Which of the following is the most appropriate initial nursing intervention for a patient presenting with early-stage psychosis and auditory hallucinations?

B) Establish a trusting relationship and provide a safe environment

A) Encourage the patient to ignore the voices and continue with daily activities

B) Establish a trusting relationship and provide a safe environment

C) Immediately administer antipsychotic medication prescribed by the physician

D) Focus on reorienting the patient to time and reality

Which of the following is the most appropriate initial nursing intervention for a patient presenting with early-stage psychosis and auditory hallucinations?

B) Establish a trusting nurse-patient relationship

A) Encourage the patient to ignore the voices

B) Establish a trusting nurse-patient relationship

C) Immediately administer antipsychotic medication

D) Restrict the patient's social interactions

What is an appropriate nursing intervention to monitor for potential side effects of atypical antipsychotic medications?

A) Check the patient's blood glucose levels

B) Monitor for signs of dehydration

C) Assess for increased respiratory rate

D) Evaluate for signs of infection

What is the most likely reason for the patient's improvement after starting the atypical antipsychotic medication?

B) Decreased frequency and intrusiveness of auditory hallucinations

A) Increased engagement in therapy sessions

B) Decreased frequency and intrusiveness of auditory hallucinations

C) Improved sleep hygiene and stress management

D) Stabilization of vital signs

A patient undergoing treatment with an atypical antipsychotic medication reports mild restlessness and occasional muscle stiffness. What is the most appropriate nursing action to address these symptoms?

B) Monitor for worsening symptoms and report to the psychiatrist

A) Encourage increased physical activity

B) Monitor for worsening symptoms and report to the psychiatrist

C) Advise the patient to stop taking the medication immediately

D) Increase the patient's fluid intake

What is the primary nursing intervention for addressing mild extrapyramidal side effects in a patient taking atypical antipsychotic medication?

C) Report symptoms to the prescribing physician

A) Encourage increased physical activity

C) Report symptoms to the prescribing physician

D) Discontinue the medication immediately

Which of the following vital signs recorded during the patient's follow-up nursing assessment indicates a stable condition?

C) Respiratory rate of 22 breaths per minute

D) Blood pressure of 140/90 mmHg

Which action is most appropriate for the nursing team to take based on the patient's current condition as described?

C) Continue with the current treatment plan and focus on enhancing coping mechanisms

A) Discontinue the beta-blocker since the patient's vital signs are stable

B) Initiate a dietary restriction plan to manage potential medication side effects

C) Continue with the current treatment plan and focus on enhancing coping mechanisms

D) Increase the frequency of blood tests to monitor for new adverse effects

What is the primary purpose of conducting a comprehensive assessment in the fourth week of a patient's treatment?

B) To evaluate the patient's progress and readiness for the next phase of treatment

A) To determine the patient's eligibility for discharge

B) To evaluate the patient's progress and readiness for the next phase of treatment

C) To identify new health issues that may have developed

D) To assess the effectiveness of the medical staff

What is the primary reason for monitoring liver function tests in patients undergoing medication therapy for mental health conditions?

B) To evaluate potential hepatotoxic effects of medications

A) To assess the patient's hydration status

B) To evaluate potential hepatotoxic effects of medications

C) To determine the patient's nutritional status

D) To monitor the effectiveness of diet modifications

acute psychosis - Nursing Case Study

Pathophysiology

• Primary mechanism: Dysregulation of dopamine pathways in the brain, especially the mesolimbic pathway, leads to an excess of dopamine activity, which is strongly associated with the positive symptoms of psychosis, such as hallucinations and delusions.

• Secondary mechanism: Glutamate dysfunction, particularly involving NMDA receptors, may contribute to disruptions in brain signaling and connectivity, exacerbating cognitive and negative symptoms of psychosis like disorganized thinking and emotional withdrawal.

• Key complication: If untreated, acute psychosis can lead to significant distress, impaired functioning, and potential harm to self or others, highlighting the need for prompt medical intervention.

Patient Profile

Demographics:

25-year-old female, university student

History:

• Key past medical history: No significant past medical history

• Current medications: None

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Hearing voices for the past 2 days

• Key symptoms: Auditory hallucinations, mild paranoia, some disorganized thoughts

• Vital signs: Blood pressure 120/80 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

Upon conducting a thorough initial assessment, the nursing team found that the patient, a 25-year-old female university student, appeared visibly anxious and slightly disoriented. Her speech was occasionally tangential, indicating some difficulty in maintaining a coherent conversation. Despite this, she was cooperative and oriented to person and place, though she struggled with orientation to time. Her affect was noted to be flattened, and she exhibited mild restlessness, frequently shifting in her seat during the interview. The auditory hallucinations she reported were primarily voices commenting on her actions, which contributed to her mild paranoia.

The mental status examination revealed that her insight was limited; she was aware of the voices but had difficulty understanding that they might be a symptom of a mental health condition. Her judgment was similarly impaired, as she expressed uncertainty about whether she could trust her own perceptions. No suicidal or homicidal ideations were noted at this time. Physical examination was unremarkable, with vital signs stable: blood pressure 120/80 mmHg, heart rate 78 bpm, respiratory rate 16 breaths per minute, and temperature 98.6°F.

This assessment suggests early-stage psychosis with minor complications, primarily involving her cognitive processing and mild paranoia. The findings underscore the importance of initiating an appropriate treatment plan that may include antipsychotic medication to address the dysregulation of dopamine pathways, as well as supportive psychotherapy to help her process and manage her experiences. These interventions are crucial to prevent further deterioration in her functioning and to reduce the risk of potential harm, setting the stage for the next steps in her care journey.

