MENTAL HEALTH SCHIZOPHRENIA CASE 1

Mental Health Schizophrenia Case Study

Chris Maronen

Youngstown State University

Abstract
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This paper will explore a patient with a diagnosis of Schizophrenia. Schizophrenia will be

outlined in detail with possible signs and symptoms, nursing diagnoses, and treatments.

Additionally, information obtained on the day of the interview will be used to discuss and

evaluate the specific care, manifestations, and outcomes of this patient.

Objective Data
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Nancy K. was admitted to the Emergency Department of Trumbull Memorial Hospital on March

10th, 2018 for stroke like symptoms. Upon evaluation and ruling out of stroke symptoms or any

stroke threats, the patient was admitted to the psychiatric unit for Schizophrenic behavior. The

DSM IV-TR Axes are as follows:

Axis I: Schizophrenia & Anxiety

Axis II: Patient displayed and/or mentioned experiencing paranoia, delusions of grandeur, fine

tremors, visual/auditory hallucinations, and anxiety.

Axis III: Medical history includes: previous CVA, GERD, Insomnia, Liver Laceration, Chronic

Back Pain, and Asthma.

Axis IV: Family problems include: Death of son within recent years and not seeing daughter

often. Environmental problems include: Living in government housing and not having personal

transportation

Axis V: Not applicable

Nancy presented to Trumbull’s ED on the 8th and 9th of March for the same complaint of

stroke-like symptoms. After examination revealed no evidence of stroke, Nancy was placed

under observation and eventually admitted to the psychiatric unit for Schizophrenia and Anxiety.

Nancy claimed to have stopped her most recent stroke by focusing on it and apparently putting

herself into “shock”. Manifestations observed or conveyed by the patient include paranoia,

hallucinations, anxiety, and fine tremors.

Emily and I tag-teamed the interview with Nancy. She was initially found in her room

staring out of the window. We asked her if she would like to meet in the day room to talk and she

agreed to do so. Nancy was very open to conversation on the day of care. She did not hesitate to

answer any questions asked or any topics initiated. Her appearance and attitude was appropriate
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and pleasant. One thing that sets Nancy’s appearance aside from most is her facial tattoo that is

between her eyebrows. The client admitted that the tattoo has a general religious connotation

with Oriental origin. Nancy maintained a normal conversation. However, she displayed some

odd themes throughout. The first thing that caught me off guard was when she admitted to

purchasing a hospital for $8 billion. She also stated that she was looking for someone to place in

charge of the facility. These delusions of grandeur were the first red flag. Secondly, Nancy

admitted to using telepathy to communicate with her boyfriend. She also said her and her

boyfriend could see each other during these telepathy episodes. During our conversation about

her medications, Nancy told us that she was skeptical of one of her medications because she

believed that it was nuclear medicine. Instead of arguing with her, Emily and I simply stated we

did not think that certain medication was nuclear. She also displayed some paranoia by

questioning the doctor’s intentions by prescribing her Trileptal, which she believed was nuclear.

The patient told Emily and I that she was compliant with her medications and she

believed them to be effective (with an exception to the Trileptal skepticism). At the time of the

interview, she admitted that she was anxious because she did not yet receive her morning

medications from the nurse. She appears somewhat dependent on her medications for

minimization of symptoms. However, she did not display physical characteristics of anxiety

despite admitting she was anxious. Nancy seemed somewhat concerned with the possibility of

not being prescribed Klonopin upon discharge. Her ordered medications on the day of care were

Abilify 20 mg for Schizophrenia/Aggression, Trileptal 30 mg as a mood stabilizer, Klonopin 0.5

mg PRN for anxiety, Haldol 2.5 mg PRN for Schizophrenia, and Trazadone 25 mg PRN as a

sleep aid. Also her past medical history includes CVA, Insomnia, Asthma, GERD, Liver

laceration and back pain (due to previous car accident), and anxiety.
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Summary of Psychiatric Diagnoses:

Nancy has a current psychiatric diagnosis of schizophrenia and anxiety. Schizophrenia has many

myths and is often misperceived. In Dr. Roxanne Dryden-Edwards’ words, schizophrenia “is a

chronic, severe, debilitating mental illness” that affects over 2 million people just in the United

States. Schizophrenia is more commonly found in men than women and appears to manifest in

the mid 20’s to early 30’s in women. Problems associated with Schizophrenia are thought,

behavioral, and social. These thought problems are described as psychosis which is essentially

the loss of reality. Psychosis can manifest as sensory hallucinations which can include auditory,

olfactory, taste, visual, or tactile. Other common or expected manifestations with this diagnoses

include “disorganized speech, disorganized behavior, physically rigid or lax behavior (catatonia),

significantly decreased behaviors or feelings, as well as delusions, which are defined as ideas

that have no basis in reality”. Overtly psychotic symptoms are categorized as “positive” whereas

potentially less overtly psychotic symptoms are deemed as “negative”. The cause of

Schizophrenia is not known. However, it is believed that individuals with abnormalities of

neurochemicals and the presence of lower brain matter in certain areas puts that individual at

higher risk of being diagnosed with Schizophrenia at some point in their life.

The presence of Anxiety is also a prominent diagnosis in Nancy’s life. Nancy depends on

medications to reduce her anxiety. According to Dr. Cheryl Lane, “anywhere from 30% to 85%

of individuals with schizophrenic spectrum disorders (schizophrenia and similar disorders) had

an anxiety disorder at some point in their lifetime.” It is safe to say that a diagnosis of anxiety in

the presence of schizophrenia is not surprising. Diagnosing anxiety in patients with

schizophrenia can be difficult due to locating it’s origin. For example, the anxiety that a

schizophrenic patient is experiencing can be spontaneous, related to psychotic symptoms, or may

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even be a side effect of an antipsychotic medication. No matter the cause, it is important to

identify and treat anxiety accordingly to correct or suppress the physiologic and mental effects

that anxiety can have on the body.

