CASE STUDY #146 Schizophrenia SCENARIO: You are working on a

CASE STUDY #146 Schizophrenia SCENARIO: You are working on an… CASE STUDY #146 SchizophreniaSCENARIO:You are working on an inpatient psychiatric unit and need to do an initial assessment of R.B., who has just been admitted. He has a diagnosis of schizophrenia, paranoid type. He is 22 years old and has been attending the local university and living at home with his parents. R.B. has always been a good student and has been socially active. Last semester his grades began declining. He became very withdrawn and spends most of his time alone in his room. His personal self-care has deteriorated as he can go days without bathing. Prior to admission, R.B. spent several weeks in seclusion. He refused to join family gatherings, isolated himself, and closed the blinds. Within the past 2 days he refused to eat, stating, “They have contaminated the food.” As you approach R.B., you note that he appears to be talking to himself. When you talk to him, he looks around and answers in a whisper but gives you little information. He states, “They are watching me and told me not to cooperate.”1. Identify at least 3 negative symptoms of schizophrenia that R.B. might be experiencing.    2. Identify at least 2 positive symptoms of schizophrenia that R.B. might be experiencing.    3. Give the definition of each of the following types of delusional thinking:                      a. Grandeur                      b. Persecutory/Paranoid                         c. thought insertion                        d. Ideas of reference                         e. Somatic delusions 4.  What symptoms indicate that R.B. has paranoid schizophrenia?  5. Why is it important to know R.B.’s history before he is diagnosed with schizophrenia?  6. What diagnostic screenings are important in evaluating R.B.?  7. What are the most important initial interventions for treating R.B.?  The psychiatrist evaluates R.B. by conducting a mental status assessment and orders antipsychotic medications with close monitoring in the inpatient setting.8. Identify the class of antipsychotic medications considered as first-line therapy for schizophrenia?  9.R. B. will need to be monitored closely. How will this be done?  10. Identify 5 types of psychosocial treatments that may be used to treat R.B.’s schizophrenia?  R.B. is started on olanzapine (Zyprexa). You inform R.B. and his family about the common side effects of the second- generation antipsychotics. 11. What are the common side effects of second-generation antipsychotics such as olanzapine (Zyprexa)? Select all that apply.NauseaDry mouthDrowsinessPalpitationsWeight gainTardive dyskinesia 12. Which condition is a risk associated with second-generation antipsychotics, such as olanzapine?Metabolic syndromeProlonged QT interval Anticholinergic toxicityNeuroleptic malignant syndromeAs you go in to give R.B. his medication, he speaks to you in a hushed tone. “Is that a bird?” Before you can say anything, he asks, “Do you see that bird over my bed? She is telling me not to leave this room. If I move, she will swoop down and try to peck at my eyes. Be careful!”13. Is he experiencing a delusion or a hallucination? Explain your answer.  14. Identify the appropriate nursing response you would state to R.B. Select all that apply.”There is no bird over your bed.””Tell me more about what you are seeing.””I’ll come back to talk to you when you are settled down.””The voice you are hearing is part of your illness. It can’t hurt you.””I don’t see a bird over your head. I can understand how that would be upsetting to you.”After 2 weeks of inpatient therapy, R.B. is discharged back to his parents’ home and is enrolled in a day treatment program. He and his parents attend family therapy sessions twice a month. He hopes to move to a halfway house in the community.Health Science Science Nursing NURS 105

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