CASE STUDY ON SCHIZOPHRENIA DISORDER

Coverage Date: December 11, 2023

Instructions:
●
This case study is equivalent to one whole day of Related Learning Exposure.
●
Read the case provided below thoroughly and answers all questions and activities below.
●
Use long sized bond paper when answering the activities in this case study.

A. CASE
A 15 year old male, belongs to a middle socio-economic status, the child attained
developmental milestones as per to age. From his early childhood he was too young to be exposed to
an aggressive behaviour by his father, who often attempted to discipline him in this pursuit at times
was abusive and aggressive toward him. Marital problems and domestic violence since marriage lead
to divorce of parents when he was 10 years old. He was brought for consultation a week ago brought
with complain of academic decline and experienced to have auditory hallucination for over a year.
His educational history revealed that he was declined in his academic performance with hand
writing deterioration, and irritable, sad behaviour was noted. He engaged in fight at school and often
times his teacher will suggest for an individual meetings to her mother with undesirable behaviour was
noted. He also preferred solitary activities and resented to eat with the rest of the family.
He was on sodium valproate up to 400 mg./day for nearly 2 months which to decline in his irritability
and aggression.
After a year, he manifested worsen hearing hallucination and even his family members believe
it was done to tease him. Seen awake late at night, muttering to self, shouting at person as if a
person existed, self-care deterioration noted. His behaviour worsen that sought for his mother for
another consultations, And now he was diagnosed with Schizophrenia and treated patient with
Risperidone 3mg. and Carbamazipine 300mg./day with some improvement of his symptoms.
After 3 months since he was discharged, it was revealed that there is a relapse of his
symptoms due to a poor compliance of his medication that leads to a multiple hospital admission of
his acute exacerbation of symptoms. He was admitted for diagnostic clarification and rationalization of
his medications. Non –cooperation for mental state examination and aggressive behaviour were still
noted. A schedule of activities in the institutions was also conducted. However, poor socialization and
lack of motivation to participate was noted. The family was psycho educated about the illness and
mother’s expressed emotions and over involvement was addressed by supportive psychotherapy.

B. MENTAL HEALTH ASSESSMENT FINDINGS

List down significant mental health assessment findings and provide brief discussion of each finding.
You may add more spaces if you believe there are more assessment findings in the case.
ASSESSMENT FINDINGS DISCUSSION
Child abuse Childhood trauma and family
stress are one of the contributing
factors in developing
schizophrenia.
Auditory hallucination Is the most common type of hallucination, it involves
hearing sounds, most often voices, talking to or about the
client.
Hand writing deterioration Schizophrenia, tremors, depression, autism and
Asperger’s syndrome all end in a gradual deterioration
in handwriting.

Undesirable behavior and irritability Aggressive behavior may be a result of psychotic

symptoms including delusions and hallucinations, which
can elicit suspicion and hatred. Impulsive acts of violence
and dysfunctional impulsivity are common in patients
with schizophrenia.
Preferred solitary activities, poor socialization and lack of Asociality is the preference for solitary pursuits combined
motivation with a lack of desire to engage in social relationships.
People with schizoid personality disorder and introverts
are prone to this. This symptom of schizophrenia may
cause individuals with it to wish to isolate themselves
from others.
Awake at night, muttering to self, shouting at person Some people with schizophrenia appear to talk to
themselves as they respond to the voices. They believe
that the hallucinations are real disordered thoughts.
Self-care deterioration Clients with schizophrenia may have significant self-care
deficits. Inattention to hygiene and grooming needs is
common, especially during psychotic episodes. The client
can become so preoccupied with delusions or
hallucinations that he or she fails to perform even basic
activities of daily living.
Poor compliance to medication treatment Failing to take medications as prescribed is one of the
most frequent reasons for recurrence of psychotic
symptoms and hospital admission.

C. PSYCHOSOCIAL THEORY

Discuss the particular psychosocial stage where the client is in. Highlight either the positive resolution
or negative resolution findings provided in the case and expected in the client.
Psychosocial Stage Age Range: ADOLESCENCE (12-18 YEARS
IDENTITY VS ROLE CONFUSION OLD)
Discussion:

In adolescence (ages 12–18), children face the task of identity vs. role confusion.
According to Erikson, an adolescent’s main task is developing a sense of self. Adolescents
struggle with questions such as “Who am I?” and “What do I want to do with my life?” Along
the way, most adolescents try on many different selves to see which ones fit; they explore
various roles and ideas, set goals, and attempt to discover their adult selves. Adolescents who
are successful at this stage have a strong sense of identity and are able to remain true to their
beliefs and values in the face of problems and other people’s perspectives. When adolescents
are apathetic, do not make a conscious search for identity, or are pressured to conform to their
parents’ ideas for the future, they may develop a weak sense of self and experience role
confusion. They will be unsure of their identity and confused about the future. Teenagers who
struggle to adopt a positive role will likely struggle to find themselves as adults.