Section 2

Response to Interventions:

After initiating treatment with a low-dose atypical antipsychotic medication, the patient demonstrated a gradual improvement over the following week. Her anxiety levels decreased, and she became more engaged and cooperative during therapy sessions. The frequency of auditory hallucinations diminished, and she reported that the voices were less intrusive and distressing. In sessions with the psychiatric nurse, she began to explore her experiences more openly and was able to acknowledge that the voices might be linked to her stress and lack of sleep during the university exams.

Her vital signs remained stable, with blood pressure at 118/78 mmHg, heart rate at 76 bpm, and respiratory rate at 16 breaths per minute. The nursing team continued to monitor her for any potential side effects from the medication, such as sedation or weight gain, but thus far, she tolerated the treatment well. The patient’s affect became more appropriate, and she showed moments of humor and engagement during conversations. Her insight improved modestly; she could now articulate that while the voices seemed real, they could be a symptom of stress or a mental health condition.

The patient was encouraged to participate in a structured routine that included regular meals, exercise, and sleep hygiene practices, which further contributed to her stabilization. Nursing staff provided psychoeducation to help her understand the importance of medication adherence and stress management strategies. With a support system developing through therapy and medication, she began to regain confidence in her perception and decision-making abilities, marking a positive trajectory in her recovery process. The care team planned a follow-up assessment to ensure continued progress and to adjust the treatment plan as necessary.

Section 3

Change in Patient Status:

In the second week of treatment, the patient continued to show positive progress with a noticeable enhancement in her daily functioning. However, during a routine nursing assessment, she expressed mild concerns about feeling slightly restless and experiencing occasional muscle stiffness, particularly in the mornings. These symptoms were consistent with mild extrapyramidal side effects, a possible consequence of the atypical antipsychotic medication. Her vital signs remained stable, with a blood pressure reading of 116/76 mmHg, a heart rate of 74 bpm, and a respiratory rate of 16 breaths per minute. The nursing team promptly discussed these findings with the psychiatrist, who decided to slightly adjust the medication dosage and incorporate a low dose of a beta-blocker to alleviate the restlessness.

Despite these minor side effects, the patient remained optimistic and engaged in her care. She expressed understanding of the need for medication adjustments and was actively participating in daily therapeutic group sessions. Her ability to manage stress improved as she practiced relaxation techniques taught by the nursing staff. She also reported a continued decrease in the intensity of auditory hallucinations, which were now less frequent and less distressing. The patient's improved insight allowed her to recognize the importance of maintaining a balanced lifestyle, as she diligently adhered to her structured routine of regular meals, exercise, and sleep hygiene.

These developments indicated a promising shift in her mental health status, allowing the care team to focus on reinforcing coping strategies and ensuring medication adherence. The team planned to reassess the patient's symptoms and medication effects in the coming days, preparing for a potential gradual transition towards outpatient care. This phase of treatment aimed to empower the patient with the tools necessary to manage her condition effectively, fostering resilience and promoting long-term recovery.

Section 4

The patient's progress continued positively into the third week of treatment. During a follow-up nursing assessment, she reported a further reduction in restlessness and muscle stiffness after the medication adjustment. The inclusion of the beta-blocker seemed effective, as the patient felt more relaxed and noted an improvement in her morning routine. Her vital signs remained stable, with a blood pressure of 118/78 mmHg, a heart rate of 72 bpm, and a respiratory rate of 15 breaths per minute. The nursing team observed that her mood was consistently upbeat, and she actively engaged in conversations, demonstrating clearer thought processes and improved judgment.

In addition to the physical assessments, new diagnostic results from a recent blood test showed that her white blood cell count was within normal limits, ruling out potential adverse hematological effects from the medication. Electrolyte levels were also normal, indicating that her nutritional and hydration status was well-maintained. These findings provided reassurance to both the patient and the care team, highlighting that the current treatment plan was well-tolerated and effective.

Given this stable condition and the absence of significant side effects, the care team decided to focus on enhancing the patient's coping mechanisms further. They introduced additional psychoeducational sessions focusing on medication management, recognizing early signs of relapse, and developing a robust support network. The plan involved gradually preparing the patient for outpatient therapy, reinforcing her ability to manage her condition independently. The team remained vigilant, planning regular follow-ups to ensure continued stability and to address any emerging concerns promptly, paving the way for a successful transition to community-based care.

Section 5

In the fourth week of treatment, the nursing team conducted another comprehensive assessment to gauge the patient's progress and readiness for outpatient therapy. This assessment highlighted continued positive trends in the patient's condition. Notably, her sleep quality had improved significantly, with the patient reporting feeling more rested and energetic during the day. This change was reflected in her increasingly stable mood and enhanced concentration during psychoeducational sessions. Her appetite remained consistent, contributing to her overall physical well-being and ability to engage with her treatment plan actively.

The care team also reviewed recent diagnostic results, which continued to support the patient's stable condition. Her liver function tests returned normal, alleviating concerns about potential hepatotoxicity from her medication regimen. Furthermore, her cholesterol levels were within a healthy range, benefiting from the lifestyle modifications introduced during her treatment. These results reassured the team that the patient's physical health was being effectively monitored and managed alongside her mental health care.

Based on these positive indicators, the care team decided to initiate a gradual tapering plan for her inpatient medications, while introducing her to community-based resources. The patient expressed optimism about this transition, supported by her family, who had been actively involved in family therapy sessions. The team planned for continued weekly follow-ups to monitor her response to these changes, ensuring that she maintained stability and was adequately supported as she moved towards more independent management of her condition. This step marked a significant milestone in her recovery journey, reinforcing the importance of a comprehensive, supportive approach to mental health care.