CRITICAL PATHWAY of Care for Client with Schizophrenic Psychosis
Estimated length of stay: 14 days-variations from designated pathway should be documented in progress notes.|
Nursing Diagnosis and Categories of Care
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Time Dimension
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Goals/Actions
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Dimension
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Goals/Actions
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Dimensions
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Discharge Outcome
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Alteration in thought processes/ sensoryperceptual alteration
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Day 7
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Client is able to differentiate between what is real and what is not
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Day 14
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Client experiences no delusional thinking or hallucinations.
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Referrals
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Day 1
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Psychiatrist Psychologist
Social worker Clinical nurse spe-
Music therapist Occupational thera-
Recreational thera-
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Day 14
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Discharge with follow-up appointments as required.
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Diagnostic studies
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Day l
Day 3-5
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Drug screen
CT, MRI, PET, EEG (may be ordered to examine structure and function of the brain)
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Additional assessments
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Day 1
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VS every shift
Assess for:
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Day 2-14
Day 2-5
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Ongoing assessments
Establish trust with at least one person
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Day 2-14
Day 14
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VS daily if stable. No evidence of delusions, hallucinations, loose associations, inappropriate affect, excitement/ stupor, panic anxiety, suspiciousness.
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Medications
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Day 1
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Antipsychotic medication
scheduled and prn); may need order for concentrate and injectable form Antiparkinsonian
medication prn
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Day 1-14
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Assess for effectiveness and side effects of medications
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Day 14
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Client is discharged with medica-
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Client education
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Day 7
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Discuss correlation between increased anxiety and psychotic symptoms.
Discuss ways to deescalate anxiety.
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Day 12-13
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Reinforce teaching.
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Day 10
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Discuss importance of taking medications regularly, even when feeling well.
Discuss possible side effects of medications and when to see the doctor.
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Day 14
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Client verbalizes understanding information presented before discharge.
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Risk for violence: Self-directed
or directed at others
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Day 1
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Environment safe for client and others
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Ongoing
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Client does not harm self or others
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Day 14
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Client is discharged without harm to self or others
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Referrals
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Day 1
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Alert hostility management team for the admission of a potentially violent client
For relaxation therapy:
Music therapist
Clinical nurse specialist
Stress management specialist
Psychiatrist:
May give order for mechanical restraints to be used if needed
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Day 14
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Discharge with follow-up, appointments as required.
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Additional
assessments
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Day 1
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Assess for signs of
impending violent behaviors:
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Day 2-14
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Ongoing assessments.
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Medications
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Day 1
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Antipsychotic medications, prn, when signs of agitation begin
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Day 1-14
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Use of medications, isolation/sedusion, or mechanical restraints. If client refuses medications, administer after application of restraints.
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Day 14
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Client is discharged with medications
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Client education
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Day 3-12
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Teach relaxation techniques; discuss activities in which client could participate to relieve pent-up tension
Discuss signs and symptoms of escalating anxiety.
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Day 12-13
Day 14
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Reinforce teaching. Client verbalizes understanding of information presented before discharge.
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