Source: [Link]
psychosocial-theory/
D. DIAGNOSIS
Discuss the pathophysiology/progression of the diagnosis of the specified case
Diagnosis:

The underlying pathophysiology of schizophrenia demonstrated that people with

schizophrenia have relatively less brain tissue and cerebrospinal fluid than those who
do not have schizophrenia; this could represent a failure in the development or a
subsequent loss of tissue. Computed tomography scans have shown enlarged
ventricles in the brain and cortical atrophy. Positron emission tomography studies
suggest that glucose metabolism and oxygen are diminished in the frontal cortical
structures of the brain. The research consistently shows decreased brain volume and
abnormal brain function in the frontal and
temporal areas of persons with schizophrenia. This pathology correlates with the
positive signs of schizophrenia (temporal lobe), such as psychosis, and the negative
signs of schizophrenia (frontal lobe), such as lack of volition or motivation and
anhedonia. It is unknown whether these changes in the frontal and temporal lobes
are the result of a failure of these areas to develop properly
or whether a virus, trauma, or immune response has damaged them.
Intrauterine influences, such as poor nutrition, tobacco, alcohol, and other drugs, and
stress are also being studied as possible causes of the brain pathology found in
people with schizophrenia (Kendall et al., 2017). Neurochemical studies have
consistently demonstrated alterations in the neurotransmitter systems of the brain in
people with schizophrenia. The neuronal networks that transmit information by
electrical signals from a nerve cell through its axon and across synapses to
postsynaptic receptors on other nerve cells seem to malfunction. The transmission of
the signal across the synapse requires a complex series of biochemical events.
Currently, the most prominent neurochemical theories involve dopamine
and serotonin.

SOURCE: Videbeck S. L. & Miller C. J. (2020). Psychiatric-mental health nursing

(Eighth). Wolters Kluwer.

Source:
 E. MEDICATION REVIEW (DRUG STUDY)
Create a Medication Review for all medications provided in the case. Use the format provided below:
Medication Indication Mechanism of Contraindication Adverse Nursing
action Effects Responsibilities
Generi Tegretol is -Hypersensitivity Dizziness, Observe for
c
Name:
Carba
indicated for use
as an
anticonvulsant
Carba -Severe hemic
disorders
ataxia
fatigue,
confusion and
agitation in older
people.
-Atrioventricular drowsiness, 
mazep
mazepi drug.
 heart block skin Observe for
ne
Tegretol is -Severe reaction, changes in
indicated bradycardia. leucopenia, mental

ine is
Brand
in the -History of nausea, state.
Name
treatment of the
previous bone vomiting 
:
pain associated Observe for
Tegre marrow increased y allergic reactions
tol

Dosage
with true
trigeminal
neuralgia.
a depression or a GT,
history of
such as rashes,
edema, fluid purpura.
 intermittent retention, 
300mg/day This drug is not a
simple analgesic
and should not be
sodiu porphyria.
-Concomitant
increased
weight,
Leucopenia which
is severe,
use of hyponatremi progressive or
used for the relief
of trivial aches or
pains.
m monoamine
oxidase
a,
associated with
clinical symptoms
decreased requires
 inhibitors. blood
chann
withdrawal.
Beneficial results -Lactation. osmolarity, 
have also been headache, When the patient
reported in
accommodat is in a more
glossopharyngeal
neuralgia el ion
disorders,
upright position,
check his or her
blood pressure

blocke
diplopia, (lying t
elevated o standing,
liver sitting to
standing, lying to

r. It
enzyme
sitting). When
thrombocyto systolic BP goes
peni below 20 mm Hg

binds
a or diastolic BP
eosinophilia. falls below 10 mm
Hg, document
orthostatic

prefer hypotension and

notify your doctor.

