CASE STUDY
Martin is a 21-year-old business major in university. He was diagnosed with schizophrenia last year and after two unsuccessful antipsychotic medication trials he was finally started on Clozapine 300 mg BID. He was admitted to acute psychiatry today due to another acute episode. He has been medically evaluated and his urine toxicology screen was negative.
Over the past few weeks, his family and friends have noticed increasingly bizarre behaviors. They observed him whispering in an agitated voice – even though there was no one nearby. He has been increasingly isolative, stopped attending classes altogether, and is refusing to answer or make calls on his cell phone. His parents have tried to have him assessed by a psychiatrist – but he refuses accusing them of conspiring with the aliens to have him killed so they can remove his brain and pu it inside one of their own.
Rose is Martin’s nurse. She observes that Martin is mildly overweight i.e., belly bulging through his hospital pajamas; and his hygiene is poor i.e., unruly and oily long black hair, scruffy beard, and he is malodorous. He appeared indifferent with the interview and often just sat motionless while staring intensely at Rose while moving his lips. Periodically, he glanced about the room as if distracted and appeared quite suspicious of the security camera located on the ceiling. When he did answer questions, they were typically one or two-word responses in a low monotone voice.
Rose: Martin, my name is Rose, I will be your primary nurse while you are in hospital. If it is okay with you, we will try to meet every hour.
Martin: I can’t talk to you. If I do, it will activate a deadly chip that was implanted in my brain by evil aliens. I know this because the voices tell me. It’s a bad voice and I have to do what it tells me. People say that it happens because I stopped taking my medications, but that’s not true. The medications make me tired, overweight, and I can’t have sex.
Rose: The thought of having a deadly chip in your brain sounds frightening. I want you to know that you are safe here. Can you tell me more about this as you seem to be focusing on something other than our conversation?
Martin: The voices are telling me other things – telling me not to say – I think I might hurt myself.
Rose: That sounds disturbing. Can you tell me more about the thoughts to hurt yourself so I can try to help you?
Martin’s stops communicating with Rose and asks her to leave.
Martin’s prescribed medication regime is:
Clozapine 300 mg BID
Rose plans to find out how long it has been since Martin last had his medications and also to determine what he knows about them.
Part 1:
What are the criteria for the diagnosis of schizophrenia?
Part 2:
Complete an MSE based on the written scenario interview by Rose. Refer to the diagnostic criteria for schizophrenia as a guide for MSE completion. Be sure to include the following MSE components:
Appearance
Attitude (also referred to as “rapport”)
Behavior
Mood and affect
Speech
Thought process
Thought content
Perceptions
Cognition
Insight
Judgment
Part 3:
As a group, write the two Nursing Diagnoses as a three-part statement (PES format). Watch the video resource: How To Write A Nursing Diagnosis.
For the symptoms, include all pertinent objective and subjective information that supports each diagnosis. Indicate what is objective and subjective by denoting an “O” or an “S”, after each one.
Part 4:
Provide ONE short term goal for each previously identified nursing diagnosis (Total 2). Goals should be S.M.A.R.T.:
Specific (to the assessed priority)
Measurable
Attainable
Realistic
Time limited (should be accomplished within a realistic time frame – this may be a shift, a set of shifts, or by discharge, but not after discharge)
Part 5:
Provide TWO evidence-informed interventions for each goal (Total 4).
Interventions need to be evidence based and they must include at least one medication with detailed information i.e., starting dose, adverse effects to assess/monitor etc. (to tie in other classes/show synthesis of information.
Part 6:
Provide ONE potential patient evaluation for each goal (Total 2).
