Question

Behavioral Case Study 1: Psychosis

The patient is a 53-year-old male with a history of schizophrenia with many psychiatric hospitalizations.
The patient was admitted on an involuntary “blue paper” for dangerousness towards himself and being
unable to take care of himself. In the emergency department he became agitated and attempted to
assault a staff member. A psychiatric emergency was declared, and Olanzapine 10 mg and Ativan 2 mg
was administered I.M.
This patient lived with an elderly mother who recently died. His father died years ago. This patient still
believes his parents are alive. He is brought to the hospital by the police as he can no longer live in his
parent’s home. He has no insight into his situation or illness. He is delusional that multinational
corporations are trying to control his mind and inhibiting him from being with his parents. He endorses
that he does hear his parents talking to him from time to time. He currently does not have any suicidal
or homicidal ideations. He has not been taking his prescribed medications regularly.
This patient has not been seen by a PCP in over a year. He has recently lost about 20 pounds and has not
been eating well. He also states that he has had difficulty sleeping. He can answer questions. His speech
is well organized. He is suspicious of the staff and reluctant to engage in conversation. He is currently his
own guardian. There is concerns that he does lack capacity to make informed decisions.
Diagnosis: Schizophrenia
Medications: Risperdal 2 mg BID
Ativan 2 mg PO or IM q 4h PRN agitation
Diagnostic Tests
Metabolic Panel
Lipid Panel
EKG
Answer the following questions:
What are the psychotic symptoms demonstrated in this case study?
What is the treatment for his psychotic symptoms?
What does the nurse need to consider about the current medications this patient is prescribe?
Why are these diagnostic tests ordered?
What are the psychosocial issues that impact the care of this patient?
What is the significance of lack of capacity?
What should his discharge plan look like?
What are the milieu considerations and group activity for this patient?
What other target symptoms in this presentation that must be assessed daily?
What are the long-term care implications for this patient?

Answer 1

1. The importantant psychotic symtoms presented in this above scenario is agitation,,attempted to assault a staff member, delusional ideas are present in the patient, hallucination is present in the patient and us evident from the idea that he is taking with his latest ,insomnia ,suspicious,inability to take any independent decision , attempt for injury towards self and others .he is having associative looseness as evident by inability to think logically and take decision.

2.Treatment includes Risperdal 2mg BID and Ativan 2mg PO or IM Q4h PRN Risperdal belongs to a class of drugs called atypical antipsychotics and ativan is used for sleep disorder and reduce anxiety is given to this patient.

The main medication given are antipsychotic medication. They include phenothiazine for example chlorpromazine.

Thioxanthenes for example fluoenthixol

Butyrophenones for example haloperidol

Diphenylbutyl for example pimozide

Piperidines for example penfluridol

Atypically antipsychotic which includes clozapine , olanzapime etc

3.The nurse should know the action and side effects of of these medications. If the patient is too agitated there is an order of PRN Q4 hr. Continuous cardiac monitoring or frequent vital signs to be monitored.

She should ask the patient to take sips of water to relive dry mouths

Observations of any abnormality in movement should he checked

Take seizure precautious

Orthostatic hypotension should be taken care of

4 .Diagnostic test includes metabolic panel.,lipid panal and EKG. A metabolic panel is a blood test that specifically measures blood sugar (glucose) levels of the patient as well as the , electrolyte and fluid balance, kidney function, and the liver function of the individual. Lipid profile or lipid panel is a panel of blood tests that serves as an initial screening test for detection of the abnormalities in lipids value of the patient, such as cholesterol as well as triglycerides.Eletrocardiogram (ECG or EKG) is a test that checks how human heart is functioning and it measures the electrical activity of our heart.