CASE STUDY 4 (Hallucinations and Illusions)

Student’s Name: Abella, Erma E. Date: 7/12/2021 Score: ____ /15

CASE: Jack

Case: Jack is admitted at 11 p.m. to a secured inpatient unit. The police found him wandering on the
street and walking into traffic, appearing to be talking to someone when there is no one there. He has
been on your unit several times, and you know he can be very violent. The client calmly enters the unit,
thanks the police, and then proceeds to run down the hall screaming, “I will not do it” Jack hits the wall
with his fists. Clients came out of their rooms looking frightened. The shift is changing, and report is just
about to begin.

1. Based on this description, what do you think Jack is experiencing? (1 pt)

- Based on the description, Jack is experiencing hallucination (false sensory perceptions or perceptual
experiences that do not rally exist).

2. What is your priority at this time for Jack? (1 pt)

- Promoting safety of client and others and right to privacy and dignity.

- Establishing therapeutic relationship by establishing trust.

3. From the perspective of the therapeutic milieu, why is it important for you to act quickly? (4pts)

- Effective milieu therapy required long length of stay because client with more stable condition helped
provide structure and support for newly admitted clients with more acute condition. For the condition
of Jack, it would be hard for the therapy to be effective if his condition will get worst because clients are
sicker when they are admitted and do not stay as long in the hospital.

4. What interventions are priority ones for Jack? (4 pts)

- Help present and maintain reality by frequent contract and communication with the client.

- Elicit description of hallucination to protect the client and others.

- Engage client in reality-based activities, such as card playing, occupational therapy, or listening music.

- Focus on what is real and to help shift the client’s response toward reality.

5. What are the concerns you should have about client protection intervention? (5 pts)

- Safety to both the client and the nurse, because the client may be paranoid and suspicious of the nurse
and the environment.

- Approach in a nonthreatening manner, giving the client ample personal space usually enhances his or
her sense of security.

- Protecting the client from retaliation by others who experience the client’s intrusions and socially
unacceptable behavior.
- Redirecting the client away from the situations or others can interrupt the undesirable behavior and
keep the client from intrusive behaviors.

- Providing physical protection for the client is the nurses first consideration, helping others affected by
the client’s behavior is also important. Usually, the nurse can offer simple and factual statements to
others that do not violate the client’s confidentiality.

CASE STUDY 5 (Delusions)

Student’s Name: Abella, Erma E. Date: 7/12/2021 Score: ____ /17

CASE: Rose

Case: You are making a home visit to Rose, a client who has a long psychiatric history. She has been an
haloperidol (Haldol) for some time. The purpose of your visit is to follow up about her recent surgery
following a broken hip. This is your second visit in four days. On your first visit, she appeared to be
pleasant and was responsive to your suggestions. As you enter the home, she seems reluctant to let you
in. When you, enter you notice that she is wearing dirty clothes and responds, “How can possibly sleep?
So much has been said about me. I have to be alert for people watching me.

1. What data do you have about this client that are important in understanding her current status? (5
pts)

- The client has false beliefs that have no basis in reality. She appeared to be pleasant and was
responsive to your suggestions at the 1st visit but when you visited her 2nd time, she seems reluctant to
let you in. She is wearing dirty clothes and responds, “How can possibly sleep? So much has been said
about me. I have to be alert for people watching me.

2. What further data do you need regarding Rose’s status? (9 pts)

- Non-reality-based thinking

- Disorientation

- Labile effect

- Short attention span

- Impaired judgment

- Distractibility.

3. You respond with Rose; I am sure that no one is watching you.” Based on this case description why
might this response not be appropriate? (3 pts)

- In handling a person with delusion, directly interject doubt regarding delusions as soon as the client
seems ready to accept this. Do not argue but present a factual account of the situation. As the client
begin to trust you, she may become willing to doubt the delusion if you express your doubt.