CASE 1: SCHIZOPHRENIA

- 38 yr. old, male, single (never married, no children)

- experienced first symptoms of mental illness in 2012
: having feelings of deja vu experiences off and on for the past two years
and these are intensifying
: smoked marijuana once per week and drank alcohol occasionally
- 2014: delusions (beliefs that the television was sending him messages; belief
that mythological creatures were trying to entice him to battle; belief that a
celebrity on TV wanted to marry him; misinterpretation of numbers to indicate that
he was GOD
: paranoia, isolation
: received medication but stopped until feel better
: he was never instructed to refilled the medication once he left hospital
- 2017: feeling down, depressed, crying a lot, believed he was not himself
: expressed beliefs that he had been in military but he's not sure (actually,
he had been in Navy for approx. 4 months but discharged due to reported feelings of
suicide)
: at the hospital, he reported his thoughts were jumbled
: records indicate he was treated with Risperdal and diagnosed with Psychotic
Disorder, NOS
: Again, he took medication until prescription ended but did not seek a
renewal
- 2018: stopped by the restaurant and reported feeling very paranoid as if someone
was going to harm him
: believed that some people at the restaurant looked like devils and were
possessed by demons
: secured a knife for protection, stabbed the bystander to death, go to
cashier on his way out as if nothing happened. arrested after. after receiving
medications, he could be restored and he was also evaluated for a second opinion
sanity evaluation
: stabilized and was able to be aware that he committed a murder, he was
despondent, isolated and overwhelming remorseful thus requiring further medication
adjusted
: began to work with therapist to address the guilt and shame he felt due to
his actions. and slowly, he began to make progress

Risk factors
- Having a family history of schizophrenia. Some pregnancy and birth complications,
such as malnutrition or exposure to toxins or viruses that may impact brain
development. Taking mind-altering (psychoactive or psychotropic) drugs during teen
years and young adulthood.Jan 7, 2020
Diseases or conditions caused: Psychosis
Symptoms: Suicidal ideation

1. As Mr. Z’s nurse, what assessment data must you analyze to determine priorities
and establish plan of care and parallel it to 2 NANDA nursing Diagnosis.

Assessment:
- having feelings of deja vu experiences off and on for the past two years and
these are intensifying
- feeling down, depressed, crying a lot, believed he was not himself
: expressed beliefs that he had been in military but he's not sure (actually,
he had been in Navy for approx. 4 months but discharged due to reported feelings of
suicide)
: at the hospital, he reported his thoughts were jumbled
: records indicate he was treated with Risperdal and diagnosed with Psychotic
Disorder, NOS
- stopped by the restaurant and reported feeling very paranoid as if someone was
going to harm him
: believed that some people at the restaurant looked like devils and were
possessed by demons
: secured a knife for protection, stabbed the bystander to death, go to
cashier on his way out as if nothing happened. arrested after. after receiving
medications, he could be restored and he was also evaluated for a second opinion
sanity evaluation
DIAGNOSIS 1: IMPAIRED VERBAL COMMUNICATION RELATED TO ALTERED PERCEPTIONS DUE TO
BIOCHEMICAL FACTORS SUCH AS INABILITY TO CONCENTRATE AS EVIDENCED BY DIFFICULTY
ESTABLISHING VERBAL COMMUNICATION, INABILITY TO DISCERN USUAL OR NORMAL
COMMUNICATION PATTERNS, COGNITIVE DISTURBANCES SUCH AS THOUGHT BLOCKS OR CONFUSED,
AND HALLUCINATIONS/DELUSIONS

NURSING DIAGNOSIS: DISTURBED THOUGHT PROCESS RELATED TO INADEQUATE SUPPORT SYSTEMS

AS EVIDENCED BY DELUSIONS, INAPPROPRIATE NON-REALITY-BASED THINKING, INACCURATE
INTERPRETATION OF ENVIRONMENT, AND MEMORY DEFICIT/PROBLEMS

2. What are the possible nursing interventions applicable to Mr. Z and why?

DIAGNOSIS 1:
-

DIAGNOSIS 2:
- Attempt to understand the significance of these beliefs to the client at the time
of their presentation. (Important clues to underlying fears and issues can be found
in the client’s seemingly illogical fantasies.)
- Recognizes the client’s delusions as the client’s perception of the environment.
(Recognizing the client’s perception can help you understand the feelings he or she
is experiencing.)
- Identify feelings related to delusions. For example:
If client believes someone is going to harm him/her, client is experiencing fear.
(When people believe that they are understood, anxiety might lessen.)
- Interact with clients on the basis of things in the environment. Try to distract
client from their delusions by engaging in reality-based activities (e.g., card
games, simple arts and crafts projects etc). (When thinking is focused on reality-
based activities, the client is free of delusional thinking during that time. Helps
focus attention externally.)
- Explain the procedures and try to be sure the client understand the procedures
before carrying them out. (When the client has full knowledge of procedures, he or
she is less likely to feel tricked by the staff.)
- Do not touch the client; use gestures carefully. (Suspicious clients might
misinterpret touch as either aggressive or sexual in nature and might interpret it
as threatening gesture. People who are psychotic need a lot of personal space.)
- Initially do not argue with the client’s beliefs or try to convince the client
that the delusions are false and unreal. (Arguing will only increase client’s
defensive position, thereby reinforcing false beliefs. This will result in the
client feeling even more isolated and misunderstood.)
- Show empathy regarding the client’s feelings; reassure the client of your
presence and acceptance. (The client’s delusion can be distressing. Empathy conveys
your caring, interest and acceptance of the client.)
- Utilize safety measures to protect clients or others, if the client believe they
need to protect themselves against a specific person. Precautions are needed.
(During acute phase, client’s delusional thinking might dictate to them that they
might have to hurt others or self in order to be safe. External controls might be
needed.)