Running Head: Nursing of Psychosis 1

The Nursing of Psychosis

Ashley Fagert

Youngstown State Nursing

11/13/18

Abstract
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In this paper a patient with psychosis with be discussed and all the behaviors that go along with

psychosis. The stressors and behaviors that precipitate psychosis will also be discussed. The

patient's history and her family history will be discussed along with the treatment regimen

implemented to help with her recovery. The ethnic, cultural and spiritual opinions of T.M will be

discussed in relation to her current state. Lastly the patients plans for discharge and potential

nursing diagnoses will be discussed.

Key Words: Psychosis, stressors, Bipolar 2 Disorder

Objective Data
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Bligh, G. (2013) says,“ It was shocking to read that life expectancy in people with

psychosis is reduced by up to 20 years compared with the general population” (para. 7). This

statement made in a nursing article shows us how truly common psychosis is in our society in

today's times. T.M was admitted on 11/8/18 and she was a pink slip from the Emergency Room.

She is voluntarily here on her own will to get better for herself and her family. T.M would fall in

Axis I of the DSM:iV which includes anxiety disorders, mood disorders, schizophrenia and other

psychotic disorders.When the client was first admitted she could not go to group which showed

she was isolating herself from everyone and everything. She was not eating, bathing or doing any

activities of daily living when she was first admitted. She came in initially having suicidal

ideations, no homicidal ideations and they implemented a safety contract when the client was first

admitted to the unit. When she first came in she was having delusional thinking & hallucinations.

These mainly featured animals all around her especially rabid dogs whom were trying to harm her.

She also was having command hallucinations which were telling her to harm her daughter. On day

of care she stated that she has no suicidal ideations or homicidal ideations. The voices & animals

had also gone away on day of care. She only stated that she was paranoid & had racing thoughts

at times. T.M medical conditions include; Hallucinations, CAD,angina at rest, degenerative disk

disorder, obsessive compulsive disorder, PTSD, chronic back pain, sore throat, acute psychosis,

Bipolar 2 Disorder. The treatment regimen that was being implemented for T.M includes the

following; “She will have lifelong treatment even when her symptoms have subsided. Her

treatment will be: medications, psychosocial therapy and hospitalization as needed.“ The safety

and security measures that were maintained were those such as listed in her care plan. They used

elopement risk routine, use of low risk hazard items, psychiatric precautions, VTE risk assessment

medical routine and many other precautions to ensure patient safety. T.M was on various
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medications for all of her various conditions. She is on Divalproex (DEPAKOTE) P.O. 500 mg

B.I.D, which is used for her Bipolar 2 Disorder. She takes Fluoxetine HCL ( PROZAC) 40 mg P.O

Daily, which is mainly used for her Obsessive Compulsive Disorder. She has an order for

Haloperidol (HALDOL) 5 mg P.O or I.M Q6hrs PRN for agitation which is a basic medication

ordered for most psychiatric patients. T.M is ordered Hydroxyzine injection 50 mg I.M or P.O

Q6hrs PRN given for anxiety. There is also an order for Isosorbide Mononitrate (IMDUR) 30 mg

P.O Daily which is given for her angina and CAD. She has Metoprolol Tartrate (LOPRESSOR)

12.5 mg P.O daily which will help with PTSD and anxiety. There is an order for Olanzapine

(ZYPREXA) 5 mg P.O QHS, which is given for her Bipolar 2 disorder and the psychosis she has

been more recently experiencing. She lastly has an order for Trazodone 100 mg P.O QHS PRN

which is given for her insomnia which is a very strong sedative which will help her to get some

sleep when her psychiatric disorders are not allowing for her to sleep.

What is Psychosis?

According to Merriam Webster’s Dictionary (2018), “a serious mental illness (such

as schizophrenia) characterized by defective or lost contact with reality often with hallucinations

or delusions” (pg. 1). The diagnosis of psychosis is often given to a patient when it’s the first

episode of psychosis or they do not believe the patient is schizophrenic completely. T.M was

hearing voices and seeing animals which gave her this diagnosis. The expected commons

behaviors are mainly hallucinations and delusions. Expected behaviors which I observed were the

fact that when she came in she was hearing voices and seeing animals which since her admit and

adjustment of medications have ceased.

Stressors & behaviors that precipitated event

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T.M had various stressors and related behaviors that caused her to be hospitalized on the

psychiatric unit. The biggest stressors in her life were those in her household which was mainly

trouble caring for herself and her daughter. T.M had a very stressful fast with a father whom was

very abusive and an alcoholic. T.M’s mother was not present during her childhood and this caused

the trauma by her father to be increased with no one to protect her. She stated multiple times that

she came in because she was worried that she was going to start causing harm to her daughter with

her mental breakdown which caused her psychosis. She seemed like she had so much on her plate

that she just could not handle everything anymore. She had suicidal ideations which caused her to

be pink slipped from the emergency room up to the psychiatric. Various things were factors that

influenced the patients current state of psychosis.

Patient & Family History

T.M had a very traumatic childhood which may have been one of the main causes of such

a large list of medical diagnoses. T.M has a history of acute psychosis, Bipolar 2 Disorder, PTSD,

OCD, and Hallucinations. Wade (2015) made the following statement in their nursing article,

“Intrusive memories of trauma are important symptoms of PTSD. Research has not established

which aspects of intensive care are most traumatizing; invasive medical procedures, fear of dying

from life-threatening illness or injury, or effects of psychoactive drugs, including hallucinations

and delusions” (para. 1). T.M had PTSD from her cesarean delivery that did not go as planned

which may be part of her past trauma that caused her current diagnosis. T.M has no family history

of psychiatric illness per patient, but her father had a history of alcoholism. T.M has had a lot occur

in her life which could have partially caused her psychiatric illness’.

