Question

Mr. M, a 42-year-old thin male with a history of schizophrenia, is brought to the emergency room from an assisted living facility because of worsening delusions along with hypertension. Staff at the assisted living home reported that he has been increasingly agitated and physically aggressive at times. His delusions consist of creatures from outer space who are trying to kill him. He appears to be experiencing visual hallucinations and states that he sees creatures in the corner of the room telling him to hide. He recently has withdrawn from others and has difficulty initiating activities of daily living (ADLs) such as washing his face and combing his hair. His affect is flat. Later, Mr. M is admitted to the Psychiatric Unit and is prescribed Haldol which is a first-generation antipsychotic. However, after a few days, Mr. M has some muscle stiffness and it is also determined that newer 2nd generation antipsychotic medication would be more helpful to address both positive and negative symptoms of schizophrenia. Seroquel 100mg is ordered daily and the Haldol stopped. Soon, Mr. M is responding well to the medication with a decrease in hallucinations and agitation. He is being discharged back to the assisted living facility.

1. Identify the positive and negative symptoms of schizophrenia in the above case by highlighting the positive symptoms and underlining the negative symptoms
2. Describe the nursing care plan for this patient using the nursing process; include aspects of the mental status exam in your plan
3. State a therapeutic communication skill you could use with this patient and give an example of a question you would ask
4. State 2 side effects other than muscle stiffness that could occur with Haldol
5. List 2 side effects that can occur with Seroquel, a 2nd generation anti-psychotic
6. Discuss 2 areas of education to teach the assisted living staff and provide rationale

Answer 1

Q. No. 1. Answer :

Positive symptoms of schizophrenia :

* hallucinations like visual, hearing6, smell, feel ect.

* dellusions,

* confused thoughts and disclosures organized speech,

* concentration difficultly,

* movement disorders ect.

Negative symptoms of schizophrenia :

* poverty of speech and thoughts,

* anhedonia,

* apathy,

* loss of social motivation,

* lack of social interest,

* inattention to cognitive and social inputs.

Q. No. 3. Answer :

Therapeutic communication skills with schizophrenia clients :

* we need to maintain low stress environment, because already they are in stress.

* one person should be speak at a time and keep voice down,

* use good language that is positive and it is in supportive manner rather than argue.

* be encourage and understand the client problems,

* use simple and clear language.

For example :

Question : you are appearing to talking with some one but I didn't see them, please mention, can you are seeing them?

Please describe what you are seeing?.

Q. No. 4. Answer :

Halodol side effects :

* in ECG prolongation of QT interval,

* irregular heart beat,

* mental status changes,

* death in elderly,

* neuroleptic malignant syndrome with fever.

Q. No. 5. Answer :

Seroqel side effects :

* stomach upset,

* mood and behavioral changes,

* nausea,

* vomiting,

* drowsiness,

* dizziness,

* constipation ect

Q. No. 6. Answer :

* cognitive behavioral therapy should be provided because here the client is having hallucinations and delusions and other thought disturbances.