How can nurses deal with a patient with paranoid schizophrenia?

a) What nursing strategies could you document in your care plan that might assist the patient to drink the volume required to maintain their physical well-being?

Patients with paranoid schizophrenia are highly suspicious of their environment, always being on the lookout for lurking dangers where none really exist.  In order to make the patient in question drink the required volume of water everyday, the caretaker must come up with strategies that take into account the fragile and unpredictable state of mind of the patient.  If the patient suspects that the water given to him is poisoned, it would be a good idea to take a sip of water before the patient’s eyes, so that he is reassured of its palatability.  Since water is an essential intake for the patient, the caretaker might have to repeat this exercise several times over the course of a day.  While it might be cumbersome and annoying at first, there are good chances that the patient grows less suspicious of the water as days go by.  In that scenario the hard work put in by the caretaker in the initial period pays off later.

b) The person also believes that you and the other nursing staff involved believe you are assassins. How will you respond to this? What care plan strategies for communication will you document?

Since the schizophrenic patient cannot make a distinction between what is real and what is imagined, it is probable that he misunderstands and misattributes the actions and intentions of those around him.  The particular case where the patient believes that the nursing staff is conspiring to kill him can be real difficult to handle and can so easily get out of control.  The patient may even act upon his beliefs and may act aggressively toward the nursing staff as a way of defending himself.  Hence, it is prudent on part of the nursing staff to approach the patient cautiously and put objects that could be potentially used as weapons out of his reach.  If the patient is known to have a history of violent behavior, then it is not unwarranted to restrain him to his bed or chair during periods of close contact.