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Case Study Methodology: Problem Classification for Adult with Schizophrenia

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

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  1. Case Study Methodology:Problem Classification for Adultwith Schizophrenia Elaine H Darst, PhD, RN Nicole Gapp, BSN, RN Karen Monsen, ,PhD, RN, FAAN

  2. Case StudyComplex Factors and Interactions

  3. 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

  4. 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)

  5. 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.

  6. 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

  7. 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

  8. 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

  9. 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.

  10. 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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