NURSING NU 333 Schizophrenia Case Study 1 Complete

UNFOLDING Clinical Reasoning Case Study NURSING NU 333 Schizophrenia Case Study 1 History of Present Problem: Jeremy Brown is a 30-year-old Caucasian male who was brought to the emergency department (ED) by the police after being involved in an altercation at work. Jeremy was at work today, and he threw a large piece of metal at a coworker and began yelling, “Stop following me, I know what you have been up to!” Because Jeremy was very agitated and upset, and the police were called. Since arriving in the ED, he has been agitated, displaying rapid pressured speech and repeating the phrases he hears the police and others in the ED said. Jeremy reported that he recently stopped taking his risperidone and citalopram because he believed his coworkers have been breaking into his house and poisoning his medications. Jeremy’s manager reports that he was diagnosed with schizophrenia five years ago. Personal/Social History: Jeremy graduated from college with a 4.0 GPA and was in his first year at law school when he experienced the first episode of acute mental illness and was diagnosed with schizophrenia. He had to drop out of law school at age 24 and never finished. Jeremy lives at home with his mother and father and recently broke up with his girlfriend. Jeremy likes his job at the foundry but feels he is a disappointment because both of his sisters are lawyers, as is his father. Jeremy has no close friends and only a few acquaintances. Jeremy’s mental health had been stable up until the last three months. He has been feeling more paranoid the past three months and experienced a dramatic increase in symptoms when he stopped taking all of his medications one month ago. What data from the histories are RELEVANT and have clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: He threw up a large piece of metal at a coworking Rapid pressured speech Diagnosed with schizophrenia six years ago Believed his co working have been breaking into his house Heightened emotions and tension must be monitored closely Continual repetition of another words like in a parrot-like manner Not taking medications may lead to further decompensation Suspiciousness or paranoia that is unrealistic RELEVANT Data from Social History: Clinical Significance: Recently broke up with his girlfriend Feels like a disappointment because both of his sisters are lawyers The past 3 months has been feeling more paranoid Emotional trigger and increase symptoms of schizophrenia, increase stress Can lead to depression and anxiety Been off this meds Has no friends Risk for disturbances in interpersonal relationships Patient Care Begins: Current VS: P-Q-R-S-T Pain Assessment: T: 97.8 F/36.6 C (oral) Provoking/Palliative: Denies pain P: 100 (regular) Quality: R: 22 (regular) Region/Radiation: BP: 130/84 Severity: O2 sat: 98% room air Timing: What VS data are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT VS Data: Clinical Significance: P: 100 ( regular ) R: 22 ( regular ) Slightly elevated , monitor the vital signs Current Assessment: GENERAL APPEARANCE: Calm, body relaxed, no grimacing, appears to be resting comfortably RESP: Breath sounds clear with equal aeration bilaterally ant/post, nonlabored respiratory effort CARDIAC: Pink, warm & dry, no edema, heart sounds regular with no abnormal beats, pulses strong, equal to palpation at radial/pedal/post-tibial landmarks, brisk cap refill NEURO: Alert & oriented to person, place, time, and situation (x4) GI: Abdomen flat, soft/nontender, bowel sounds audible per auscultation in all four quadrants GU: Voiding without difficulty, urine clear/yellow SKIN: Skin integrity intact, skin turgor elastic, no tenting present Mental Status Examination: APPEARANCE: Diaphoretic, uncombed shoulder-length, somewhat greasy hair; cloths are stained and torn. Cooperative with the admission process. MOTOR BEHAVIOR: No abnormal muscle movements SPEECH: Rapid and pressured. Client often repeats words and phrases he hears others in the emergency room say. The client says, “He was brought to the emergency room” over and over again when he is not distracted or engaged in conversation. MOOD: Reports feeling very upset AFFECT: Becomes agitated/anxious when talking about his co-workers and his meds; guarded and suspicious, mood and affect are congruent. THOUGHT PROCESS: Linear but irrational THOUGHT CONTENT: Displays paranoid delusions that coworkers are following him to hurt him and are poisoning his medication. PERCEPTION: Denies auditory or visual hallucinations, or feelings of depersonalization (feeling detached from self or environment) INSIGHT: Poor-believes he was brought in to the emergency room for protection from his coworkers JUDGMENT: Poor-stopped meds and is acting aggressively towards co-workers COGNITION: Alert and oriented times 4 (person, place, time and purpose), is easily distracted INTERACTIONS: Is in good control when talking with nursing staff, his boss, and police. SUICIDAL/HOMICIDAL: Denies any suicidal thoughts or thoughts of self-harm. Stated he wants to “punish” his coworkers. What assessment data are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT Assessment Data: Clinical Significance: Diaphoretic , uncombed shoulder length somewhat greasy hair , clothes are torn Self-care can deteriorate RELEVANT Mental Status Exam Data: Clinical Significance: Rapid pressured speech with echolalia Agitation Paranoia Delusional belief that he has to protect himself He said he wants to punish his co-workers Acute symptoms of schizophrenia Assess and watch an agitated patient Acute symptoms of schizophrenia Increase risk for assertiveness Evaluate statement Lab Results: Basic Metabolic Panel (BMP:) Current: High/Low/WNL? Most Recent: Sodium (135–145 mEq/L) 130 135 Potassium (3.5–5.0 mEq/L) 3.5 3.8