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Case Study Methodology: Problem Classification for Adult with Schizophrenia. Elaine H Darst, PhD, RN Nicole Gapp , BSN, RN Karen Monsen, ,PhD, RN, FAAN. Case Study Complex Factors and Interactions. Mental Health. Problem: schizophrenia Knowledge - 2

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case study methodology problem classification for adult with schizophrenia

Case Study Methodology:Problem Classification for Adultwith Schizophrenia

Elaine H Darst, PhD, RN

Nicole Gapp, BSN, RN

Karen Monsen, ,PhD, RN, FAAN

mental health
Mental Health
  • Problem: schizophrenia
  • Knowledge - 2
    • does not identify self as having a mental illness, but is discussing schizophrenia with a support person
  • Behavior - 4
    • takes medications as prescribed because “I have to take them to live here” (supervised setting)
  • Status - 2
    • Paranoia ongoing
    • Psychotic symptoms at a stable level
    • Executive functioning (initiative, planning) impaired
cognition
Cognition
  • K – 2 Needs external reminders/management regarding personal and room hygiene
  • B – 3 Reminders by support system (HHA) to shower/change clothes
  • S – 3 Cognitive deficits in executive functioning (memory, initiative; follow-through, but normal intelligence)
income
Income
  • K – 3, B – 2, S - 5
  • K – 3 (Basic), client requires use of payee
  • B – 2 Behavior is rarely appropriate regarding overall financial management, but he tries to use his allowance carefully
  • S – 5 In contrast, status is rated 5. No issues are present, so the structure is working.
abuse
Abuse
  • K – 2, B – 3, S - 5
  • Minimal knowledge about self & other protection
  • Basic ability for self-protection
  • Status - no problems at this time. Has been assaultive in past when paranoid
interpersonal relationship
Interpersonal Relationship
  • K – 3, B – 3, S – 4
  • K - basic knowledge about relationship maintenance
  • B - sometimes inappropriate suspiciousness and interpersonal withdrawal
  • S - minimal symptoms – the environment provides daily social opportunities and support, as well as help with interpersonal conflict
environmental support provides
Environmental Support provides
  • Mental Health management – medication compliance
  • Stability in Interpersonal Support & contact with others
  • Structure to support executive functioning
  • Protection from abuse due to accessible support
  • Prevention of aggression through mental health management
case conclusion
Case Conclusion
  • This patient
    • Takes medications as prescribed although not able to recognize illness
    • Keeps appointments although not able to plan and execute plans
    • Works on managing self-care
  • Conclusion:
  • The environment/setting provides supports that accommodates deficits, so the client is functional.
complex data is distilled for decision making
Complex Data is Distilled for Decision Making
  • The Omaha system was used to distill complex information into meaningful problem categories and KBS ratings.
  • Contrasting KBS ratings clarified the contribution of the environment to the client’s abilities.
  • Significant decisions, such as the optimal living situation or discharge planning from acute care, can be more effectively implemented.
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