entiall
y to
voltag
e-
gated
sodiu
m
chann
els in
their
inactiv
e
confor
mation
,
which
preven
ts
repetit
ive
and
sustain
ed
firing
of an
action
potenti
al
Carba
mazep
ine is
a
sodiu
m
chann
el
blocke
r. It
binds
prefer
entiall
y to
voltag
e-
gated
sodiu
m
chann
els in
their
inactiv
e
confor
mation
,
which
preven
ts
repetit
ive
and
sustain
ed
firing
of an
action
potenti
al
Carba
mazep
ine is
a
sodiu
m
chann
el
blocke
r. It
binds
prefer
entiall
y to
voltag
e-
gated
sodiu
m
chann
els in
their
inactiv
e
confor
mation
,
which
preven
ts
repetit
ive
 and
sustain
ed
firing
of an
action
potenti
al
Carbamazepine
is a sodium
channel blocker.
It binds
preferentially to
voltage-gated
sodium channels
in their inactive
conformation,
which prevents
repetitive and
sustained firing of
an action
potential

Medication Indication Mechanism Contraindication Adverse Nursing

of action Effects Responsibilities
Generi Risperidone is indicated for
c
Name:
Risperi
the treatment of
schizophrenia and irritability
associated with autistic
bloc
ks
done disorder. It is also indicated
as monotherapy, or
Brand adjunctly with lithium or
valproic acid, for the

dopa
Name
treatment of acute mania or
:
mixed episodes associated
with bipolar I disorder.
Dosage - Risperidone is additionally
indicated in Canada for the
short-term symptomatic
mine
management of aggression
or psychotic symptoms in
patients with severe
and
dementia of the Alzheimer
type unresponsive to
nonpharmacological
approaches.
serot
-Risperidone is also used
off-label for a number of
conditions including as an
onin
adjunct to antidepressants in
treatment-resistant
depression
rece
ptors
in
the
brain
,
depr
esses
the
RAS
;
antic
holin
ergic
,
antih
ista
mini
c,
and
alph
a-
adre
nergi
c
bloc
king
activ
ity
may
contr
ibute
to
some
of
its
 thera
peuti
c and
adve
rse
actio
ns
blocks
dopamine
and serotonin
receptors in
the brain,
depresses
the RAS;
anticholinergi
c,
antihistaminic
, and alpha-
adrenergic
blocking
activity may
contribute to
some of its
therapeutic
and adverse
actions

Medication Indication Mechanism Contraindication Adverse Nursing

of action Effects Responsibilities
Generic Name: Pharyngitis, * Contraindicated in
CEFUROXIME patientshypersensitive to
tonsillitis,in Cefuroxim drug.
Brand Name: fections of e, like the * Use cautiously in
ZOLTAX penicillins, patientshypersensitive to
the urinary penicillinbecause of
andlower is a beta- possibility of cross-
Dosage
500 MG 1 TAB lactam sensitivity with other beta-
respiratory lactam antibiotics.
antibiotic.
tracts, * Use with caution in
By binding breast-feeding women and
FREQUENCY andskin and inpatients with history of
BID to specific
skin- colitisor renal sufficiency.
penicillin-
ROUTE structurein
binding
PO fections
 caused proteins
byStreptoc (PBPs)
occus located
pneumoniae inside the
and S. bacterial
pyogenes,H cell wall, it
aemophillus inhibits
the third
influenzae,
and last
Staphylococ
stage of
cus
bacterial
aureus,Esch
cell wall
erichia coli. synthesis.
Cell lysis
is then
mediated
by
bacterial
cell wall
autolytic
enzymes
such as
autolysins;
it is
possible
that
cefuroxim
e
interferes
with an
autolysin
inhibitor.

Medication Indication Mechanism Contraindication Adverse Nursing

of action Effects Responsibilities
Generic Name: ULORIC is
FEBUXOSTAT
a xanthine Cefuroxim
Brand Name: oxidase e, like the
ULORIC
(XO) penicillins,
inhibitor is a beta-
Dosage
40 MG 1 TAB lactam
indicated
antibiotic.
for the
By binding
FREQUENCY chronic
OD to specific
management
ROUTE of penicillin-
PO
hyperurice binding
mia in adult proteins
patients (PBPs)
with gout located
who have an inside the
inadequate bacterial
cell wall, it
response to
inhibits
a maximally
the third
titrated
and last
dose of
stage of
allopurinol, bacterial
who are cell wall
intolerant synthesis.
to Cell lysis
allopurinol, is then
or for whom mediated
treatment by
with bacterial
allopurinol cell wall
is not autolytic
advisable. enzymes
such as
autolysins;
it is
possible
that
cefuroxim
e
interferes
with an
autolysin
inhibitor.