Psychiatric evidence based nursing care provided and milieu activities attended
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T.M at first did not attend groups and wanted to stay in her room in bed. She has Bipolar 2

Disorder which is a disease that is mainly associated with depression and some anxiety. After T.M

was put back on her medications which she had abruptly stopped due to no supply and no money.

T.M since coming to the hospital has started going to all her groups and she is beginning to start

getting back to being herself. She feels very safe and comfortable in the milieu environment that

is provided on the mental health unit. T.M when first on the unit did not perform any activities of

daily living. T.M currently allow the nurses to help her bathe and changes her clothing as needed.

T.M is starting to get better mentally and eventually will get back to her daughter.

Ethnic, spiritual and cultural influences that impact the patient

The patient has no ethical or cultural background which have impacted her. T.M has no

religious background and she grew up in a house with an atheist father. People with no religious

background have been proven to be more likely to not recover easily from a psychiatric illness.

T.M also has a very small support system to no support system which have also impacted her.

Evaluation of Patient Outcomes Related to Care

The main outcomes for this patient include getting her mentally stable and able to care for

herself and her daughter. T.M eventually needs help being taught how to be able to care for her

daughter and get financial help from the government which will help her care for her daughter

even when she is without a job. Helping T.M to establish a daily schedule and a routine for her life

would help her to have a schedule where she takes her medications at a specific time, gets her

daughter ready for school at a specific time and cares for herself. Teaching T.M about her

medications & setting up a routine for her to have someone make sure she is compliant with her

medications may help her get back to a stable life where she is mentally able to care for her
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daughter and herself adequately. Overall our patient outcomes are goals are to help T.M to be able

to perform her activities of daily living.

Plans for Discharge

Abdin,E. et al. (2017).,“Schizophrenia is one of the leading causes of long-term disability”

(para. 5). Plans for discharge include many things that will help T.M to live a normal life and keep

her from being re-hospitalized. Plans for discharge include getting her on some type of Medicaid

and helping her to receive things such as WIC and food stamps. She is not at the point get with her

psychosis that there has been multiple episodes where they call it a diagnosis of schizophrenia so

right now these are the best options before the social workers begin to help her to attempt to get

on disability for her chronic mental health illness. T.M will follow up with her psychologist to

make sure she is following some type of routine and taking her medications as prescribed. One of

the biggest things is they want to help alleviate her anxiety with the help of medications. The plans

for discharge will hopefully help T.M to stay out of the hospital and to care for herself and her

daughter the best that she can.

Prioritized list of all actual diagnoses using individualized NANDA format

1. Altered Thought processes

2. Altered sensory perception

List of Potential Nursing Diagnosis

1. Risk For Violence: Self-Directed or Other Directed

2. Risk For Injury

3. Total Self-Care Deficit

4. Impaired Social Interaction

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5. Ineffective Individual Coping

6. Interrupted Family Processes

Conclusion

In this case study I talked about many things that brought T.M to the mental health unit at

the hospital. First I spoke about the objective data which gave the background on the case. Second

I went over the definition of psychosis and the behaviors associated with psychosis. Then I went

over the stressors that precipitated the major psychiatric break that brought T.M into the hospital.

The patient also had a very large history of her own psychiatric illness, but not family history of

psychiatric illness. Then wide team of health care providers put together T.M’s evidence based

nursing care & milieu activities to help her heal. There were no ethic or spiritual influences for

T.M and very little cultural influence since she claimed she had none of the three. We lastly went

over the plans for discharge and the nursing diagnoses associated with her diagnosis.

Sources Cited

Abdin, E., Chong, S. A., Vaingankar, J. A., Peh, C. X., Poon, L. Y., Rao, S., … Subramaniam,

M.

(2017). Trajectories of positive, negative and general psychopathology symptoms in first

episode psychosis and their relationship with functioning over a 2-year follow-up period.

PLoS ONE, 12(11), 1–16. https://doi.org/10.1371/journal.pone.0187141

Bligh, G. (2014). Psychosis... This practice profile is based on NS703 Mairs HJ, Bradshaw T
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(2013) Promoting mental and physical health in adults with psychosis. Nursing Standard.

27, 47, 50-56. Nursing Standard, 28(33), 61. Retrieved from

https://eps.cc.ysu.edu:8443/login?url=https://search.ebscohost.com/login.aspx?direct=tru

e&AuthType=ip,uid&db=a9h&AN=95617731&site=ehost-live&scope=site

Wade, D. M., Brewin, C. R., Howell, D. C. J., White, E., Mythen, M. G., & Weinman, J. A.

(2015). Intrusive memories of hallucinations and delusions in traumatized intensive care

patients: An interview study. British Journal of Health Psychology, 20(3), 613–631.

https://doi.org/10.1111/bjhp.12109

Case Study Comment Sheet 4842

Student Name_____________________________________
Pt Identifier______________
Date(s) of Care_____________

__________ Objective Data presentation the patient, treatments, medications

_ _________ Discuss patient / family history of mental illness

___________ Identify stressors and behaviors that precipitated current hospitalization

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___________ Summarize the psychiatric nursing interventions with

rationales

___________ Evaluate patient outcomes for nursing care provided

___________ Analyze ethnic, spiritual and cultural influences that impact care of the
patient

__________ Summarize discharge plans and community care

__________ Actual nursing diagnoses, prioritized, using R/T and a.e.b.

___________ List of potential nursing diagnoses

___________ Conclusion paragraph

____________ Style, spelling, grammar, clarity, organization, APA format