Common Mental Health Scenarios (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:01 Well, for right now, let's consider a patient who has schizophrenia.

    00:05 Mr. Zeno is a 45-year-old man. His pronouns are he/him.

    00:11 He has been admitted for exacerbation of symptoms of chronic schizophrenia secondary to medication noncompliance.

    00:21 Mr. Zeno reports seeing animals in the room and hearing God telling him just to behave.

    00:33 He is unable to identify himself, his residence, the year, or date, the name of the President of the United States, or where he is in the present moment.

    00:48 As we're talking to him, we noticed his speech is, at times, nonsensical, including neologisms or words that he's making up, and word salad or words that have just been tossed together and don't make any sense.

    01:07 So, as we're thinking about risk for injury with the client who might be diagnosed with schizophrenia, for example, we're going to say it's risk for injury related to impaired thought process.

    01:24 Our subjective data is that the client is unable to explain where he is or how he arrived at the hospital and is stating that he is very confused in his head.

    01:38 And if the patient says it, we put it in quotations so that it is known that it is subjective, and it is something that the patient themselves have said.

    01:49 Our objective data is client admitted with a diagnosis of schizophrenia.

    01:56 The client is alert but not oriented to time, place, or person.

    02:02 The nursing outcomes will be that the client will remain free from injury during hospitalization.

    02:11 Let's try another patient, okay? We'll apply nursing diagnosis to a client who has Alzheimer's disease.

    02:23 Mrs. Martin, an 82-year-old woman, her pronouns are she/her, is admitted for acceleration of the signs and symptoms of Alzheimer's disease.

    02:35 She has severe memory deficits, is unable to problem solve, has inappropriate social behaviors, and now emergence of paranoid ritualistic behaviors recently.

    02:49 So, what might our nursing diagnosis be? Well, disturbed thought process might be one of the nursing diagnoses that we might choose.

    03:00 And when we look at the subjective data, we're able to say she's unable to follow simple directions, she misinterprets behaviors and statements of others, and she states that she, "Has to spit on others to keep them and the devil away".

    03:19 What is our objective data? We can say client admitted with a diagnosis of Alzheimer's disease.

    03:29 She is alert, but highly distractible, intermittently oriented, dressed in a dirty nightgown and high heels.

    03:38 What are our nursing outcomes? Our nursing outcomes might include the patient will be supported to appropriately interact and cooperate with staff and peers during the hospital stay and within the hospital setting.

    03:58 Let's try another one. Let's think about the patient who is admitted with a diagnosis of major depressive disorder.

    04:09 Pat Phil is a 17-year-old transgendered person.

    04:14 They/them are Pat's pronouns. Pat has been admitted for major depressive disorder.

    04:24 Pat has attempted suicide twice in the past six months.

    04:30 Pat arrives in the unit in old, ripped clothing and matted dirty hair.

    04:37 Pat is very slow to respond to any questions and refusing all eye contact.

    04:43 So, what might our nursing diagnosis be? Now, it's important to remember there are multiple nursing diagnosis that might be coming up in your mind, most or maybe all of them if they are specifically related to Pat, will be appropriate.

    05:02 But let's focus on self-care deficit for Pat. What was our subjective data? Well, there was a demonstration of poverty of speech.

    05:15 In other words, Pat didn't want to talk to us. Couldn't seem to find the words.

    05:21 Pat refused eye contact with anyone and was frequently brushing aside tears, stating, "Why waste your time on me? Let me just rot away". What's our objective data for Pat? Well, Pat was admitted with a diagnosis of major depressive disorder.

    05:44 Pat is oriented times three, has poor personal hygiene, appears in dirty and torn clothing, black dirty feet with some cuts that are red and blistering.

    06:00 What would our nursing outcomes be? Our desired nursing outcomes for Pat.

    06:07 Client will remain free from injury during hospitalization and be able to take care of self.

    About the Lecture

    The lecture Common Mental Health Scenarios (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Psychiatric Assessment (Nursing).

    Included Quiz Questions

    1. The client was diagnosed with schizophrenia in 2006.
    2. The client is oriented to person and place but not time.
    3. The client appears upset, agitated, and frustrated.
    4. The client states, “All you do is ask me where I am instead of helping me.”
    5. The client’s mother reports that the client is, “always crying.”
    1. Risk for injury
    2. Risk for self-care deficit
    3. Risk for harm to others
    4. Risk for nutritional deficit
    1. "The client brushes their hair in the morning without prompting."
    2. "The client retrieves their meal tray and eats 100% of the food provided."
    3. "The client refuses to shower."
    4. "The client stays in their pajamas all day."
    5. "The client requires frequent reminders and encouragement to brush their teeth."

    Author of lecture Common Mental Health Scenarios (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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