F. PROBLEM LIST
Based on the case provided above, cite the top 3 Nursing Diagnosis of the identified client. Provide your
rationale/discussion on your choice and discuss briefly about the Nursing Diagnosis.
Problem Rationale
1. Disturbed sensory perception related to auditory Auditory hallucination is one of the common types of
hallucination hallucination in patient diagnosed with schizophrenia. It
manifested worsen hearing hallucinations and seen awake at
night, muttering to self, and shouting at a person as if a person
existed.
2. Self-care deficits related to cognitive impairment Self-care deterioration is noted in people diagnosed with
schizophrenia followed by lack of motivation and poor
compliance to medication treatment.
3. Impaired social interaction related to disturbed Patient with schizophrenia involves doing solitary
thought process activities, impulsive behavior and disruptions of social
interactions.
Source:
 F. NURSING CARE PLAN
Formulate an NCP for each of the 3 Nursing Diagnosis in your Problem List which applicable for the
client using the format below:

Defining Nursing Scientific Goals of Nursing Rationale

Characteristics Diagnosis Analysis Care Intervention
Subjective Data: Disturbed Disturbed Short term goal: Independent 1. This decrease the possibility of
sensory sensory After 7 days of 1. Decrease amount offorming inaccurate sensory
perception nursing perceptions
stimuli on patient’s
perception is a
related to intervention, environment 2. Safety is always the #1 priority,
change in the patient will be 2. Provide safety especially when a patient is
auditory
Objective Data:
amount of able to 3. Help the patient to
mentally and emotionally
hallucination
pattering of participate in recognize triggers unstable.
incoming stimuli social activities [Link] distraction 3. Attempt to decrease delusional
accompanied by behavior by uncovering triggers
such as during times of intense
a diminished, stress or anxiety and learning
exaggerated Long term goal: how to cope with these feelings.
distorted or After a month of 4. Patients can distract
impaired nursing themselves from hallucinations
response to intervention, by listening to music, wearing
such stimuli. patient will be headphones, writing, drawing, or
able to maintain playing games. It can also be
Auditory and social helpful to remind the patient that
visual relationship and Collaborative when experiencing a
hallucinations decrease 1. Collaborate with a hallucination to loudly state “Go
are the most recurrence of psychiatrist for away!” or “Leave me alone!” to
hallucination. counselling gain control.
common in
schizophrenia.
Collaborative
1. Client needs supervision and
counselling as part of the treatment
process.

Defining Nursing Scientific Goals of Nursing Rationale

Characteristics Diagnosis Analysis Care Intervention
Subjective Data: Risk for
self/other
directed
violence related Collaborative
Objective Data: to command
hallucination

Defining Nursing Scientific Goals of Nursing Rationale

Characteristics Diagnosis Analysis Care Intervention
Subjective Data: Impaired social Social isolation is Short term goal: 1. Develop a 1. Patients with schizophrenia may be
-Auditory hallucination interaction the condition of After 5 days of trusting distrusting of others. By
- Muttering to self related to aloneness nursing relationship acknowledging and actively listening
altered thought experienced by the intervention,
to the patient’s thoughts the nurse is
process individual and patient will be
perceived as able to involve in
establishing rapport and building trust.
Objective Data: 2. Provide positive 2. When a patient takes a step to
-Social isolation imposed by others social interaction
and as a negative and participate in reinforcement. improve social interaction such as
-Disordered thought
or threatened state. group activities walking outside of their room
sequencing
Impaired social acknowledge and support their efforts.
-Discomfort in social situation
interaction is an 3. Encourage 3. Schizophrenia can cause a lack of
-Lack of participation on insufficient or
social engagement group activities. motivation. Patients should never be
excessive quantity Long term goal: forced to socialize but offering
or ineffective After a month of
4. Identify with opportunities to interact may help with
quality of social nursing
exchange. intervention, client negative symptoms they may be
patient will be symptoms he experiencing such as the inability to
able to maintain a experiences when express emotions.
good relationship he or she begins 4. Increase anxiety
between family,
to feel anxious can intensify agitation,
friends, and
peers.
around others aggressiveness, and
suspiciousness

Collaborative Collaborative
1. Refer to 1. Social skills training is conducted in
specialists for small groups by trained clinicians.
social skills Patients learn communication skills,
training. appropriate and inappropriate
behaviors in public, and how to
develop personal relationships as well
as maintain jobs and live
independently.