A 20-year-old college student who lives in

A 20-year-old college student who lives in a college dormitory on campus is transported to the emergency department (ED) for psychiatric evaluation. He has always been quiet, somewhat withdrawn, and had very few friends, but his roommate noticed that he has become more and more isolated and withdrawn in the past few months. He rarely attends any of his classes, but rather stays in his dormitory room most of the time, searching the Internet or playing video games. Last night, when the client’s roommate came back to their room late at night, the client was pretending to be asleep in the top bunk bed. When his roommate got into bed, the client jumped down from the top bunk holding a knife and threatened to kill him for stealing his things and turning people against him. The roommate managed to get out of the room unharmed and called the police. The client told the police that the FBI was after him and wanted to kill him. He also states that he had gone outside to smoke a cigarette earlier that evening and had heard someone telling him that his roommate had stolen his cell phone and was texting all of his contacts, turning them against him and that he needed to stop him. The police questioned the roommate, who said he did not take the client’s cell phone, and has not contacted any of the client’s family or friends. The roommate said he didn’t think he even had any friends anymore. When the police searched the client’s dormitory room, they found the client’s cell phone in his backpack. The police contacted emergency medical services (EMS) and the client was transported to the emergency department (ED). On arrival to the ED, the nurse receives the report about the events that led to the ED transport. 1-Identify the data that requires immediate follow-up by the nurse. 2-What symptoms of schizophrenia does the client exhibit? 3-What are the priorities identified at this time 4- Following a psychiatric evaluation and mental health exam, the psychiatrist prescribes a computed tomography (CT) and a magnetic resonance imaging (MRI) of the brain to rule out other disorders that can cause psychoses, such as enlarge ventricles. Both tests were negative. A ventricular-brain ratio (VBR) showed elevated VBR, and the brain scan revealed functional cerebral asymmetries in a reverse pattern, both of which are characteristic of schizophrenia. The psychiatrist diagnoses paranoid schizophrenia. The client’s parents visit the client and the client, parents, psychiatrist, and interprofessional team meet to decide on a plan of care. It was decided that the client would receive an antipsychotic, and would attend psychotherapy and social skills training sessions. After the meeting the nurse notes that the client is agitated and develops a plan of care for de-escalating aggression if it occurs. For each nursing action listed select if it is Indicated (appropriate or necessary), Contraindicated (could be harmful), or Non-Essential (makes no difference or not necessary) for de-escalating the aggression. Only one selection can be made for each nursing action. Respond with an aggressive posture Provide a snack Respect personal space Avoid verbal contact Check blood pressure and pulse Provide clear options that deal with the behavior Listen to what the client is saying Maintain safety 5- Later that evening, the client tells the nurse that no one can know he is there, and he wants to be called a different name because the FBI are looking for him, and if they find him, they will kill him. What nursing actions are appropriate for the client at this time? Select all that apply. 1.Ask the client to describe the delusion 2 Focus the conservation on reality-based topics 3 Convince the client that the delusion is false 4 Set firm limits on the amount of time that the client talks about the delusion 5 Let the client know that the FBI is not going to harm him because the unit is guarded by security 6 Tell the client that he can be given an alias name if that will make him feel better 7.Be open and honest in interactions to reduce suspicious 8 Encourage the client to express feelings and focus on the feelings that the delusions generate. 9 Reinforce the fact that the FBI are located in another state so it is unlikely that they will come to the unit to find him 6-One week later, the psychiatrist performs a mental exam and a follow-up psychiatric examination. The nurse reviews the progress notes, which reveal that following. 6- Identify the findings in the progress notes that indicate that the client is progressing. Progress Notes Client continues to have acute episodes of delusions but aggressive behavior is lessened. He is attending psychotherapy and social skills training sessions and is showing independence in activities. He has been participating in unit activities and social interactions showing controlled behavior. Orientation to reality is not always demonstrated and he continues to believe that the FBI is looking for him to kill him. He is cooperatively taking his medications and asks for his family to visit. He lacks interest in learning about his medications and is not concerned about plans following discharge. SCIENCE

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