Question

A 21-year-old man is brought to the emergency department by the police after he was found sitting in the middle of a traffic on a busy street. By way of explanation the patient states, “the voices told me to do it”. For at least a year, he experiences delusion and auditory hallucinations. The hallucinations consist of several voices commenting on the patient’s behavior and giving him commands to do “bad things”. He became socially isolated and dysfunctional as a result of the symptoms. He denies current drug use or medical problems. A mental status examination shows several abnormalities. Disturbance in grooming, hygiene and behavior (paranoid) are noted, and he has flat affect. His thought processes are occasionally loose and he reports auditory hallucination and delusion.  

1. Describe the DSM 5 diagnostic criteria for the diagnosis of schizophrenia.
2. What symptoms did the patient manifested that establishes the diagnosis?
3. What other conditions need to be ruled out to fully establish the diagnosis of schizophrenia?
4. Should the patient be hospitalized? Provide a rationale for your answer.
5. Provide 3 prioritized nursing diagnoses and 3 priority interventions for each diagnosis.

Answer 1

Ans)

               DSM 5 criteria: Schizophrenia cannot be diagnosed by laboratory investigations. It requires a precise and concrete criteria (history collection and mental status examination) to confirm the diagnosis. The DSM 5 diagnostic criteria states the individual when manifested with 2 or more of the following symptoms:
a. Delusions.B.Hallucination. C. Disorganised speech. D. Catatonic behavior. E. Negative symptoms that is affective flattening, alogia or a volition.
2) The symptoms that confirmed the patients diagnosis are:A. Patient verbalized he experienced delusion and hallucinations(auditory) which provoked him to commit bad things since 1year. B. He was socially isolated, had loose speech.

3. The patients thorough subjective and objective assessment (mental status examination) has ruled out effectively which is based on DSM 5 criteria.

4. The patient has to be definitely hospitalised as he vulnerable to be threat to himself and others. For instance, through the assessment he verbalized the voices command him to do bad things which is really dangerous.

5. The following are the nursing diagnosis based on the priority:
A.Disruption in cognitive operations and activities(ADL's) related to neurological disturbances as evidenced by delusions.
# recognise clients delusions as the clients perception of environment.
#Interact with client on basis of things in the environment.
# try to distract client from delusion by engaging in reality based activity (eg. Arts, crafts).
# Donot touch client use gestures to avoid interpretation.

2.Disturbed sensory perception (auditory) related to neurological changes as evidenced by hallucination.
# accept the fact that voices are real to the client but explain that you do not hear the voices.
#Take necessary environmental precautions if voices tells him to do bad things.
# Explore how hallucinations are experienced by the client by sharing experiences.
# clearly document what client says.

3. Impaired verbal communication related to altered perception as evidenced by tanfentiality (loose talks).
# Keep voice in a low manner and speak slowly as much as possible to reduce anxiety. # keep environment calm, quiet and free of stimuli as possible to reduce confusion.
# Use clear or simple words and keep directions simple as well