client with an acute psychotic episode of schizophrenia will receive treatment in an intensive set-ting such as an inpatient hospital unit. During this phase, the focus of care is stabilizing the client’s thought processes and reality orientation as well as ensuring safety. This is also the time to evaluate resources, make referrals, and begin planning for the client’s rehabilitation and return to the community.
Examples of outcomes appropriate to the acute, psy-chotic phase of treatment are as follows:
· The client will not injure self or others.
· The client will establish contact with reality.
· The client will interact with others in the environment.
· The client will express thoughts and feelings in a safe and socially acceptable manner.
· The client will participate in prescribed therapeutic interventions.
Once the crisis or the acute, psychotic symptoms have been stabilized, the focus is on developing the client’s abil-ity to live as independently and successfully as possible in the community. This usually requires continued follow-up care and participation of the client’s family in community support services. Prevention and early recognition and treatment of relapse symptoms are important parts of suc-cessful rehabilitation. Dealing with the negative signs of schizophrenia, which medication generally does not affect, is a major challenge for the client and caregivers. Exam-ples of treatment outcomes for continued care after the stabilization of acute symptoms are as follows:
· The client will participate in the prescribed regimen (including medications and follow-up appointments).
· The client will maintain adequate routines for sleeping and food and fluid intake.
· The client will demonstrate independence in self-care activities.
· The client will communicate effectively with others in the community to meet his or her needs.
· The client will seek or accept assistance to meet his or her needs when indicated.
The nurse must appreciate the severity of schizophrenia and the profound and sometimes devastating effects it has on the lives of clients and their families. It is equally impor-tant to avoid treating the client as a “hopeless case,” some-one who no longer is capable of having a meaningful and satisfying life. It is not helpful to expect either too much or too little from the client. Careful ongoing assessment is necessary so that appropriate treatment and interventions address the client’s needs and difficulties while helping the client to reach his or her optimal level of functioning.