456585540-schizophrenia-clinical-case-study.docx

Running Head: SCHIZOPHRENIA CLINICAL CASE STUDY 1
Schizophrenia Clinical Case Study
Ariel Aiken
Nursing Department, Youngstown State University
NURS. 4842/L: Mental Health Nursing
William Church RN, BSN
April 12, 2020

ABSTRACT
Schizophrenia is one of the most complex mental health disorders that individuals endure for
many years and it is a chronic illness. It is characterized by episodes of hallucinations and
delusions that cause a person to not be able to process thoughts correctly and clearly while also
affecting their sense of reality, schizophrenic patients need long-lasting treatment plans (Mayo
Clinic, 2020).
1.) In this paper Schizophrenia disorder is explained throughout about how a woman’s life has
been affected by the chronic hospitalizations from her disorder. This case study will discuss the
brief outlook into the patient’s lifestyle and history of schizophrenia, including her family life,
her auditory hallucinations, and her medication regimen. The study will analyze the patient’s
past and present relapses of schizophrenic episodes. It will also discuss the overall planned
outcomes for the patient, her future goals, and the outcome of her medication regimens. Three
research studies will also be included to further explain the wide range of signs and symptoms of
the disorder, the various medication treatments used, and how to manage care with patients with
the disorder.

Objective Data:
J.W. is a 45-year-old female diagnosed with schizophrenia disorder related to auditory
hallucinations upon admission on April 6th, 2020 and the day of care was on April 16th, 2020.
Her mother stated that she thinks that she has not been taking her medications because she had
been displaying less motivation and more paranoid episodes, with signs of hypersomnia,
decreased cleanliness and hygiene self-care, and displaying word salad. Majority of her labs
including CBC/BMP were within normal limits specifically the WBC level of 6.2, with the
TSH/T4 being normal, drug screen was negative, and alcohol level on admit was < 0.03 which
did not show any thyroid over or under production, substance abuse, or infection. In some cases,
those factors could cause a relapse in schizophrenia, that is why it is checked when admitted to a
unit. The patient’s vital signs were as follows: blood pressure 140/94, pulse- 70 bpm,
respirations- 18, and temperature 97.9.
J.W.’s affect was flat, and her facial expressions were fixed and immobile with periods
of agitation, anxiety, and mood swings changing throughout each interview conducted. J.W. held
a previous job at Wal-Mart as a shelf stocker until she was fired because of poor attendance and
is now on disability. Her mother is her legal guardian and controls her finances and the patient
also lives with her sister, Lyndsay. Her father had left the family when J.W. was only 10 years
old, which could have affected her life with her disorder peaking from the loss and rejection that
her father had shown her at an early age. During each interview she had frequent digressions
from the topic asked of her to answer while also demonstrating flight of ideas by stating to the
interviewer, “you’re with them”, and “ you already know why I am here” and on admission she
stated that she was hearing, “a mean female voice telling her she is worthless”. J.W. had

graduated high school and was going to college for nursing and when she was 22 years old, when
she had her first psychotic break. She continued to have relapses within the years leading up to
the most recent admission.
Some of her medications are Ziprasidone (Geodon) 40mg orally twice daily, Venlafaxine
(Effexor) 75mg orally daily, Haloperidol (Haldol) both orally and intramuscularly every 4 hours
as needed for agitation (depending on circumstances of episode of agitation), and Lorazepam
(Ativan) 2mg orally every 8 hours as needed for anxiety. She has had an EKG taken on the day
of admission and an EKG taken the morning of day of care which showed signs of an abnormal
QT interval as it had widened from the previous EKG taken upon admission. One main cause of
this would be the medication administration of Ziprasidone (Geodon) as it is known for widening
QT intervals. Therefore, a medication reconciliation will need to be done for the patient. If the
widened QT interval is not fixed, it can lead to a life-threatening arrhythmia formation. I think a
good structured daily routine will help with her hallucinations and anxiety/agitation of not taking
her medications. J.W. is currently on a lockdown psychiatric unit with unit restrictions and
suicide precautions are put in place. Her activity is as tolerated, she is on a regular diet, and she
is getting vital sign checks every 4 hours and as needed during the time spent on the lockdown
unit.
Summarize the Psychiatric Diagnoses and Common Behaviors
“Schizophrenia is a term describing a group of disorders caused by genetic and
nongenetic factors. Although the exact causes haven’t been pinpointed, research has strongly
implicated genetics. Nongenetic factors such as maternal viral infection or poor nutrition during
pregnancy and birth injuries that deprive the infant of oxygen may play a role as well.” (Sheila
Hoban (2010) p.45) Some positive symptoms consist of hallucinations such as auditory in the

