Schizophrenia Case Study Charles

Client Profile
Charles is a 23-year-old male graduate student who comes from a single-parent, middle-class family; his father abandoned the family when Charles was a baby. He attends school on a scholarship, and his mother works two jobs to help support him. Although Charles has a roommate, they interact infrequently. One day Charles pins his roommate to the wall and threatens him with a knife while mumbling something about people trying to control his brain through radio waves. Charles accuses the roommate (and others) of trying to poison him. The campus police respond to calls for help. Case Study The campus police officer brings Charles to the psychiatric unit of a local hospital. Charles moves to the corner of the room and sits by himself, but remains within eyesight of the police officer and staff. The nurse notices the Charles lips move occasionally and his head turns as if to hear someone speaking. She also notes that Charles is tall and thin. His appearance is unkempt, with an unshaven face and soiled, wrinkled clothing. He does not make eye contact. Charles seems frightened, yet his manner and history suggest that he poses a threat to others. The nurse introduces herself to Charles and tells him that he is in a safe place. She speaks softly and slowly, and she chooses her words with care. Then she takes Charles to an office to interview him. She is alone with hi, but leaves the door open. A mental health worker stands outside the door. Charles refuses to sign any information release forms during the admissions process. Later, the nurse calls medical records for Charles records from an admission one year ago. The record reveals a diagnosis of schizophrenia, Paranoid Type and that Charles was discharged on haloperidol (Haldol) and referred to the college health center psychiatrist Charles tells the nurse that he has not been taking haloperidol. The nurse calls the psychiatrist for admitting orders. The psychiatrist debates whether to put Charles back on haloperidol or prescribe a newer atypical antipsychotic/neuroleptic. The nurse then receives a call from Charles mother. She questions whether Charles is there and asks to speak to him. When the nurse tries to tell Charles that his mother has called, Charles asks whether she is married, where she lives, and if he may see her after he is discharged. Disscussion Questions/Topics: 1. What is the significance of Charles appearance and behavior? 2. Which signs and symptoms match the criteria for Schizophrenia? 3. What are the positive and negative signs and symptoms of schizophrenia? Which ones does Charles manifest? 4. Which subtype of Schizophrenia do Charles signs and symptoms suggest?

Schizophrenia Case Study Charles 5. What provisional nursing diagnoses could be made based on the limited data available? Which one would rank as the top priority? 6. With what basic issues is the nurse dealing? 7. What does the nurse do to protect herself from Charles? What else could she do? 8. How should the nurse deal with the mothers inquiry and request? Why? 9. What could be the most therapeutic response the nurse could offer Charles when he talks about his delusions or admits to hearing voices or other hallucinations? 10. If you were Charles nurse, what response would you give to questions about your marital status and dating availability? How would you feel if you were asked these questions? 11. What is Charles developmental stage? What are the tasks of that stage (use Ericksons or Havinghursts theories of developmental stages)? 12. If you were the nurse, how would you respond Charles admission that he had stopped taking haloperidol? Discuss the haloperidol and older neuroleptics as well as newer atypical neuroleptics. 13. In addition to the medication, what other treatments might be used with Charles and other clients with Schizophrenia?