Identification of Precipitation Leading to Current Hospitalization

The precipitating factors to Nancy’s current hospitalization cannot be pinpointed for

certain. However, there is a coincidence in the timing of her hospitalization. Nancy had a son

that she failed to mention during the interview. According to the patient’s medical record, her

son passed away in recent years. Her son’s birthday would have been on March 11th. Nancy was

hospitalized a few times in the day’s leading up to her son’s birthday. The days leading up to her

son’s birthday may have reminded her of his absence and subsequently precipitated the

exacerbation of anxiety and/or exaggerated stroke like symptoms.

History of Mental Illness

According to the medical record and Nancy’s interview, no presence of mental illness

exists in her family. Nancy has a history of CVA, GERD, Back pain, Asthma, Insomnia, and

Liver laceration due to a vehicle accident. Nancy admitted that after her stroke in the late 90’s,

she has noticed a presence of anxiety ever since. According to her family’s medical history, her

mother and sister are both drug users. Additionally, her son was in prison and ended up passing

away there. Although her family doesn’t appear to have been diagnosed, it’s not entirely

impossible to say that mental illness did not exist in previous generations. Schizophrenia can be

familial, but is not always known to pass generation to generation. Nancy moved to Ohio within

the last year so her environment is still somewhat new. Her medical record shows that she has

been receiving care for Schizophrenia from Valley Care since May of 2017.
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Nancy was previously married and had two children during that previous marriage. She

talked about her daughter during the interview. However, she never mentioned her son. Today

she is divorced, but claims to have a fiance. Her fiance is apparently from Pennsylvania. She

states that she has not seen him since she has been in the hospital, but claims that she

communicates with him via telepathy. Nancy said during the interview that she is looking

forward to their wedding in May.

Evidence Based Care:

Nancy is on a psych unit that uses certain precautions as standard practice. All patients

are checked on during the day at least every 15 minutes. There are additional safety measures

such as no plastic trash bags, no glass mirrors, and silverware precautions as well. The unit is

locked and anyone coming on to or leaving the unit must be given access by staff behind the

nurse’s station. On top of that, medications are given to patients as prescribed and are highly

encouraged by staff. Nancy attended group during the day of care which is encouraged and

believed to have therapeutic effects for most patients.

Ethnic, Spiritual, and Cultural Influences:

When asked about her facial tattoo, Nancy admitted that it was done by a friend of hers

that was a tattoo artist. She explained that she was indecisive about what she wanted. So she

trusted her friend with the content and location of the tattoo. The tattoo between her eyebrows

appears to be symbols of Oriental origin. Nancy confirmed that the tattoo has a literal meaning of

peace and love in Oriental culture. She also stated that the tattoo generally carries the

connotation that she is a religious person. Her admitted use of telepathy may also suggest that

she is spiritual. However, this use of telepathy is perceived as a possible hallucination.

Evaluation of Patient Outcomes:

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After being admitted on the 10th of March, Nancy is ready to be discharged on the day of

care. She appears to be ready and accepting of her discharge. Nancy is aware of her medications,

their effects, and the importance of compliance. She had the false belief that Trileptal was of

nuclear origin. However, I believe that Nancy will become comfortable with her transition from

Klonopin to Trileptal over time.

Summary of Discharge Plans:

Nancy’s discharge plans are quite simple. She will be discharged with home health care and

weaned off of Klonopin. The emphasis of discharge is on her compliance and effectiveness of

Trileptal. Home health should evaluate the compliance and effectiveness of her medications and

anything out of the ordinary should be reported by the patient.

Prioritized List of Nursing Diagnoses

1. Disturbed Sensory Perception related to altered sensory perception as evidenced by

delusions of grandeur and the admitted use of telepathy

2. Interrupted family process related to loss of son as evidenced by coincidence of being

admitted leading up to birthday of her son.

3. Disturbed sleep process as related to insomnia evidenced by patient stating that she has

not been sleeping very well.

List of Potential Nursing Diagnoses

1. Impaired social interaction related to impaired thought processes

2. Disturbed thought process related to hallucinations/delusions

3. Defensive coping related to paranoia

Conclusion:
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Nancy appears to have made progress since her admission. She was pleasant and kind to

everyone in her presence on the day of care. Although displaying some symptoms of

Schizophrenia (delusions and possible hallucinations), Nancy seems to have the ability to

function outside of the hospital as long as she maintains her medication compliance. If her son’s

birthday was the precipitating factor that brought her into the hospital, that date has passed.

Hopefully Nancy’s symptoms diminish now that she has received care and has been approved for

discharge.

References

Dryden-Edwards, R., MD. (n.d.). Schizophrenia Symptoms, Causes, Types, Diagnosis &

Treatment. Retrieved April 01, 2018, from

https://www.medicinenet.com/schizophrenia/

article.htm#what_professionals_diagnose_and_treat_schizophrenia_are_there_particular_tests_th

at_assess_schizophrenia
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Lane, C., Dr. (n.d.). Anxiety and Schizophrenia. Retrieved April 01, 2018, from http://

www.schizophrenic.com/content/schizophrenia/symptoms/anxiety-and-

schizophrenia

6 Schizophrenia Nursing Care Plans. (2017, October 05). Retrieved April 01, 2018, from https://

nurseslabs.com/schizophrenia-nursing-care-plans/5/