case of J.W., delusions, unusual behaviors such as agitation, anxiety, mood swings, and
disruptions in thought processes evidenced by flight of ideas, word salad, and slowed,
disorganized speech, while there are negative symptoms as well, like flat affect, ambivalence,
apathy, lack of volition, and anhedonia. (Hoban (2010) p. 46) J.W. exhibited both positive and
negative symptoms of schizophrenia disorder throughout the 10 days that she has been on the
unit. Some of the main symptoms that were noted were the marked lack of volition which she
showed that she did not have the effort to do basic hygienic needs and self-care along with
auditory hallucinations, a flat affect with a fixed and immobile facial expression and restricted
movement, disruptions in thought processes such as presenting with word salad and flight of
ideas. She also showed signs of agitation and irritability when interviewed during certain
sessions. The staff reported J.W. had been seen talking to and motioning to “unseen others”
during the visit. She told the staff that she would not eat the food because the staff was “trying to
poison her” so she only ate prepackaged foods but with a poor appetite in general as she had not
eaten breakfast and ate 25% of her lunch on day of care. Patient has had history of delusions
other than auditory such as somatic, grandiose and paranoia. Patient had stated that public
messages refer to specifically her such as a salesman on TV and that she is president of the
world.
Identify the Stressors and Behavior Prior to Admission
J.W. has had a history of psychotic breaks with exacerbations and remissions of
schizophrenia episodes over the years from the age of 22. The stress of nursing school is what
could have triggered her to have her first psychotic break and from then on has had a few each
year with multiple hospitalizations thereafter. She does not seem to want help and has stated
during interviews that her mother, neighbors, people at the shelter, no one believes that she is

president, which caused her stress to increase before admission. She only has one parental figure
in her life. She has had history of auditory hallucinations as previously mentioned but has denied
auditory hallucinations on the latest visit. Patient had displayed more paranoia and had become
less motivated before the most recent visit. She was recently fired from her job at Wal-Mart
because she stopped going to work even with the encouragement from her mother to continue to
work.
Discuss Patient and Family History of Mental Illness
On admission the mother had stated that J.W.’s did not have a father figure in her life
which could have caused some emotional trauma. She has never been married and has no
children. I think with the background that she has grown up with that it has set her up with how
she has become currently. Patient has had thoughts of decreased self-worth. Patient is currently
on disability due to the disorder. No stated family history of mental illness, the father was “a
mean alcoholic”, therefore substance abuse has been noted.
Describe the Psychiatric Evidence Based Nursing Provided
The unit at the hospital that the patient was located at had a lockdown unit that ensures
safety to those who are being treated there. J.W. had unit restrictions and was on suicide
precautions. On day of care the client was prompted with group therapy sessions to attend but
had refused as she had preferred to stay in her room. Staff were obtaining vital signs every 4
hours and as needed for adequate care. Staff also provided aftercare planning as discussed with
the mother about where J.W. would be staying once she has been discharged by either a group
home or her mother’s home. As stated by researchers,” An understanding of the health behaviors
of people with schizophrenia is necessary to guide clinical treatment and program development

to reduce morbidity in this population” (Holmberg & Kane (1999) p. 827). It is crucial to have an
extensive thorough treatment plan in order for schizophrenic patients to thrive in their
environment and with the disorder.
Analyze Ethnic, Spiritual, and Cultural Influences
J.W. had stated upon admission that she does not attend church but believes in God. I feel
as if spiritual influences are not in her life enough as they can be helpful for others if they
practice in religion more. Her ethnic and cultural influences that were stated were from the
interviews as she is of White race and lives with her mother and sister, Lyndsay. While her father
had left the family when she was a young child. She had attended some college but did not
receive a degree.
Evaluate the Patient Outcomes
J.W. would need to start to comply to treatment with attending more group sessions,
continuously taking her medications as ordered and be willing to get along with staff.
“Compliance with treatment is defined as attendance at scheduled individual therapy, medication
clinics, group therapy, partial day care, psychosocial rehabilitation programs and taking
medications as prescribed.” (Karen Dearing, (2004) p. 156). It is also important as a nurse to
establish good rapport with the patient, J.W. Some things that nurses and staff could incorporate
could be socializing the client more, normalizing the patient’s routine more by adding tasks to
complete, teaching healthy lifestyles, reinforcing changes, and praising goal attainment by the
patient. (Dearing, (2004) pp. 158-160). J.W. did increase her hygienic needs by showering with
encouragement but did not attend two therapy sessions on day of care. When interviewed, the
patient asks how long she will be interviewed as she had become inpatient and agitated at times.

