UNFOLDING Clinical Reasoning Case Study
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:
Heightened emotions and tension must be monitored closely
He threw up a large piece of metal at a
coworking Continual repetition of another words like in a parrot-like manner
Rapid pressured speech Not taking medications may lead to further decompensation
Diagnosed with schizophrenia six years ago Suspiciousness or paranoia that is unrealistic
Believed his co working have been breaking
into his house
RELEVANT Data from Social History: Clinical Significance:
Recently broke up with his girlfriend Emotional trigger and increase symptoms of schizophrenia, increase
stress
Feels like a disappointment because both of
his sisters are lawyers Can lead to depression and anxiety
The past 3 months has been feeling more Been off this meds
paranoid
© 2018 Keith Rischer/www.KeithRN.com
This study source was downloaded by 100000841138256 from CourseHero.com on 06-16-2022 03:34:13 GMT -05:00
https://www.coursehero.com/file/82869259/Schizophrenia-case-study-1docx/
, Risk for disturbances in interpersonal relationships
Has no friends
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 Calm, body relaxed, no grimacing, appears to be resting comfortably
APPEARANCE:
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.
© 2018 Keith Rischer/www.KeithRN.com
This study source was downloaded by 100000841138256 from CourseHero.com on 06-16-2022 03:34:13 GMT -05:00
https://www.coursehero.com/file/82869259/Schizophrenia-case-study-1docx/
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:
Heightened emotions and tension must be monitored closely
He threw up a large piece of metal at a
coworking Continual repetition of another words like in a parrot-like manner
Rapid pressured speech Not taking medications may lead to further decompensation
Diagnosed with schizophrenia six years ago Suspiciousness or paranoia that is unrealistic
Believed his co working have been breaking
into his house
RELEVANT Data from Social History: Clinical Significance:
Recently broke up with his girlfriend Emotional trigger and increase symptoms of schizophrenia, increase
stress
Feels like a disappointment because both of
his sisters are lawyers Can lead to depression and anxiety
The past 3 months has been feeling more Been off this meds
paranoid
© 2018 Keith Rischer/www.KeithRN.com
This study source was downloaded by 100000841138256 from CourseHero.com on 06-16-2022 03:34:13 GMT -05:00
https://www.coursehero.com/file/82869259/Schizophrenia-case-study-1docx/
, Risk for disturbances in interpersonal relationships
Has no friends
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 Calm, body relaxed, no grimacing, appears to be resting comfortably
APPEARANCE:
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.
© 2018 Keith Rischer/www.KeithRN.com
This study source was downloaded by 100000841138256 from CourseHero.com on 06-16-2022 03:34:13 GMT -05:00
https://www.coursehero.com/file/82869259/Schizophrenia-case-study-1docx/
