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Read through case study and answer question from 1 to 11.
ABC is a 32 years old male, black/white American, (white American father, black American mother), diagnosed with paranoid personality disorder.
Setting: Outpatient mental health center clinic
Pharmacology: – Captopril in combination with
hydrochlorthiazide(Capozide), lorazepam(Ativan), Olanzapine (Zyprexa)
PSYCHOSOCIAL
– Paranoia limits and distorts interactions with others
ALTERNATIVE THERAPY: Over-the-counter vitamins, minerals
and enzymes
COEXISTING CONDITION: hypertension
Overview: Requires critical thinking and decision making in regard to who is going to be most effective in interacting with the client when the client’s paranoia worsens. The nurse is required to
work collaboratively with other team members and to provide supervision for the client’s non-nurse case manager who works with the client in his independent living situation. The nurse is required to work with physical problems as well as mental health problems and to look at possible connections between psychological and medical problems and the medications used to treat them.
client profile: ABC is a 32-year-old single male. ABC lives alone in a
government-subsidize apartment and receives social security disability income (SSDD). He says he stays away from his neighbors, as they are not to be trusted and could turn against him
for no reason at all if he were to let them into his apartment.
ABC holds grudges against his mother and has not attempted to contact her for a couple of years. He talks about his mother trying to control his mind and his life and working against him to get him into treatment when he did not want or need it. He carries a grudge over his mother not giving him a birthday party ten years ago when his brother got a party: “Not that I wanted one, but it just was no
fair of my mom to do that.” ABC is also angry at his mother for giving him a White American father so Black American peers did not accept him and for her being Black American and causing him not to be accepted by White American peers when he was growing up. He was married briefly to Yvonne, a Black American woman he met in group therapy. He was extremely jealous of Yvonne talking to other people and thought she was unfaithful when he heard her talking to a “Bobby” on the phone. Bobbie was a girl his wife had met when she was an inpatient in the psychiatric hospital. This prompted him to follow his wife everywhere she went and to try to
keep her home whenever he could to prevent her from meeting this “other man.” ABC was verbally hostile to his wife at times, thinking she was criticizing him when in fact she was complimenting him. ABC was jealous every time Yvonne went for psychiatric treatment. He thought she was “hogging all the therapy” (i.e., getting
more than her share of psychiatric care)
ABC gets psychiatric care through the county outpatient mental health center clinic. He has a non-nurse case manager who takes vital signs, supervises him in taking his daily medication, helps him with managing his money, and transports him to appointments at the clinic where he sees a psychiatric mental health nurse
for all his medication reviews and health assessments. He sees the psychiatrist only if the nurse refers him, and this usually happens only if he is experiencing a significant change in his mental health, has medical problems or problems with his medications, or needs to have additional medication prescribed. ABC currently
has prescriptions for two medications: a pill for hypertension (captopril [Capozid 25/15]) and a multivitamin. His medicine cabinet is full of various kinds of vitamins, minerals. and
enzymes.
case study: ABC reports in at the reception desk at the mental health center clinic. The nurse is walking out to call him into her office about the same time he notices two women talking across the waiting room. He calls out a derogatory name and tells them to
stop talking about him. When he sees the nurse, he puts his hands on his hips in a threatening kind of stance and says: “You think you are so smart, but I know what you put in those pills. Don’t think you fooled me. And don’t put that in my chart.”
The nurse feels a great deal of energy coming from ABC and feeling threatened; she senses she needs to back away from him. The nurse says gently: “Please sit down and rest for just a few minutes. I’Il have your caseworker sit with you, and in a little
while when you are ready to talk she can come and get me.”
The nurse alerts the psychiatrist that she is going to try to talk with ABC about hi medication, but that if Stan is too paranoid, she may need the psychiatrist to discuss his medications with him. The nurse knows from working with ABC for a while and reading his chart that he has a diagnosis of Paranoid Personality Disorder. When the psychiatrist sees ABC he notes that ABC’s blood pressure is still elevated and that he is paranoid and somewhat psychotic. The psychiatrist continues the Capozide and vitamin and orders lorazepam (Ativan) and olanzapine( Zyprexa).
Please answer 1-11 questions:

1. How would you feel and what would you think if you were assigned to work with ABC or any patient has Paranoid Personality Disorder?
2. If you were the nurse and ABC said to you: “You think you are
smart.” and you felt threatened, what would you think is going on with ABC?
3. What concept or rationale did the nurse possibly have in mind when she alerted the psychiatrist that she might need to have him go over ABC’s medication?
4. What behaviors does ABC have that match those of someone with Paranoid Personality Disorder?
5. Is Paranoid Personality Disorder apparent in childhood and adolescence, and if so, what behaviors would clue the family and/or clinicians that a child has this disorder?
6. Some of the behaviors that qualify a person for diagnosis of Paranoid Personality Disorder seem similar to other personality disorders. How can a person differentiate between PPD and other personality disorders,
especially Schizotypal Personality Disorder (SZPD)?
7. How does Paranoid Personality differ from Schizophrenia, Paranoid Type?
8. What is the current treatment for Paranoid Personality Disorder?
9. What does the nurse need to know about the antihypertensive, anxiety, and antipsychotic medications the client is on? Is there any connection between the clients race and taking one or more of these medications? What do these three medications have in common.
10. What assessment would you want/need to do if you were the nurse in this case? Given the information you have on this client, what nursing diagnoses would you write:
11. What goals would you write for this client? What interventions would be helpful?

 

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GNRS 584

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