PSYCHOSIS NOS

DIANE NICHOLS N360 CAPSTONE CHAT AUGUSTIN

23 Year Old Male Legal Status: MH-4, 1/24/12 1453 Expiration Date: 1/27/14 1200 DSM Diagnosis: Psychosis NOS Axis I Psychosis NOS, Substance Abuse (marijuana) Axis II None Axis III Tongue laceration, Positive TB, Appendectomy age 4 Axis IV Parents getting divorced, living with father and 2 older brothers after leaving military service, unemployed, no income Axis V GAF 50-41 (unable to locate in EMR) per observation and interview

Examples 1. Postpartum Psychosis 2. Psychotic symptoms that have lasted <1 month but have not yet remitted, so criteria for Brief Psychotic Disorder are not met 3. Persistent auditory hallucinations in the absence of any other features 4. Persistent nonbizarre delusions with periods of overlapping mood episodes that have been present for a substantial portion of the delusional disturbance 5. Situations in which clinician concludes that a Psychotic Disorder is present but is unable to determine whether it is primary, due to a medical condition or substance induced

Psychotic Disorder Not Otherwise Specified

Patient called EMS then, just before they arrived, cut a 3X5 cm piece of his tongue off and Patient believes that he did threw the piece onto the roof. what he had to do to unite He was taken to Castle then humanity and because he was transferred to Queens for care. taking it for granted by lying and getting into trouble. His After 3 days of treatment he Christian beliefs led him to was admitted under an MH-4 to what he did. He also realized Kekela.
that dogs had been implanted with cameras in order to watch him. Despite this he does not believe there is anything wrong with him.

Patients Strengths: Per pt mentally ready to move on Per staff intelligent/educated Per observation willingness to cooperate

Patients Limitations: Per pt Im in here Per staff refusal to discuss illness Per observation pts denial of any problems

MEDICATION ORDER
Clindamycin, 300mg PO Q6H

CLASS
Antibiotic

TARGET SX
Prevent infection Constipation

24H TOTAL
1200 mg

SIDE EFFECTS
None per pt

DOSE RANGE
600 1800mg

Sennosides/docusate Stimulant laxative sodium, 8.6/50mg 2 tabs PO BID

34.4/200mg None per pt

8.6/50 34.4/200mg

Haloperidol, 5mg IM PRN 5mg PO PRN

Lorazepam, 2mg IM PRN 1mg PO PRN

Antipsychotic Agitation

NTE 20 mg Pt not currently taking

NTE 6 mg Pt not currently taking

PO 3, up to 100mg, IM 25mg/hr PRN

PO 2 10mg, IM 2 6mg

Antianxiety Anxiolytic

Agitation Anxiety

Prioritized Patient Needs

1. P: Noncompliance E: Patient continually denies any problems, believes he dealt with it already. Refuses to take medications. S: During therapeutic communication discussed why self-harm did not solve all his problems and refusal to face problems will not make them go away. 2. P: Safety E: Patient admitted due to self-mutilation (voluntarily cut off tip of his tongue) and SI. S: Therapeutic communication to discuss plans to prevent further self-harm (i.e.; letting someone know what hes feeling before doing something)

3. P: Coping E: Patient believes that he is to blame for his parents divorce and had some suicidal ideation in a letter to his father. S: Patient denies any SI at time of interview but still believes his family doesnt understand. Through therapeutic communication pt came to realize that if he doesnt talk to them it will be very difficult for them to do so.
4. P: Marijuana abuse E: Patient states I use it more since I came back to live in Hawaii but denies it is a problem. S: Discussed coping mechanisms to replace the need to use marijuana to relax.

Priority # 1 CARE PLAN Nursing Diagnosis: P: Noncompliance E: Pt denies any problems, refuses medications S: Therapeutic communication to discuss accepting diagnosis and how to deal with it. LT goal: Patient remains compliant with treatment during hospitalization. ST goal: Patient will accept illness and treatment.

Intervention & Frequency

Assess patients perceptions of diagnosis. Once per shift. Develop a therapeutic relationship with the client. Ongoing.

Scientific Rationale

Evaluation

Patients perceptions of threat of disease and Patient continues to deny any problems and states that he benefits of treatment affect compliance. dealt with it already (Gulanick & Meyers, p. 140, 2011) Compliance increases with a trusting relationship. (Gulanick & Meyers, p. 141, 2011) After second day of therapeutic communication patient began to open up and talk more about why he believes he is in the hospital and his plans for discharge.

Provide specific information and instructions. Ongoing, as needed and as patient becomes more receptive.

Information allows the patient to take control of changing his own behavior. (Gulanick & Meyers, p. 141, 2011)

After second day of therapeutic communication patient was asking questions about the goals of hospitalization.

Explore community resources. Before pt discharge.

Outreach workers in the community serve as a bridge to health care provider. (Gulanick & Meyers, p. 142, 2011)

Social work is scheduled to discuss this with patient the day of discharge.