Summarize Plans for Discharge
No stated plans for discharge yet. The mother had stated that J.W. could live with her
again once the medications are at a level that maintains schizophrenic disorder. The mother of
the patient wanted to start to consider other possible living arrangements for her daughter, as her
older sister is getting married soon and the mother is getting older in age. She was interested in
the details on group homes and how they were set up, but the mother is concerned for the
reaction that J.W. would express if told about possibly having to move to group home instead of
being with her mother. The ultimate goal for the patient is their safety and recovery from the
current relapse. As stated by researchers, Mahone, Maphis and Snow (2016),
“ Recovery-a process of change through which clients improve their health and wellness,
live a self-directed life, and strive to reach their full potential-is usually accomplished
through a combination of personal empowerment, a sense of responsibility, choice, and
active self-help”(p. 373)
Having active participation within the family setting would be a good goal for the patient,
along with a therapeutic regimen and structured schedule for the patient to be as independent as
possible and also be to complete basic activities of daily living easily and on her own.
Prioritized List of All Actual Diagnoses
Ineffective coping skills related to relapse as evidenced by inadequate social support
created by characteristics of relationships.
Impaired Verbal Communication related to altered perceptions as evidenced by
disturbances in cognitive associations.

Disturbed Sensory Perception related to altered sensory perceptions as evidenced by
auditory distortions and altered communication pattern.
Interrupted Family Process related to situational crisis or transition as evidenced by
changes in mutual support and inability to meet the needs of family.
Self-Care Deficit related to decreased motivation and perceptual impairment as evidenced
by poor personal hygiene.
Risk for Injury related to hallucinations and delusions as evidenced by auditory, somatic,
grandiose and paranoia delusions.
Disturbed Thought Process related to overwhelming stressful life events as evidenced by
delusions and inappropriate non-reality-based thinking.
Potential Nursing Diagnosis
Impaired Social Interaction related to impaired thought processes as evidenced by
observed discomfort in social situations and dysfunctional interaction with others.
Anxiety related to perceived threat to biologic integrity as evidenced by delusions and
disorganized thought process.
Imbalanced Nutrition: Less Than Body Requirements related to unwillingness to eat and
self-neglect as evidenced by patient eating only prepackaged foods and stating staff is “trying to
poison me”.
Defensive Coping related to suspicions of the motives of others as evidenced by false
beliefs about the intentions of others and grandiosity.

Conclusion
J.W. had made some progress on the unit while also having some setbacks throughout the
admission to the day of care. She started her experience confused and anxious while having
delusional thoughts. Her compliance with medication was poor as her mother had noticed
symptoms of schizophrenia again as she believed she had not been taking them. She refused to
eat any food that was not prepackaged due to her delusions. Her health and well-being were in
jeopardy on admission, now discharge planning is being adapted to her needs and she will be
either placed in a group home or back into her mother’s home and live with her and her sister,
Lyndsay.
J.W. has gone through many experiences in her life to trigger this disorder, such as
emotional and mental trauma. With continuation of medication compliance, some of her signs
and symptoms of the disorder should decrease and she will be able to incorporate more activities
of daily living with having a thorough, structured schedule to keep her mind busy on everyday
tasks. Teaching the mother of relapse signs and symptoms will also help with J.W.’s condition,
along with the family aspect of care being obtained more and have them follow J.W.’s schedule
and make sure treatment is being administered correctly after hospitalization.

References

Mahone, I. H., Maphis, C. F., & Snow, D. E. (2016, May). Effective Strategies for Nurses
Empowering Clients With Schizophrenia: Medication Use as a Tool in Recovery.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898146/
Dearing, K. S. (2004, October). Getting it, together: how the nurse patient relationship influences
treatment compliance for patients with schizophrenia. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/15529280
Hoban, S., School of Nursing, & California State University. (n.d.). Caring for a patient with
schizophrenia in a med-surg unit : Nursing2020. Retrieved from
https://journals.lww.com/nursing/fulltext/2010/01000/Caring_for_a_patient_with_schizo
phrenia_in_a.18.aspx
Holmberg, S. K., & Kane, C. (1999, June). Health and self-care practices of persons with
schizophrenia. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10375155
Schizophrenia. (2020, January 7). Retrieved from https://www.mayoclinic.org/diseases-
conditions/schizophrenia/symptoms-causes/syc-20354443

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