The paper presents a case study of a psychiatric mental health client at an acute care psychiatric hospital suffering from a severe psychiatric disorder, schizophrenia. Direct client interview and medical record, personal observation, DSM-5-TR, and peer-reviewed papers are among the sources of information. The purpose is to inform the reader about a comprehensive case study with a schizophrenia diagnosis and the rationale for a nursing care plan.
Demographic Data and History of the Patient’s Psychiatric Illness
Patient’s name is Lori; she is 53 years old, Christian, not married, and has no children. Lori was admitted to Pacific Grove Hospital for the gravely disabled by the Riverside Community Hospital Emergency Room on June 20, 2022. The reason for current hospital admission is schizophrenia; patient’s ideas and feelings felt disconnected from reality, as evidenced by confused speech or conduct and diminished engagement in regular activities. She had trouble concentrating, and her mind was always in the past. Lori has spent much of her life suffering from schizophrenia and severe depressive disorder. As she was neither confrontational, suicidal, or homicidal, it was easy to continue correcting her behavior. Lori refuses to discuss previous medications and claims that her mother has always been her care provider. The patient denies any mental health history, suicide attempts, or previous hospitalizations.
DSM V
The DSM V diagnosis is schizophrenia (F20.9); symptoms include delusions, hallucinations, and disordered speech, such as frequent derailment or incoherence. Lori hallucinates, has disorganized thoughts, and auditory hallucinations tell her to take everything out of her room in groups of two.. The patient’s thoughts never remained in one place, making it difficult to understand what she tries to express. According to the American Psychiatric Association (2022), detecting a constellation of signs and symptoms linked with reduced occupational or social functioning is required for diagnosis. Because schizophrenia is a diverse clinical condition, individuals with the illness will differ significantly in most aspects (American Psychiatric Association, 2022). Anxiety and phobias are prevalent; for example, Lori is paranoid and always concerned that the CIA and TSA are following her and “listening to our conversations.” The stressors include conversations about medications and her past.
Without antipsychotic medications, it is impossible to execute successful rehabilitation programs in most of schizophrenia patients. Therefore, the psychotropic medications, such as Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Haloperidol (Haldol), and Clozapine (Clozaril) are mentioned in Table 1. The nurse’s role is to monitor and assess patient’s condition and possible side effects.
Table 1. Psychotropic medication treatment (Bhandari, 2021, Cerner Multum, 2022).
A nursing assessment should be performed on the patient in order to develop an individualized care plan. Impaired verbal communication, difficulty with social interaction, disrupted sensory perception (auditory), disordered thought process, and defensive coping are the five crucial problems. Gaines (2022) claims that a nursing diagnosis, according to NANDA International, is a conclusion based on a complete nursing examination. Nursing diagnoses are based on the patient’s present condition and health evaluation, allowing nurses and other healthcare practitioners to see a patient’s treatment holistically.
The first nursing diagnosis was determined based on the patient’s altered sensory perception. The most prevalent hallucinations in schizophrenia are auditory and visual hallucinations. Altered sensory perception and psychologic stress are related elements, but auditory distortions, hallucinations, and disorientation to person, place, and time are defining features. The initial long-term aim is for the patient to report, on a scale of 1 to 10, that the voices are less frequent and frightening when medication is used. The second long-term objective is to keep in touch with nurses and physicians. The patient’s short-term aims are to identify two stressful occurrences that cause hallucinations and to exhibit one stress-reduction approach.
As a second nursing diagnostic for schizophrenia, impaired verbal communication is used. Because the patient has poor communication function, the speech content and patterns are being evaluated. The patient will spend two to three 5-minute sessions with the nurse discussing observations in the surroundings as the initial short-term goal. The second short-term goal is for the patient to spend time with one or two other individuals in structured activities that are neutral in nature. The long-term goals are for the patient to be able to speak in a way that others can understand with the aid of medicine and to display reality-based mental processes in vocal communication.
Conclusion
Thus, schizophrenia can be characterized as a condition in which the patient manifests significant disturbances in the perception of the surrounding world. The patient has delusional ideas in which he is strongly convinced and cannot give them up. Moreover, in patients there is an incoherent, non-generating semantic load and, as a rule, non-objective. At the same time, in the treatment of the disease, an integrated approach should be used, which includes medical and psychological treatment. With measures aimed at stopping the disease, relatives who surround the patient should take part. This will most successfully establish the hierarchy and bring the patient out of the incoherent state.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, text revision DSM-5-TR. (5th Ed.). APA.
Bhandari, S. (2021).Medications that treat schizophrenia. WebMD.
Cerner Multum. (2022).Fluphenazine. Drugs.com.
Gaines, K. (2022). The ultimate guide to nursing diagnosis in 2022. Nurse. org.
Martin, P. (2022). Schizophrenia nursing care plans. Nurseslabs.