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CASE STUDY

Harry Hansen: Paranoid Schizophrenia

Harry Hansen is a 28 yr old African American male, admitted to the psychiatric emergency department at 0200h after experiencing acute auditory command hallucinations. Harry lives with his grandmother who called the police due to Harry’s aggressive outburst related to his command hallucinations. Harry’s grandmother raised Harry and she has been very involved in his care and treatment, however recently she reports feelings of caregiver fatigue. 

Upon arrival to the ED, Harry appears disheveled and is malodourous. His grandmother reports he has not showered or slept in days. She also reports that Harry has stopped taking his medication (Risperidal 2mg PO BID, and Trazodone 25mg PO QHS).

Following a comprehensive assessment, Harry is admitted to the adult inpatient psychiatric unit for further assessment and safety measures. You review the following admission orders:

Inpatient Medication Orders:
Nicotine patch 21mg/24 hours 1 patch daily
Lorazepam 1mg PO PRN Q4H PRN for anxiety and or agitation
Haloperidol 5mg PO Q4H PRN for agitation
Haloperidol 5mg IM Q4H PRN for agitation
Diphenhydramine 25 mg IM Q4H PRN for acute EPS
Trazodone 25 mg PO QHS PRN for insomnia
Labs: 
CBC
Urinalysis
Diagnostics:
12 lead ECG

The charge nurse asks you the complete Harry’s admission interview.

__________________________________________________

QUESTIONS :

1) What therapeutic communication techniques would be effective when interviewing Harry, given that he is currently experiencing acute paranoia and command hallucinations?

2) What safety measures would you put in place prior to your admission interview with Harry?

3) During the admission interview, Harry, becomes agitated, claiming that you are trying to read his thoughts and control his mind. He begins to yell at you. You notice his hands are clenched in fists. What de-escalation techniques may be effective in this situation?

Day 14:

Harry has been on the unit for 2 weeks. He has been agreeable to treatment including reinstatement of his oral medications as well as unit programming. Harry is beginning to display increased insight and orientation to reality. You discuss discharge plans with Harry’s physician which includes initiation of a long-acting antipsychotic. The charge nurse makes you aware of the following physician’s order:

Invega Sustenna 150 mg IM today
Invega Sustenna 100 mg IM in 1 week

Questions:

1) What are potential reasons why Harry is being prescribed a long-acting injectable antipsychotic instead of oral antipsychotic medication? 

2) Provide the medication profile for Invega Sustenna. Why is Harry receiving 150 mg initially, and then 100 mg 1 week later?

3) Provide step by step instructions for administering an IM injection. Are there any special considerations when choosing the injection site and needle size? What additional information would you need from the patient? 

Day 25:

Harry is being discharged on a community treatment order (CTO). You have been asked to provide discharge teaching to Harry and his grandmother regarding CTOs. The physician has already scheduled an appointment for Harry at his local community health unit to receive his next dose of Invega Sustenna.

Questions:

1) What information about CTOs will you include in Harry’s discharge teaching?

2) What questions would you ask Harry and his grandmother that would help you develop a discharge plan for Harry? Hint: consider things like transportation and/or benefits/coverage.

3) Is there any other information about Harry treatment plan that you would include in the teaching session?

4) Are there any supports that you would put in place for Harry’s grandmother given that she is his primary caregiver?

NOTE: Link below is reference for CTO questions (THANK YOU)

https://www.albertahealthservices.ca/assets/info/hp/mha/if-hp-mha-cto-infosheet.pdf

NOTE: If the link below is not accessible; any reference for Psychiatric Mental Health Nursing will do. ( thank you)

https://mega.nz/file/StEBnA5I#Z7GOyRi0QCbPeVSEdzWv8R7OmbzystfYEYpvOTee8iQ

NOTE: please add references used

THANK YOU

SCIENCE
HEALTH SCIENCE
NURSING
NURSING 2600

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