Schizophrenia: Case Analysis Paper

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Table of Contents

Demographic Data and History of the Patient’s Psychiatric Illness
DSM V
Conclusion
References

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).

Drug	Therapeutic Class	Action usual dosage	Special monitoring	Side effects	Nurse’s role
Chlorpromazine (Thorazine)	Phenothiazine antipsychotics	2-4 times daily, based on medical condition, age, and response to treatment.	By mouth, with or without food	Drowsiness, dizziness, dry mouth, blurred vision, exhaustion, nausea, constipation, and weight gain.	Monitoring and assessing
Fluphenazine (Prolixin)	Phenothiazine and antipsychotic agent	Initial dose: 1 to 2.5 mg orally, divided every 6 to 8 hours -Maintenance dose: 1 to 5 mg/day -Maximum dose: 40 mg	Fluphenazine oral concentrate solution should be combined with at least 2 ounces (1/4 cup) of liquid, such as milk, tomato juice, or fruit juice (but not apple juice).	Fluphenazine is not licensed for the treatment of dementia-related psychosis in older persons. Allergic symptoms, severe skin response, and movement problem	Monitoring and assessing
Haloperidol (Haldol)	Typical Antipsychotics	Injected deep into a muscle every 3-4 weeks	May be utilized in persons who have difficulty remembering to take their prescription on a daily basis.	Dizziness, lightheadedness, sleepiness, inability to urinate, difficulties sleeping, headache, and anxiety	Monitoring and assessing
Clozapine (Clozaril)	Atypical Antipsychotic type	Depends on the medical condition and treatment response	By mouth with or without food. Clozapine is the only FDA-approved medicine for treating schizophrenia that has become resistant to previous medications.	Seizures, disorientation, and sleepiness	Monitoring and assessing

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.

Primary problems

Short-term goals

Long-term goals

Interventions

Rationale

Expected outcomes

Lori hallucinates, has disorganized thoughts, and auditory hallucinations tell her to take everything out of her room in groups of two.

Ability to identify two stressful events that trigger hallucinations.
One stress reduction technique.

The voices are less frequent and frightening.
Maintain social relationships with nurses and doctors

Long-term:

Accept that the client believes the voices are real, but clarify that I do not hear them.
Keep the discourse straightforward, basic, and grounded in reality. Assist the customer in focusing on one concept at a time.

Short-term:

Investigate how the client perceives the hallucinations.
Assist the client in identifying the requirements that may be behind the hallucination.

Validating that the reality does not include voices can help the client cast doubt on the validity of her voices (Martin, 2022).
Exploring and discussing the hallucinations might offer the individual a sense of authority that she may be able to handle the hallucinatory voices (Martin, 2022).

Improved communication with nurses and doctors, ability to manage hallucinations, and the fear of voices.

Impaired verbal communication

Two to three 5-minute sessions with the nurse.
Spending time with one or two other individuals in structured activities.

Speak in a way that others can understand.
Display reality-based mental processes in vocal communication.

Long-term:

Creation in a small social environment of the patient of a clear and understandable hierarchical structure with a strict distribution of rights and duties of its members.
Since the behavior of the patient with schizophrenia is based on the duality of perception, it is important to counter his communication style with the paradoxical actions of the doctor.

Short-term:

Explanation to the patient’s environment of the hierarchical system and the principles of feedback for their successful implementation.
Cognitive training aimed at correcting negativism, impaired concentration and thinking disorders.

In a clearly organized hierarchical structure, the patient has no room for the uncertainty of relationships (Martin, 2022). This leads to a limitation of the patient’s ability to maintain the previous style of intra-family response, which also creates conditions for changing the nature of intra-family relations.

Destruction of the created stereotypes about relationships and hierarchy, change in the style of the patient’s reaction to words and actions.

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. (5^th 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.

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Schizophrenia: Case Analysis Paper

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