Nursing Case 3: Carrie a 13-year-old Hispanic Female

Examine Case 3: You will be asked to make three decisions concerning the diagnosis and treatment for this client. Be sure to consider co-morbid physical as well as mental factors that might impact the client’s diagnosis and treatment.

At each Decision Point, stop to complete the following:

Decision #1: Differential Diagnosis

Which Decision did you select?

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources. Nursing Case 3: Carrie a 13-year-old Hispanic Female

Explain any difference between what you expected to achieve with Decision #1 and the results of the Decision. Why were they different?

Decision #2: Treatment Plan for Psychotherapy

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #2 and the results of the Decision. Why were they different?

Decision #3: Treatment Plan for Psychopharmacology

Why did you select this Decision? Support your response with evidence and references to the Learning Resources.

What were you hoping to achieve by making this Decision? Support your response with evidence and references to the Learning Resources.

Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different? Nursing Case 3: Carrie a 13-year-old Hispanic Female

Also include how ethical considerations might impact your treatment plan and communication with clients and their families.

Note: Support your rationale with a minimum of five academic resources.

Case 3: Carrie a 13-Year-Old Hispanic Female with Schizophrenia

Schizophrenia is a mental health disorder that impairs the way an individual behaves and interprets reality. A person with schizophrenia interprets reality based on delusions, and hallucination, which they tend to believe is the reality; in some cases, the individual develops disordered behavior and normal functioning.However, it is crucial that diagnosis is carried out to determine and be clear that a person is suffering from schizophrenia and not any other mental disorder that presents similar symptoms prior to preceding to the treatment process. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) criteria, a patient must present at least two of the symptoms that align with schizophrenia that is hallucinations and delusions (Mayo Clinic, 2020). This paper seeks to explore the different decision points that will be involved in the treatment of schizophrenia. Nursing Case 3: Carrie a 13-year-old Hispanic Female

Decision Point One

The case demonstrates the early onset of schizophrenia and this aligns with the symptoms that the patient presents, which are different from other mental disorders that have similar symptoms; that is schizoaffective disorder, which is characterized with recurring episodes of mood that can either be manic or depressive or both; psychotic and affective symptoms, and schizotypal personality disorder, which is characterized by paranoid ideation, thought disorder, and severe social anxiety (Basu, 2013). The objective data demonstrates that there are some signs and symptoms of the early onset of schizophrenia, which include talking with imaginary beings, believing the television has special programs for her and affective constriction. However, the patient maintains a positive attitude and is completely aware of her surrounding, including the fact that she is concerned and cares about her mother, demonstrated by the caution she takes when discussing about the things that she talks too, as her mother asks her not to talk about them. The decision point therefore, reached is that the patient should be presented after two weeks for follow up and observation of any changes that might have taken place. This period will permit for effective diagnosis of the condition and thereby plan for the next plan of action. Nursing Case 3: Carrie a 13-year-old Hispanic Female

Decision Point Two

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Based on the observed situation in the first decision point, it is only appropriate that further measures are taken. The first is referring Carrie for psychological testing, which will involve a mental health profession carrying out tests to determine the mental status. The test involves observing the demeanor and appearance of the patient and asking about their thoughts, hallucinations, delusions, moods and thoughts of suicide or violence. The next course of action is psychotherapy using a psychodymanic approach, whereby since the patient is not free to speak in the presence of her mother, the healthcare provider will recommend an individual therapy, which is very crucial as it assists in normalizing the thought patterns of a patient (Stijažiü, et al., 2017). The mother appears to be limiting the expression process of the patient and it is also possible that she has contributed towards the isolative and affective constriction of the patient. This is by reprimanding her to not speak of the things she talks to and even her imaginary friends, yet this can pave way in identifying the reason even at her age, she continues to interact with her imaginary friends and talks to objects such as the television. The psychotherapy a will also involve social skills training, which aligns with the fact that the patient’s affective is constricted (Granholm & Harvey, 2018). The positive side of utilizing this approach is the fact that the patient believes that she has the ability of making friends, interacting and socializing with her mates, if only she makes up her mind to do so. The social skills training will help the healthcare professional understand the thought process of the patient including the factors that make her be isolative and unwilling to make friends with her mates. The follow-up is done after four weeks and the patient appears to be engaged with her therapist, and reports that she “looks forward” to seeing her therapist, but her parents are not reporting any appreciable change in psychotic symptoms.  The report by Carrie patients demonstrates that there is need for further course of action to address the reported psychotic symptoms. Nursing Case 3: Carrie a 13-year-old Hispanic Female

Decision Point Three

Based on the results of the second decision point, it is clear that more needs to be done for the patient. First is increasing the frequency of the psychotherapy visits using the psychodynamic approach as it will pave way in identifying or rather observing the psychotic symptoms that the parents reports and it will also make it easy to track down the thought and mental process of the patient. It is also crucial to start the psychopharmacology; however, this will begin by first convincing the parents that it is very important that Carrie be placed on medication owing to the continued presentation of the psychotic symptoms. The first medication is Haloperidol 0.5 mg orally daily; this is a second-line antipsychotic medication that should be administered for a period of two to four weeks to start observing any reactions or changes (Medscape, 2018). Since the psychotherapy sessions are maintained even with the administration of the drug, it will be easier to observe the changes that the patient is making, including any side effects in line with the use of the drug. The other medication that will be prescribed to the patient is Lurasidone 40 mg orally daily, which is a second-generation anti-psychotic drug, meaning that it is preferred in the treatment of schizophrenia as it has minimal side effects and risks compared to the drugs listed under first generation anti-psychotics (Meltzer, et al., 2011). Like Haloperidol, it will take two to four weeks to observe when changes aligned with the use of Lurasidone. Following observation of positive changes, such as a decrease in the psychotic symptoms, the frequency of the psychotherapy using psychodynamic approaches sessions will decrease and be maintained to a minimal of two per week. Nursing Case 3: Carrie a 13-year-old Hispanic Female

Ethical consideration must be taken into account during the treatment process of Carrie; this begins with the application of cultural competency of treating a Hispanic patient. The consent of the patient and that of the parents since she is still a minor must be taken into consideration, especially owing to the fact that Carrie’s mother is already setting boundaries concerning what she should talk about and what she should not. The other ethical consideration that must be taken into account is with the administration of medication as the parents were not ready to place her under any, yet they report an increase of the psychotic symptoms.

References

Basu, S. (2013). Differential Diagnosis of Schizophrenia & Co-Morbid Psychiatric Conditions in Schizophrenia and their Management. The Singapore Family Physician, 39(1), 15-18.

Granholm, E., & Harvey, P. D. (2018). Social skills training for negative symptoms of schizophrenia. Schizophrenia bulletin, 44(3), 472-474.

Mayo Clinic, (2020). Schizophrenia. Retrieved from <https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449>.

Medscape, (2018). Haloperidol (Rx). Medscape Drugs & Diseases https://reference.medscape.com/drug/haldol-decanoate-haloperidol-342974.

Meltzer, H. Y., Cucchiaro, J., Silva, R., Ogasa, M., Phillips, D., Xu, J., … &Loebel, A. (2011). Lurasidone in the treatment of schizophrenia: a randomized, double-blind, placebo-and olanzapine-controlled study. American Journal of Psychiatry, 168(9), 957-967.

Stijažiü, D., Jendrižko, T., &Biožina, S. M. (2017). Guidelines for individual and group psychodynamic psychotherapy for the treatment of persons diagnosed with psychosis and/or schizophrenia. PsychiatriaDanubina, 29(3), 432-440. Nursing Case 3: Carrie a 13-year-old Hispanic Female