Video Case Study - Caring for Patients With Schizophrenia

Nurse George works on an inpatient psychiatric unit and is caring for Kit, a 31-year-old with a history of schizophrenia, paranoid type, who was recently admitted for psychotic symptoms. In collaboration with the registered nurse, RN Juanita, Nurse George goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Kit’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse George recognizes important cues, including Kit’s vital signs, which are temperature of 37 C, or 98.6 F, heart rate 98 beats per minute, respirations 20 breaths per minute, and blood pressure 136/82 mmHg. Nurse George notices that Kit appears disheveled, restless, and is looking back and forth suspiciously across the room.

Nurse George: Hi Kit, how are you doing today?

Kit: There’s a man coming after me, I’ve seen him watching me from inside the closet.

Nurse George turns to look inside the closet, which is empty.

Nurse George: That sounds scary. Although I don’t see anyone else here with us, I’m here to support you and keep you safe.

Next, Nurse George analyzes these cues. They review the electronic health record, or EHR, and note that Kit has visited the emergency department three times in the past month for symptoms associated with her schizophrenia.

Nurse George knows the development of schizophrenia is related to both genetic and environmental factors that disturb the brain’s structure and balance of neurotransmitters, like dopamine and glutamate.

This leads to disabling alterations in behavior, emotions, thinking, and perception, like delusions and hallucinations. Nurse George realizes that Kit needs management of her acute episode of schizophrenia.

Now, using the information they’ve gathered, along with Kit’s medical history, Nurse George reports their findings to RN Juanita, and together they choose a priority hypothesis of altered perception.

Then, Nurse George collaborates with RN Juanita to generate solutions to address Kit’s altered perception that will include pharmacologic and nonpharmacologic interventions; and they establish the expected outcome that after intervening, Kit will report feeling safe in her environment by the end of the shift.

Nurse George then takes action to implement these solutions. RN Juanita reports their assessment findings to the health care provider who orders olanzapine by intramuscular, or IM, injection.

As Nurse George prepares the olanzapine, they ask RN Juanita to stand out of sight near Kit’s door in case she becomes agitated or violent.

Nurse George then gathers the supplies and re-enters the room.

Nurse George: Hi Kit, I’m back and I have some medicine your health care provider ordered that’ll help you feel safe and more comfortable.