lOMoARcPSD|3013804
Keith RN - Schizophrenia
Advanced Adult Health Care (Keiser
University)
, lOMoARcPSD|3013804
RAPID Clinical Reasoning Case Study DORIAN ALLEN
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:
Involved in altercation at work. The data provided will help the physician make the
Patient is agitated and displays rapid correct diagnosis & treat the patient appropriately.
pressured speech and he is
repeating phrases he hears.
Threw large metal object at coworker
& was yelling.
No longer takes his medications.
Diagnosed with schizophrenia five
years ago.
RELEVANT Data from Social History: Clinical Significance:
The following data will help understand the compliance with his medications in
Patient was an intelligent law school student.
addition it will help make the correct diagnosis and help treat the patient with new
Broke up with girlfriend & feels disappointed medications as necessary.
about being the only person in the family that
is not a lawyer. Patient also has no close
friends & only a few acquaintances.
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:
© 2018 Keith Rischer/www.KeithRN.com
Keith RN - Schizophrenia
Advanced Adult Health Care (Keiser
University)
, lOMoARcPSD|3013804
RAPID Clinical Reasoning Case Study DORIAN ALLEN
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:
Involved in altercation at work. The data provided will help the physician make the
Patient is agitated and displays rapid correct diagnosis & treat the patient appropriately.
pressured speech and he is
repeating phrases he hears.
Threw large metal object at coworker
& was yelling.
No longer takes his medications.
Diagnosed with schizophrenia five
years ago.
RELEVANT Data from Social History: Clinical Significance:
The following data will help understand the compliance with his medications in
Patient was an intelligent law school student.
addition it will help make the correct diagnosis and help treat the patient with new
Broke up with girlfriend & feels disappointed medications as necessary.
about being the only person in the family that
is not a lawyer. Patient also has no close
friends & only a few acquaintances.
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:
© 2018 Keith Rischer/www.KeithRN.com
