Positive Symptoms: Hallucinations (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:00 So, let's go over the positive symptoms again. Positive symptoms usually are what we see with an acute onset that all of a sudden the person starts hearing voices or smelling something. It's an alteration in their sensory perception and it doesn't have to have any external stimuli, in fact when we are writing up our notes we often say "patient appears to be responding to internal stimuli." And this internal stimuli can affect any one of the 5 senses. So that includes auditory. The person now is hearing voices, there is an increase risk for injury which would be our nursing diagnosis and why, because those voices might be saying "hurt yourself." Those phrases might be saying "You're worthless, run out into the street." And if the person is believing that this voice is telling him a command or telling her a command, they might just do what they are told and put themselves in danger.

    01:08 There's also a visual hallucination where you see a person who is not there. These are very real to the person who is experiencing. And when you say there is no one there, it may become part of their delusion to think that you are trying to set them up. And so, the best way to respond to it is to look at them and say "I know you see someone, I'm not seeing that same person. Can you tell me something about that person? Can you tell me what they're saying to you?" We especially want to know what the person is saying or what the voice is saying. Why? Because we want to know if it's command. Is the person with schizophrenia being commanded to do something, and is that a harmful act. Also, there could be tactile hallucinations. They might say that they feel bugs or they can feel a dog climbing up on their leg when in fact there is no one there, but they can feel it. It is real to them. Olfactory, smelling odors, is another one. I had a patient who used to believe that she knew when angels were present because she would smell syrup. And very frequently she would walk over to someone and she would actually sniff them to find out if they were truly an angel or if they were just a regular human. It would be impossible to tell her that that smell she smell didn't exist, because for her it did exist. And then, taste. They might eat something and it tastes like something completely different, which is oftentimes when that delusion combines itself with the hallucination, they might think that they are being poisoned. Something that normally tastes good to them suddenly tastes really bad. It's really important to understand that these hallucinations are real to the person who is experiencing them that when they have that kind of hallucination, it is not unreal to them.

    03:24 One thing I also want you to think about is that sometimes we all hear a voice. It is not unusual, it's not like we hear it all the time but have you ever been in a mall and suddenly heard your name being called out and you look around and you realize nobody's actually calling out your name and you just let it go because, well, you let it go because it's not there.

    03:48 That's also an auditory hallucination. Sometimes our brains do that. You might be thinking about your mother and in that thought, in that memory the smell of her perfume comes true to you just for a brief second. That is your brain making all those neurotransmitters come together and to give you a message, but it doesn't persist with the person who is having these positive symptoms. These hallucinations are persisting.

    About the Lecture

    The lecture Positive Symptoms: Hallucinations (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Schizophrenia (Nursing).

    Included Quiz Questions

    1. Visual
    2. Auditory
    3. Tactile
    4. Olfactory
    5. Gustatory
    1. “I know you’re hearing this man, but I can’t hear him. Can you tell me what he is saying?”
    2. “I don’t hear anyone talking right now; you’re experiencing an auditory hallucination.”
    3. “Why don’t you come to the lunchroom? He won’t bother you in there.”
    4. “Do you want me to tell the man to stop talking to you?”

    Author of lecture Positive Symptoms: Hallucinations (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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