Question

Case Study:

Sam is presented through the emergency department to the psychiatric unit of a major medical center. He was taken to the hospital by police, who were called by department store security personnel when Sam frightened shoppers by yelling loudly to “imaginary” people and threatening to harm anyone who came close to him.

On the psychiatric unit, Sam keeps to himself and walks away when anyone approaches him. He talks and laughs to himself and tilts his head to the side, as if he were listening to something. When the nurse

attempts to talk to him, he shouts, “Get away from me! I know you are one of them!” He picks up a chair, as if to use it for protection.

Sam’s appearance is unkempt. His clothes are dirty and wrinkled, his hair is oily and uncombed, and there is an obvious body odor about him. The physician admits Sam with a diagnosis of schizophrenia and orders Thorazine and Cogentin on both a scheduled and prn basis.

1. Identify four segments of information from the assessment data that would be significant.

2. List and prioritize four appropriate nursing diagnoses from analysis of the data identified in question   one. Provide a rationale for your prioritization.

3. Provide outcome criteria for the four nursing diagnoses.

Answer 1

His appearance and behavour shows that the patient may affect the schizophrenia,

The nursing Diagnosis are,

• impared verbal communication related to disease condition
• impared social interaction related to disease condition
• disturbed sensory perception
• Defensive coping
• interupt family process

out comes of the nursing intervensions are,

Ten years after initial diagnosis approximatly 50% of people diagnosed with schizophrenia are either completly recovered or improved to the point of being able to function independently .25% are improved but require a strong support network 15 % remain unimproved and are typically hospitalized.