Varcarolis: Essentials of Psychiatric Mental Health Nursing, 2nd Edition Chapter 17: Schizophrenia Spectrum Disorders Case Studies and Nursing Care...

Question Answered step-by-step Varcarolis: Essentials of Psychiatric Mental Health Nursing, 2nd Edition Chapter 17: Schizophrenia Spectrum Disorders Case Studies and Nursing Care Plans Disorganized ThinkingMartin Taylor, a 36-year-old white, unemployed man, has been referred to the mental health center. He is accompanied by his mother and sister. He had been hospitalized for 3 years in a state hospital with the diagnosis of chronic schizophrenia and was doing well at home until 2 months ago. His only employment was for 5 months as a janitor after high school graduation. Other significant family history includes a twin brother who died of a cerebral aneurysm in his teens. Martin tells the nurse he has used every street drug available, including LSD and intravenous heroin. His mother states that as a teenager, before his substance abuse, he was an excellent athlete who received average grades. At 17 years of age, he had his first psychotic break when taking a variety of street drugs. His behavior became markedly bizarre (e.g., eating cat food, swallowing a rubber-soled shoe that required an emergency laparotomy). Ms. Lamb, a clinical nurse specialist, meets with Martin after speaking with his mother and sister. Martin is unshaven, and his appearance is disheveled. He is wearing a red headband in which he has placed popsicle sticks and scraps of paper. He chain smokes during the interview and frequently gets up and paces back and forth. He tells the nurse that he is Alice from Alice in the Underground and that people from space hurt him with needles. His speech pattern is marked by associative looseness and occasional blocking. For example, he often stops in the middle of a phrase and giggles to himself. At one point, when he starts to giggle, Ms. Lamb asks him what he is thinking about. He stated, “You interrupted me.” At that point, he began to shake his head while repeating in a sing-song voice “Shake them tigers . . . shake them tigers . . . shake them tigers.” He denies suicidal or homicidal ideation. Ms. Lamb notes that Martin has a great deal of difficulty accurately perceiving what is going on around him. He has markedly regressed social behaviors. For example, he eats with his hands and picks his nose in public. He has no apparent insight into his problems; he tells Ms. Lamb that his biggest problem is the people in space. AssessmentObjective Data Subjective Data Self-AssessmentWorking with a patient who has limited potential for relating, poorly defined ego boundaries, and limited social skills and who demonstrates regressed bizarre behavior requires a great deal of skill, patience, and peer support. In the presence of delusions, bizarre behaviors, and regressed social skills, health care workers can experience helplessness, can feel overwhelmed, and can become anxious. Some anxiety may be caused by empathizing or acknowledging the patient’s deeply repressed feelings of inferiority, fear, and anger. At times, nurses may have similar repressed feelings that they have difficulty dealing with; these feelings may cause them to withdraw from the patient in an attempt to minimize their awareness of uncomfortable feelings. Often, the more withdrawn and regressed the patient is, the more taxing he or she is to health care workers. Diagnosis Outcomes Identification Implementation Shorts Terms Goals Interventions Rationale EvaluationEvaluation Health Science Science Nursing NUR 2310 Share QuestionEmailCopy link Comments (0)