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Schizophrenia Case Study (45 min)

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A 21-year-old male is found outside of a gas station and according to bystanders, he was constantly talking for hours straight about the end of the world and the conspiracy of the government to control our minds. The patient appears to not have taken a shower in a long time; his hair is matted, his skin is dirty, he has a strong body odor and his nails are long with dirt under them. The patient is quoting the bible and asking everyone who enters the room if God has saved them yet. The nurse is assessing this patient and is asked if she could get Jesus a glass of water.

Critical Thinking Check
Bloom's Taxonomy: Application

How should the nurse respond to the patient?

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Critical Thinking Check
Bloom's Taxonomy: Application

The patient states, “Don’t you know who Jesus is? He will kill you if he wanted to. Don’t upset Jesus and get him a glass of water.” What should the nurse do at this point?

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The patient cooperates and is answering the nurse’s questions. Vital signs are stable and the patient tells the nurse that he has never been treated for any mental health problems before. He also tells the nurse that he is running away from home because people keep breaking into his apartment to laugh at him and steal his peanut butter and all of his writings because they will lead people to the secrets the government has been keeping. The nurse asks about medications the patient takes at home and the patient replies, “I don’t take that poison.” 

 

All of a sudden the patient starts to question the nurse and accuse the nurse of trying to trick the patient into taking poison and make him conform to the societal norms that the government wants us to do. The patient becomes very anxious and is staring at the door.


Critical Thinking Check
Bloom's Taxonomy: Analysis

What is the nurse’s priority at this time?

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Critical Thinking Check
Bloom's Taxonomy: Application

How should the nurse handle the new found mistrust with this patient?

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After a break the patient decides that they would like to have a pen and paper to write down any thoughts that comes to mind while speaking. The nurse continues the assessment and looks down to see the patient drawing a picture of the nurse with a pencil stabbed into the neck.

Critical Thinking Check
Bloom's Taxonomy: Analysis

What is the most important thing for the nurse to do at this time?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What kind of antipsychotic medication (Typical or Atypical) do you think this patient should be on?

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